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Nursing 231 - Exam 2 > Exam 2 - Cardiac disorders > Flashcards

Exam 2 - Cardiac disorders Flashcards

1
Q

Equation for cardiac output?

A

CO=SVxHR

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2
Q

Normal cardiac output when someone is at rest?

A

5L/min

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3
Q

Starlings Principle?

A

The greater the fiber stretches before systole, the stronger the contraction

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4
Q

degree of fiber stretch because of load (quantity of blood) placed on the muscle before contraction

A

Preload

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5
Q

Pressure exerted in left ventricle at the end of filling (diastole), just before ejection (systole)

A

LVEDP- Left ventricular end diastolic pressure

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6
Q

Amount of blood pumped out of left ventricle is known as? Normal range?

A
  • Ejection Fraction

* 50-75%

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7
Q

Amount of resistance to blood flow after it leaves the ventricle

A

Afterload

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8
Q

What can cause decreased contractility of the heart?

A
  • Loss of muscle mass
  • Dysrhythmias
  • Drugs
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9
Q

What can cause increased contractility of the heart?

A
  • sympathetic nerve stimulation

* Inotropic drugs

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10
Q

The SA node fires at a normal rate of?

A

60 to 100 beats per minute

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11
Q

The AV node fires at a normal rate of?

A

40 to 60 beats per minute

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12
Q

The PF fire at a normal rate of?

A

20 to 40 beats per minute

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13
Q

P wave represents?

A

Atrial depolarization

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14
Q

QRS complex represents?

A

Ventricular depolarization

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15
Q

T wave represents?

A

Ventricular repolarization

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16
Q

Normal BP?

A

less than 120 for systole AND less than 80 for diastole

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17
Q

Elevated BP?

A

Systole 120-129 AND diastole less than 80

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18
Q

Stage 1 hypertension?

A

S: 130-139 OR D: 80-89

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19
Q

Stage 2 hypertension?

A

S :140 or higher OR D: 90 or higher

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20
Q

Hypertensive crisis

A

S: higher than 180 AND/OR D: higher than 120

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21
Q

is an inflammatory process involving the endothelial tissue: Atria, Ventricles, Heart Valves

A

Infective Endocarditis

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22
Q

What causes IE? Give examples

A

Bacterial or Fungal infection

  • Staph
  • Strept
  • Ecoli
  • Gram-negative
  • Fungi
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23
Q

Name and describe the two types of IE.

A

Acute - sudden onset, rapid destruction of cardiac tissue

Subacute -insidious start, up to 8 weeks

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24
Q

Portal of entry for bacteria?

