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

Exam 2 - Cardiac disorders Flashcards

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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
Q

in IE, what are the organisms attracted to?

A

*Areas of preexistent valvular or endocardial changes
*Areas of turbulent blood flow (valves)
*

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26
Q

In endocarditis, Platelets and fibrin form _______. _____ gets trapped in there and destroys the valve, causing ________.

A
  • Vegetative lesion
  • Bacteria
  • Obstruction
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27
Q

A major complication from endocarditis where a fragment of vegetation breaks loose travels through circulation?

A

Emboli

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28
Q

Triad needed to diagnose IE?

A
  • Endothelial damage
  • Platelet aggregation
  • Microbial adherence
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29
Q

Mnemonic for S+S of IE?

A 
*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
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30
Q

Most common Emboli seen in IE? Symptoms?

A
  • Splenic

* Upper left quadrant Pain

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31
Q

Signs of Renal Emboli in IE?

A

*Flank pain with hematuria

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32
Q

Signs of Mesentery Emboli in IE?

A

*Diffuse persistent abdominal pain

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33
Q

Signs of CNS Emboli in IE?

A
  • stroke
  • confused
  • decreased concentration
  • aphasic
  • dysphagia
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34
Q

Signs of Pulmonary infraction in IE?

A
  • Chest pain
  • Dyspnea
  • Cough
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35
Q

black longitudinal lines or red streaks in distal third of nail bed

A

Peripheral splinter hemorrhage

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36
Q

Pads of fingers and toes develop reddish TENDER lesions with white center (LATE SIGN)

A

Osler Nodes

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37
Q

NON-TENDER hemorrhagic lesions on fingers, toes, ear lobes, nose

A

Janeway Lesions

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38
Q

A hemorrhage in the retina with a white center.

A

Roth’s spots

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39
Q

Diagnostics for IE?

A
  • Blood Culture
  • TEE - Trans-Esohophgeal echoradiogram
  • CBC/WBC
  • ESR - 15-42 depending on age/sex
  • CXR
  • Echo
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40
Q

Medical management of IE?

A
  • Prevention
  • Antibiotics
  • Medical HF treatment
  • Subsequent Blood cultures
  • Surgery
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41
Q

What are the various antibiotics used to treat IE? How long?

A
  • VAGAL*
  • Vancomycin
  • Ampicillin / Sulbactam
  • Gentamycin
  • Amphotericin B
  • Linezolid -

(Given 4 to 6 weeks)

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42
Q

Side effects of Vanco?

A
  • Anaphylaxis
  • Neprhotoxicity
  • Super infections
  • Red-man syndrome (hypotension)
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43
Q

What must you draw for Vanco? Why are these drawn?

A
  • 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)

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44
Q

Side effects for Ampicillin / Sulbactam?

A
  • Pseudomembranous colitis

* Seizures

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45
Q

Class and side effects of gentamycin?

A
  • Aminoglycoside*
  • NEPHRO AND OTO TOXICITY*
  • Draw peak and trough
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46
Q

Class and side effects of Amphotericin B

A
  • Antifungal/Fungicide*
  • nephrotoxicity
  • agranulocytosis
  • thrombocytopenia
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47
Q

Follow up care for IE?

A
  • Risk for recurrence - Tell medical providers and dentists of past IE, may need prophylactic Abx
  • Dont use unwaxed dental floss (can cut)
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48
Q

PT teaching for IE?

A

*S/S of recurrence- fever, fatigue, chills, anorexia, joint pain.

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49
Q

an inflammatory process involving the parietal and visceral layers of the pericardium and outer myocardium? Cause?

A
  • Pericarditis

* isolated process or complication of a systemic disease

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50
Q

When does ACUTE pericarditis occur and how long does it last?

A

Occurs within 2 weeks of offending condition and lasts 6 weeks.

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51
Q

When does CHRONIC pericarditis occur and how long does it last?

A

May follow acute pericarditis and lasts up to 6 months

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52
Q

Complications from Pericarditis?

A
  • Cardiac Effusion
  • Tamponade
  • HF
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53
Q

Most common cause of Pericarditis?

A

Virus

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54
Q

What are the layers of the pericardium from inner to outer?

A

Visceral pericardium, 50 ml Of fluid in pericardial cavity, Parietal Pericardium, Fibrous pericardium

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55
Q

Pericarditis caused by directed extension of metastases?

A

Neoplastic

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56
Q

Mnemonic for causes of pericarditis?

A
  • 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
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57
Q

Pathophysiology of pericarditis?