A
  • Mouth
  • Upper respiratory tract
  • GI/GU tracts
  • Skin
  • Circulatory system
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25
in IE, what are the organisms attracted to?
*Areas of preexistent valvular or endocardial changes *Areas of turbulent blood flow (valves) *
26
In endocarditis, Platelets and fibrin form _______. _____ gets trapped in there and destroys the valve, causing ________.
* Vegetative lesion * Bacteria * Obstruction
27
A major complication from endocarditis where a fragment of vegetation breaks loose travels through circulation?
Emboli
28
Triad needed to diagnose IE?
* Endothelial damage * Platelet aggregation * Microbial adherence
29
Mnemonic for S+S of IE?
``` *FROM JANE* F-Fever/Fatigue R-Roth spots O- Osler nodes M - Murmur (new or change in existing) J - Janeway lesions A - Anemia N - Nail Bed Hemorrhage E - Emboli ``` Other S+S * Petechiae * Develping HF * Anorexia * Enlarged spleen
30
Most common Emboli seen in IE? Symptoms?
* Splenic | * Upper left quadrant Pain
31
Signs of Renal Emboli in IE?
*Flank pain with hematuria
32
Signs of Mesentery Emboli in IE?
*Diffuse persistent abdominal pain
33
Signs of CNS Emboli in IE?
* stroke * confused * decreased concentration * aphasic * dysphagia
34
Signs of Pulmonary infraction in IE?
* Chest pain * Dyspnea * Cough
35
black longitudinal lines or red streaks in distal third of nail bed
Peripheral splinter hemorrhage
36
Pads of fingers and toes develop reddish TENDER lesions with white center (LATE SIGN)
Osler Nodes
37
NON-TENDER hemorrhagic lesions on fingers, toes, ear lobes, nose
Janeway Lesions
38
A hemorrhage in the retina with a white center.
Roth's spots
39
Diagnostics for IE?
* Blood Culture * TEE - Trans-Esohophgeal echoradiogram * CBC/WBC * ESR - 15-42 depending on age/sex * CXR * Echo
40
Medical management of IE?
* Prevention * Antibiotics * Medical HF treatment * Subsequent Blood cultures * Surgery
41
What are the various antibiotics used to treat IE? How long?
* VAGAL* * Vancomycin * Ampicillin / Sulbactam * Gentamycin * Amphotericin B * Linezolid - (Given 4 to 6 weeks)
42
Side effects of Vanco?
* Anaphylaxis * Neprhotoxicity * Super infections * Red-man syndrome (hypotension)
43
What must you draw for Vanco? Why are these drawn?
* Trough- lowest concentration of drug in blood (Drawn 15 to 30 minutes before next dose/administration) * Peak - Highest concentration of drug in blood (Drawn 1 to 2 hours after completion) (Too high and the kidneys will die, too low and the infection will grow)
44
Side effects for Ampicillin / Sulbactam?
* Pseudomembranous colitis | * Seizures
45
Class and side effects of gentamycin?
* Aminoglycoside* * NEPHRO AND OTO TOXICITY* * Draw peak and trough
46
Class and side effects of Amphotericin B
* Antifungal/Fungicide* - nephrotoxicity - agranulocytosis - thrombocytopenia
47
Follow up care for IE?
* Risk for recurrence - Tell medical providers and dentists of past IE, may need prophylactic Abx * Dont use unwaxed dental floss (can cut)
48
PT teaching for IE?
*S/S of recurrence- fever, fatigue, chills, anorexia, joint pain.
49
an inflammatory process involving the parietal and visceral layers of the pericardium and outer myocardium? Cause?
* Pericarditis | * isolated process or complication of a systemic disease
50
When does ACUTE pericarditis occur and how long does it last?
Occurs within 2 weeks of offending condition and lasts 6 weeks.
51
When does CHRONIC pericarditis occur and how long does it last?
May follow acute pericarditis and lasts up to 6 months
52
Complications from Pericarditis?
* Cardiac Effusion * Tamponade * HF
53
Most common cause of Pericarditis?
Virus
54
What are the layers of the pericardium from inner to outer?
Visceral pericardium, 50 ml Of fluid in pericardial cavity, Parietal Pericardium, Fibrous pericardium
55
Pericarditis caused by directed extension of metastases?
Neoplastic
56
Mnemonic for causes of pericarditis?