A
  • Pericardial sac inflammation
  • Exudate released (fluid containing Fibrin, WBCS, Endothelial cells)
  • Friction between parietal and visceral layers causes inflammation/irritation of surrounding tissue.
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58
Q

Form of pericarditis where clear pericardial fluid exceeds 50 mL?

A

Effusion

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59
Q

Form of pericarditis involving varying amounts (100 ml to 3 Liters) of ______. Straw/amber colored and thick; May be hemorrhagic and purulent.

A

Serofibrinous exudates

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60
Q

Describe Constrictive pericarditis.

A
  • Thickening and Scarring of layers
  • Can be generalized to all chambers
  • Reduces CO
  • Leads to systemic/pulmonary congestion
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61
Q

Describe Adhesive pericarditis.

A
  • Layers become adhered to each other
  • Obliterates pericardial space
  • Can extend to epi/myocardium
  • Decrease in CO
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62
Q

Surgical procedure for pericarditis to remove fluid via needle?

A

Pericardiocentisis

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63
Q

Surgical procedure for pericarditis creating a drainage area for the excess fluid in the sac?

A

Pericardial window

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64
Q

Surgical procedure for pericarditis in which pericardial sac is removed?

A

Pericardiectomy

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65
Q

Medical treatment for Pericarditis?

A
  • Rest
  • ECG- (Rule out MI, tamponade, decompensation)
  • Hemodynamic monitoring
  • Drugs
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66
Q

Drugs used for pericarditis?

A
  • Anti-inflammatory (if w/o tamponade)
  • Analgesics/antipyretics
  • Corticosteroids (For persistent recurring type)
  • Meds for specific cause - e.g. Chemotherapeutic agents for constrictive pericarditis
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67
Q

Chest pain in pericarditis worsens with?

A

Deep breathing, coughing, lying supine

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68
Q

Chest pain in pericarditis is relieved by?

A

Sitting up or leaning forward

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69
Q

what type of pericarditis does Jugular vein distention occur with?

A

Constrictive

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70
Q

Nursing Assessment for Pericarditis?

A
  • 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

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71
Q

Diagnostic Tests for Pericarditis?

A

CXRAY - increased heart size if effusion

ECG - ST elevation, T wave inverted

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72
Q

Where is a plueral friction rub heard best?

A

ICS - 2,3,4 or apex

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73
Q

an important teaching for clients who have had pericarditis?

A

Signs and symptoms of recurrence

  • chest pain intensified by inspiration, supine, coughing
  • Fever
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74
Q

compression of the heart caused by fluid collecting within the pericardial sac surrounding the heart

A

Cardiac tamponade

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75
Q

What emergent occurrence can occur as a result of cardiac tamponade?

A

Restriction of blood flow in and out of the ventricles

MEDICAL EMERGENCY

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76
Q

Most common cause of Cardiac tamponade?

A

Acute pericarditis

other causes are chest trauma, anticoagulants, uremia, cardiac surgery

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77
Q

Slow pericardium fluid accumulation allows for________ while Rapid fluid accumlation doe not allow for ______

A
  • Stretching of fibers

* Pericardial to stretch

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78
Q

Describe what occurs once the pericardium fails to stretch during a cardiac tamponade.

A
  • Intrapericardial pressure ^
  • Ventricles restricted
  • SV and CO decrease
  • HYPOtension
  • HF
  • Cardiogenic shock
  • CARDIAC ARREST
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79
Q

A triad of symptoms that occur during cardiac tamponade?

A

BECKS TRIAD
J-uglar distention
A-rterial blood pressure drop
M-uffled heart sounds (distant)

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80
Q

What drugs are given to treat cardiac tamponade? Why?

A

Positive inotrpic drugs

  • Increase contractility
  • Increase Blood pressure
  • Increase Cardiac output
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81
Q

surgical treatment for cardiac tamponade?

A

*Pericardiocentesis – remove fluid via needle
*Pericardial Window – open drainage area
* Pericardiectomy – removal of pericardium
(chronic constrictive)

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82
Q

Assessment findings for tamponade?

A
  • BECKS TRIAD*
  • Heavy chest pain
  • Anxiety
  • Tachy
  • Paradoxical pulse
  • Elevated CVP
  • Chest x-ray (Enlarged heart, widened mediastinum)
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83
Q

Nursing interventions for tamponade?

A
  • Administer O2/Drug therapy as ordered
  • Monitor CVP/IV closely
  • assist with pericardiocentisis
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84
Q

How can the nurse assist with a pericardiocentisis?

A
  • Monitor ECG, BP, PULSE
  • Assess aspirated fluid for color and consistency
  • Send specimen to lab immediately
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85
Q

Drugs that strengthen/Weaken the force of cardiac contraction? Give examples.