* MIND VART* * Metabolic disorders - Gout, severe hypothyroidism * Infection - Bacterial, fungal, parasitic * Neoplasm - Direct extension of mestases * Drug therapy - e.g. Isoniazide, pocainamide * Virus - most common * Autoimmune disorders * Radiotherapy * Trauma - CPR, MI, Chest trauma
57
Pathophysiology of pericarditis?
* Pericardial sac inflammation * Exudate released (fluid containing Fibrin, WBCS, Endothelial cells) * Friction between parietal and visceral layers causes inflammation/irritation of surrounding tissue.
58
Form of pericarditis where clear pericardial fluid exceeds 50 mL?
Effusion
59
Form of pericarditis involving varying amounts (100 ml to 3 Liters) of ______. Straw/amber colored and thick; May be hemorrhagic and purulent.
Serofibrinous exudates
60
Describe Constrictive pericarditis.
* Thickening and Scarring of layers * Can be generalized to all chambers * Reduces CO * Leads to systemic/pulmonary congestion
61
Describe Adhesive pericarditis.
* Layers become adhered to each other * Obliterates pericardial space * Can extend to epi/myocardium * Decrease in CO
62
Surgical procedure for pericarditis to remove fluid via needle?
Pericardiocentisis
63
Surgical procedure for pericarditis creating a drainage area for the excess fluid in the sac?
Pericardial window
64
Surgical procedure for pericarditis in which pericardial sac is removed?
Pericardiectomy
65
Medical treatment for Pericarditis?
* Rest * ECG- (Rule out MI, tamponade, decompensation) * Hemodynamic monitoring * Drugs
66
Drugs used for pericarditis?
* Anti-inflammatory (if w/o tamponade) * Analgesics/antipyretics * Corticosteroids (For persistent recurring type) * Meds for specific cause - e.g. Chemotherapeutic agents for constrictive pericarditis
67
Chest pain in pericarditis worsens with?
Deep breathing, coughing, lying supine
68
Chest pain in pericarditis is relieved by?
Sitting up or leaning forward
69
what type of pericarditis does Jugular vein distention occur with?
Constrictive
70
Nursing Assessment for Pericarditis?
* Chest Pain * Fever/Faintness * Tachy/ST elevation * Pericardial Friction Rub (Grating/rubbing sound) * Inspiratory drop in systolic BP>10 mmHg (Pulsus Paradoxus) * Jugular vein distention * Elevated WBC/ESR *Memory Tip - Cant Fuck These Pussies Itai Jess Emilee
71
Diagnostic Tests for Pericarditis?
CXRAY - increased heart size if effusion | ECG - ST elevation, T wave inverted
72
Where is a plueral friction rub heard best?
ICS - 2,3,4 or apex
73
an important teaching for clients who have had pericarditis?
Signs and symptoms of recurrence * chest pain intensified by inspiration, supine, coughing * Fever
74
compression of the heart caused by fluid collecting within the pericardial sac surrounding the heart
Cardiac tamponade
75
What emergent occurrence can occur as a result of cardiac tamponade?
Restriction of blood flow in and out of the ventricles | *MEDICAL EMERGENCY*
76
Most common cause of Cardiac tamponade?
Acute pericarditis | other causes are chest trauma, anticoagulants, uremia, cardiac surgery
77
Slow pericardium fluid accumulation allows for________ while Rapid fluid accumlation doe not allow for ______
* Stretching of fibers | * Pericardial to stretch
78
Describe what occurs once the pericardium fails to stretch during a cardiac tamponade.
* Intrapericardial pressure ^ * Ventricles restricted * SV and CO decrease * HYPOtension * HF * Cardiogenic shock * CARDIAC ARREST
79
A triad of symptoms that occur during cardiac tamponade?
*BECKS TRIAD* J-uglar distention A-rterial blood pressure drop M-uffled heart sounds (distant)
80
What drugs are given to treat cardiac tamponade? Why?
Positive inotrpic drugs * Increase contractility * Increase Blood pressure * Increase Cardiac output
81
surgical treatment for cardiac tamponade?
*Pericardiocentesis – remove fluid via needle *Pericardial Window – open drainage area * Pericardiectomy – removal of pericardium (chronic constrictive)
82
Assessment findings for tamponade?
* BECKS TRIAD* * Heavy chest pain * Anxiety * Tachy * Paradoxical pulse * Elevated CVP * Chest x-ray (Enlarged heart, widened mediastinum)
83
Nursing interventions for tamponade?
* Administer O2/Drug therapy as ordered * Monitor CVP/IV closely * assist with pericardiocentisis
84
How can the nurse assist with a pericardiocentisis?
* Monitor ECG, BP, PULSE * Assess aspirated fluid for color and consistency * Send specimen to lab immediately
85
Drugs that strengthen/Weaken the force of cardiac contraction? Give examples.
* Positive inotropic (strengthens) - dopamine, adrenaline | * Negative Inotropic (weakens) - labetalol, propranolol
86
Drugs that accelerate/slow the heart rate? give examples.
* Positive chonotropic (accelerates) - adrenaline (epi) | * Negative chronotropic (slows) - digoxin
87
Drugs that speed up/ slow conduction velocity through heart? Give examples.
* Positive dromotropic (speeds up) - phenytoin | * Negative dromotropic (slows) - verapamil
88
an acquired or congenital disorder when any valve in the heart has damage or is diseased; if left untreated, can lead to CHF?
Valvular heart disease
89
Causes of vavlular heart disease?
* Old Age * Rheumatic fever * Infective endocarditis/Atherosclerosis (damage aortic valve) * Heart Attack may damage muscles controlling valves * Methysergide(migraine med)/diet drugs promote valvular heart disease * Radiation therapy
90
Signs and Symptoms of VHD?
* Dyspnea * Chronic fatigue * Coughing/Wheezing * Rapid/Irregular heartbeat * Nausea/no appetite * Confusion/impaired thinking * Fluid buildup/swelling (Feet/ankles) * Rapid weight gain (2 lbs+ in 1 day or day/5lbs in week) (CALL PROVIDER) * Fever (Bacterial endocarditis) * Urine frequency (nocturia)
91
Diagnostic tests for VHD?
* CXR * EKG * Echocardiogram
92
Complications associated with VHD?
* IE - Can cause damage to valves * Embolism * LV/RV failure * Pulmonary Edema
93
Treatment for VHD?
* Heart healthy lifestyle * Watch and wait for mild/asymptomatic cases * Antibiotics prophylaxis for bacterial IE * Anticoags in AFIB for risk of embolus * HF meds (Diuretics) * Valve surgery to replace or repair damaged valves * Balloon dilation to widen stenotic vlave
94
What are the types of replacement valves and what does the selection depend on?
* Artificial - prosthetic or Bioprosthetic - animal tissue | * Depends on client age, condition, and affected valve
95
Nursing education/management for VHD?
* Notify ALL providers of defective/replacement valves * Antibiotic therapy for invasive procedures * Clean/antibiotic ointment wounds * Balance rest/activity to conserve energy * Notify provider of fever, petechia, SOB, signs of HF
96
are pathologic heart sounds that are produced as a result of turbulent blood flow
heart murmurs
97
What are some causes of heart murmurs
Leaking or narrowing valves
98
how are heart murmurs characterized"
time of occurrence in cardiac cycle
99
What grade of murmur is only heard with optimal conditions? Thrill felt?
Grade 1 murmur - No thrill
100
what grade of murmur is just loud enough to be obvious? Thrill felt?
Grade 2 murmur - No thrill
101
What grade of murmur is moderately loud? Thrill felt?
Grade 3 murmur - no thrill
102
What grade of murmur is loud with palpable thrill?
Grade 4 murmur - thrill felt
103
What grade of murmur can be heard with stethoscope partially off the chest? Thrill?
Grade 5 murmur - thrill felt
104
What grade of murmur can be heard with stethoscope completely off the chest? Thrill?
Grade 6 murmur - thrill felt
105
What makes the 1st heart sound (s1 or "LUB")?
the tricuspid/mitral valves snapping shut at the end of diastole/beginning of systole (aortic/pulmonic valves open)
106
What makes the 2nd heart sound (s2 or "DUB")?
The aortic/pulmonic valves snapping shut at the end of systole/beginning of diastole (tricuspid/mitral valves open as blood empties from atria into ventricles)
107
When the Aortic valve doesn't open all the way this is known as______ and occurs during______.
* Aortic stenosis | * Systolic ejection (In the middle S1 and S2) (Lub-murmur-Dub)
108
During Aortic stenosis what are some changes to the leaflets (flaps of valve) that causes them to not open completely?
* Thickened/Rigid * Calcified * Stiff/Fused
109
What happens to the heart as a result of Aortic stenosis
LV hypertrophy (muscle enlargement) as a result of forcing blood through smaller opening.
110
S&S of Aortic stenosis?
* Symptoms develop gradually* * Exertional Angina -(Heart muscle works harder to pump through smaller space--requires more o2 than available, causing angina.) * Pulmonary congestion - (blood eventually begins to back up) * Syncope - (on exertion, demand for blood increases and stenotic aortic valve deters demanded blood flow)
111
Where is the best place to place the stethoscope to hear Aortic stenosis?
*2nd RICS on sternal border
112
_____ is when Blood backflows into Left Atrium during _____due to the ______ not closing all the way.
* Mitral regurgitation/insufficiency * Systolic ejection (Right after S1 until S2)(LUBMURMERDUB) * Mitral
113
What happens to the heart as a result of Mitral regurgitation?
Dilation and hypertrophy of the LA
114
S&S of Mitral regurgitation?
* DOE/Fatigue (too much back flow can go back to lungs) * Paroxysmal nocturnal dsypnea * Hepatic congestion * Ascites/Edema/Distended neck veins
115
Where is the best place to listen to a mitral regurgitation murmur?
*5th ICS-Midclavicular line (apex/mitral)
116
When the Aortic valve doesn't close all the way this is known as______ and occurs during______.
* Aortic regurgitation/insufficiency | * Early Diastole (Right after S2 Lub-DubMURMER(blowing)
117
What happens to the heart as a result of Aortic Regurgitation?
* Increased volume in LV * Increased LA pressure * Eventually pulmonary congeation
118
S&S of Aortic Regurgitation
* Can be Asymptomatic for 20 years | * potentially serious/teach follow up care
119
Where is the best place to listen to a mitral regurgitation murmur?
*5th LICS MCL
120
When the Mitral valve doesn't open all the way this is known as______ and occurs during______.
* Mitral stenosis | * Diastole - (Between S2 and S1)(Lub-Dub-Murmer)(rumbling sound)
121
During Mitral stenosis what are some changes to the leaflets (flaps of valve) that causes them to not open completely?
* Thickened/Rigid * Calcified * Stiff/Fused * Decrease in size
122
S&S of Mitral stenosis?
* heart failure may occur * Cardiac output decreas * Dysrythmias increase (AFIB in 50%)
123
Where is the best place to listen to Mitral stenosis murmur?
5th intercostal space & midclavicular line
124
What are the three types of cardiomyopathy?
* Dilated * Hypertrophic * Restrictive
125
complications from dilated cardiomyopathy?
* Dsyrhthmias | * CHF
126
complications from restrictive cardiomyopathy?
*CHF
127
complications of hypertrophic cardiomyopathy?
* CHF * Cardiac arrest * Syncope * SUDDEN DEATH
128
Signs and symptoms of left sided heart failure
LEFT - FORCED * Fatigue * Orthopnea * Rales/Restlessness * Cyanosis/Confusion * Extreme weakness * Dyspnea
129
Signs and symptoms of right sided heart failure
RIGHT - BACONED * Bloating * Anorexia * Cyanosis/Cool legs * Oliguria * Nausea * Edema * Distended neck veins
130
Diagnosing cardiomyopathy?
* S+S of CHF * Cardiac catheterization * CXR * EKG * ECHO
131
Disease of the heart muscle where the ventricles stretch and thin(dilate) and cant pump blood as well as a healthy heart. Where does this usually start?
* Dilated/congestive cardiomyopathy (DCM) | * Left ventricle
132
Predisposing factors of DCM?
* ETOH * COCAINE * Pregnancy * VIRAL INFECTIONS (coxsackie B, HIV) * MI
133
Treatment for DCM?
* Treat symptoms of heart failure * Diuretics * Vasodilators * Positive iontropic drugs (digoxin) * Control dysrhtymias * Heart transplant
134
_____ is a disease of the heart that involves abnormal growth of muscle fibers that causes thickened and stiff walls of the _____ and ______.
* Hypertrophic cardiomyopathy (HCM) | * Ventricles and Septum
135
In LV hypertrophy what happens to the LV?
* LV shrinks w or w/o LA dilation * limits from filling, less blood in means less blood out. * can block aortic valve
136
Signs and symptoms of Hypertrophic Cardiomyopathy?
* SOB, DOE * Chest pain * Afib * Palpitations * Systolic murmurs * Syncope * Asymptomatic * SUDDEN DEATH
137
HCM is often seen in?
Young adults and athletes who are genetically disposed
138
What kind of medications do you want to AVOID when treating HCM? Why?
* DVP (diuretics, vasodilators, positive inotropes) * Goal is to increase ventricular volume and outflow and decrease ventricular contractility. Diuretics decrease volume, vasodilators decrease pressure, and positive inotropes increase contractility.
139
Earliest sings of hypoxia?
restlessness and agitation
140
If a client is experiencing if SVT or Ventricular dysrhythmias with HCM, what would you want to give?
Antidysrhythmic e.g. Amiodarone
141
In HCM if the client experiences AF, you might give a _______ to decrease risk of_______
* anticoagulant | * Emboli
142
First line of drugs used to assist with HCM? Why?
Beta blockers (first line) e.g. Propranolol: myocardial↓O2 consumption & workload
143
second line of drugs used to assist with HCM? Why?
CCB, consult provider on type) ↑ LV relaxation and filling
144
a condition where the ventricular walls become rigid and hard, causing high pressure in ventricles and issues with refilling/stretch.
Restrictive cardiomyopathy
145
what happens to ejection fraction during RCM? CO?
* Stays normal (50% to 70%) or decreases | * CO decreases
146
Causes of RCM?
* radiation exposure | * scarring from surgery
147
Treatment of RCM?
* Treat symptoms of heart failure * Diuretics * Vasodilators * Positive iontropic drugs (digoxin) * Control dysrhtymias * Heart transplant
148
Prognosis for RCM?
Poor, half die within 2 years.
149
measures the blood pressure inside the veins, heart, and arteries. It also measures blood flow and how much oxygen is in the blood. It is a way to see how well the heart is working.
Hemodynamic monitoring
150
Reflects changes in the relationship between cardiac output (CO) and systemic vascular resistance (SVR) and reflects the arterial pressure in the vessels perfusing the organs.
Mean arterial pressure
151
What is the normal range for MAP? What does it mean if its lower or higher?
70-100 * Low=decreased blood flow through organs * High=increased cardiac workload.
152
What happens to the right atrium if there is an issue with the right ventricle?
Pressure increases
153
_____ is used to directly measure central venous pressure in ______ and ______.
* Central venous catheter * Right atrium * Superior vena cava
154
Where does the tip of the CVC rest within the body?
Lower third of superior vena cava
155
Two purposes of CVP catheter?
* Measure right atrial pressure (indicates alterations with RV) * Blood volume and adequacy of central venous return
156
CVPC is an IV route for?
* Blood draws * Fluids * Medications
157
normal CVP range? (right atrial pressure)?
2-6 mm Hg
158
A CVP reading above____ is considered high and may indicate?
* 12* | * Heart failure, Hypervolemia
159
A CVP reading below____ is considered low and may indicate?
* 2* | * Hypovolemia*
160
complications from a CVPC?
* Infection * Thrombosis * Air embolism * Pnemothorax * Infiltration
161
Normal cardiac output?
4-8 L/min
162
Normal pulmonary artery pressure (PAP)?
9-18 mm Hg
163
Normal range for PCWP
6 - 12 mmHg
164
arterial insufficiency to contracting muscles brought on by exercise (generally walking a predictable distance) and relieved by rest
Claudication
165
The restoration by surgical means of blood flow to an organ or a tissue, as in bypass surgery.
arterial revascularization
166
Bypass may be constructed from autologous:___, ____, ____
* Vein * Artery * Synthetic
167
Atherosclerosis is a progressive disorder; surgery is?
palliative, providing relief from debilitating symptoms
168
occlusive disease of Distal aortic and iliofemoral arteries (Leriche’s syndrome), claudication of buttock, hip or thigh.
Aortoilliac disease
169
When is an arterial revascularization surgery indicated?
disease becomes disabling, rest pain is present or if there is ischemic ulcers.
170
Most common type of surgery to corrected lower extremity arterial obstruction.
Femoral-Popliteal Bypass Surgery
171
Reasons for Femoral-Popliteal Bypass Surgery
* PAD | * Blockage secondary to atherosclerosis
172
What does a femoral-popliteal bypass surgery entail?
*Replace occluded vessel with synthetic or autgeonous vein OR *Open with balloon and place stent
173
FPBS preop nursing interventions
* Mark distal pulses * ECG * *Assess for infections * Administer meds * Education
174
FPBS postop nursing interventions
* routine postoperative care * Pain rating * Specific Assessments: Infection, nuero, vitals * Vascular assessment - Cap refill, Warmth, Distal pulses etc.. * Wound assessment - Sepsis, Labs (IF WBC are greater than 10,000, should be reported), Sepsis
175
used to predict the severity of peripheral arterial disease (
Ankle Brachial index
176
A slight drop in the ABI with exercise means
PAD is probably present
177
How is an ABI test done? when is it repeated?
* measuring blood pressure at the ankle and in the arm while a person is at rest. * repeated at both sites after 5 minutes of walking on a treadmill.
178
A normal resting ankle-brachial index is______, meaning what? Anything lower than ______ or lower could signify PAD.
* 1.0-1.4 * blood pressure at the ankle is the same or greater than the pressure at in the arm * 0.9
179
What causes coronary artery disease?
Atherosclerosis- (build up of cholesterol laden plaque, narrowing the arteries, decreases passage of blood. ) *Blood cells can cling to rough deposits and cause clot
180
Visualization of vessels (selective) or chambers via contrast media to see blockages
Angiography
181
performed to open blocked coronary arteries caused by coronary artery disease (CAD) and to restore arterial blood flow to the heart tissue without open-heart surgery. What can be used to do this?
* AngioPLASTY | * Balloon, Stent, atherectomy
182
expandable metal coil (BMS) that is inserted into the newly-opened area of the artery to help keep the artery from narrowing or closing again.
STENT
183
is done at the site of the narrowing of the artery to remove calcified plaque via tiny blades on a rotating tip at the end of the catheter, scraping off plaque.
Atherectomy
184
Inflates and crushes plaque against the vessel wall
Balloon
185
After a stent is placed, what happens with the tissue?
Tissue forms over it starting within a few days and fully after a month
186
What medications are typically given after stent placement and why?
Antiplatelet medication like aspirin and clopidogrel to prevent blood clots by decreasing "stickiness" (unless stent is already impregnated with medication
187
The degree of coronary artery stenosis is assessed during
cardiac cath
188
peripheral arterial pressure is assessed with
an A line
189
reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client.
pulmonary capillary wedge pressure
190
Nursing Outcomes for Percutaneous Transluminal Coronary Angioplasty
* Anxiety level reduced * Coronary output maintained * Tissue perfusion is maintained * Knowledge level increased
191
Reason for a CABG?
severe coronary artery disease
192
In CABG Diseased or occluded artery is _____, in order create unobstructed blood flow. There can be ___to___bypassed.
* Bypassed | * 1 to 4
193
What is used as a graft in CABG?
Saphenous vein or internal mammary artery
194
Educate patients before a CABG (PER ORDER) stop anticoagulants (including NSAIDs, ASA. etc.) _____ preop, diuretic _____ preop and digitalis _____preop.
* 1 week * 2 to 3 days * 12 hours
195
What complications need to be monitored for in a CABG post op?
* Thrombophlebitis/pulmonary embolism, * Bleeding, infection * Cardiac tamponade –distant/inaudible heart sound, pulsus paradoxxus * Dysrrhythmias –rate, rhythm, ECG changes, elyte changes especially potassium, report changes.
196
_____is a dilation of an artery, which forms a sac, in one or all _______.
* Aneurysm | * Arterial wall layers
197
cause of AAA?
a weakness and stretching of the artery wall,
198
classification of AAA - spindle shape, whole artery circumference.
Fusiform
199
classification of AAA - out-pouching on one side of artery.
saccular
200
classification of AAA - separation of arterial wall layers forms blood filled cavity.
Dissecting
201
Once an aneurysm reaches ___in diameter, it is usually considered necessary to treat to prevent rupture.
5 cm
202
Risk factors for AAA?
* MALE * SMOKERS * FAMILY HISTORY
203
half of the AAA dissections in women happen during?
pregnancy
204
location for AAA?
below renal and above the iliac bifurcation.
205
Symptoms of AAA?
*SILENT KILLER--sometimes no symptoms* • Abdominal pain (that may be constant or come and go) • Pain in the lower back that may radiate to the buttocks, groin or legs • A "heartbeat" feeling or pulse in the abdomen
206
Assessment of AAA?
* Pain – an expanding AAA sudden, severe, constant low back, abdominal, flank, or groin pain * Pulsating periumbilical mass with bruit heard over mass, slightly left of midline. The location of the arota * Diminished femoral pulses.
207
Which diagnostic test shows exact location of AAA?
Aortography
208
in AAA you want to assess for _____phlebitis post op. What are the S+S?
Thrombophlebitis | *redness, warmth, tenderness over vein, edema if deep vein
209
What position is client placed in after AAA surgery?
Flat
210
Decreased cardiac output and tissue hypoxia in the presence of adequate intravascular volume.
cardiogenic shock - no problem with blood volume, but problem with the heart itself.
211
is frequently used to assess left ventricular filling, represent left atrial pressure, and assess mitral valve function
PCWP
212
Normal cardiac index range?
2.5-4
213
Hemodynamic criteria for cardiogenic shock
* SBP < 90 mm Hg for at least 30 min * PCWP > 18 mm Hg * Low cardiac Index <2 L/ min (reflects shock state)
214
Evidence of hypoperfusion as a result of cardiogenic shock?
* oliguria * Acidosis * Cool and clammy skin * Altered mental status- Early - hyper alert/agitated, late - lethargy, coma, death
215
Cause of cadiogenic shock?
Most issues with heart - MI most common
216
Fluid volume management during cardiogenic shock?
Can give fluids to promote CO, pcwp should be kept below 18 to avoid pulmonary congestion
217
O2 management in cardiogenic shock?
O2 given to maintain pao2 above 80 *indicators for mechanical ventilation- Pao2 below 50 while on 50% O2, vital capacity below 15, Acidodic Ph and High paco2
218
SIgns of renal function decrease during cardiogenic shock?
Less than 30 ml/hr urine output | Elevated bun and creat
219
Drugs for cardiogenic shock?
Dig, Dopamine, dobutamine, norepi, Nitropusside
220
Pacemaker codes?
* Paced: A= Atrium, V=Ventricle, D= Atrium & Ventricle * Sensed: A= Atrium, V=Ventricle, D= Atrium & Ventricle * Response: T= Triggered, I= Inhibited, D= both
221
Pacemaker method - competitive, fires at a preset rate regardless of the client’s rate and rhythm.
Fixed rate(Asynchronous)
222
non-competitive, fires only when client’s own heart rate drops below a preset heart rate on the generator. Demand is “on standby”, preset rate e.g. 60-70 beats per minute.
Demand (syncrhonous)
223
When is a pacemaker used?
when intrinsic pacing fails to provide perfusing rhythm.
224
The atria are paced, when the intrinsic atrial rhythm falls below the pacemaker's threshold.
AAI
225
he ventricles are paced, when the intrinsic ventricular rhythm falls below the pacemaker's threshold.
VVI
226
The pacemaker senses atrial and ventricular events, but can only pace the ventricle. This type of pacemaker is used in patients with a reliable sinus node, but with an AV-block.
VDD
227
The pacemaker records both atrial and ventricular rates and can pace either chamber when needed.
DDD
228
As above, but the pacemaker has a sensor that records a demand for higher cardiac output and can adjust the heart rate accordingly.
DDDR
229
ICD with shock capability only
ICD-S
230
ICD with bradycardia pacing as well as shock capability
ICD-B
231
ICD with tachycardia and bradycardia pacing, plus shock capability
ICD-T

Nursing 231 - Exam 2 (4 decks)

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