A
  • Positive inotropic (strengthens) - dopamine, adrenaline

* Negative Inotropic (weakens) - labetalol, propranolol

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86
Q

Drugs that accelerate/slow the heart rate? give examples.

A
  • Positive chonotropic (accelerates) - adrenaline (epi)

* Negative chronotropic (slows) - digoxin

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87
Q

Drugs that speed up/ slow conduction velocity through heart? Give examples.

A
  • Positive dromotropic (speeds up) - phenytoin

* Negative dromotropic (slows) - verapamil

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88
Q

an acquired or congenital disorder when any valve in the heart has damage or is diseased; if left untreated, can lead to CHF?

A

Valvular heart disease

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89
Q

Causes of vavlular heart disease?

A
  • 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
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90
Q

Signs and Symptoms of VHD?

A
  • 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)
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91
Q

Diagnostic tests for VHD?

A
  • CXR
  • EKG
  • Echocardiogram
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92
Q

Complications associated with VHD?

A
  • IE - Can cause damage to valves
  • Embolism
  • LV/RV failure
  • Pulmonary Edema
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93
Q

Treatment for VHD?

A
  • 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
Q

What are the types of replacement valves and what does the selection depend on?

A
  • Artificial - prosthetic or Bioprosthetic - animal tissue

* Depends on client age, condition, and affected valve

95
Q

Nursing education/management for VHD?

A
  • 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
Q

are pathologic heart sounds that are produced as a result of turbulent blood flow

A

heart murmurs

97
Q

What are some causes of heart murmurs

A

Leaking or narrowing valves

98
Q

how are heart murmurs characterized”

A

time of occurrence in cardiac cycle

99
Q

What grade of murmur is only heard with optimal conditions? Thrill felt?

A

Grade 1 murmur - No thrill

100
Q

what grade of murmur is just loud enough to be obvious? Thrill felt?

A

Grade 2 murmur - No thrill

101
Q

What grade of murmur is moderately loud? Thrill felt?

A

Grade 3 murmur - no thrill

102
Q

What grade of murmur is loud with palpable thrill?

A

Grade 4 murmur - thrill felt

103
Q

What grade of murmur can be heard with stethoscope partially off the chest? Thrill?

A

Grade 5 murmur - thrill felt

104
Q

What grade of murmur can be heard with stethoscope completely off the chest? Thrill?

A

Grade 6 murmur - thrill felt

105
Q

What makes the 1st heart sound (s1 or “LUB”)?

A

the tricuspid/mitral valves snapping shut at the end of diastole/beginning of systole (aortic/pulmonic valves open)

106
Q

What makes the 2nd heart sound (s2 or “DUB”)?

A

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
Q

When the Aortic valve doesn’t open all the way this is known as______ and occurs during______.

A
  • Aortic stenosis

* Systolic ejection (In the middle S1 and S2) (Lub-murmur-Dub)

108
Q

During Aortic stenosis what are some changes to the leaflets (flaps of valve) that causes them to not open completely?

A
  • Thickened/Rigid
  • Calcified
  • Stiff/Fused
109
Q

What happens to the heart as a result of Aortic stenosis

A

LV hypertrophy (muscle enlargement) as a result of forcing blood through smaller opening.

110
Q

S&S of Aortic stenosis?

A
  • 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
Q

Where is the best place to place the stethoscope to hear Aortic stenosis?

A

*2nd RICS on sternal border

112
Q

_____ is when Blood backflows into Left Atrium during _____due to the ______ not closing all the way.

A
  • Mitral regurgitation/insufficiency
  • Systolic ejection (Right after S1 until S2)(LUBMURMERDUB)
  • Mitral
113
Q

What happens to the heart as a result of Mitral regurgitation?

A

Dilation and hypertrophy of the LA

114
Q

S&S of Mitral regurgitation?

A
  • DOE/Fatigue (too much back flow can go back to lungs)
  • Paroxysmal nocturnal dsypnea
  • Hepatic congestion
  • Ascites/Edema/Distended neck veins
115
Q

Where is the best place to listen to a mitral regurgitation murmur?

A

*5th ICS-Midclavicular line (apex/mitral)

116
Q

When the Aortic valve doesn’t close all the way this is known as______ and occurs during______.

A
  • Aortic regurgitation/insufficiency

* Early Diastole (Right after S2 Lub-DubMURMER(blowing)

117
Q

What happens to the heart as a result of Aortic Regurgitation?

A
  • Increased volume in LV
  • Increased LA pressure
  • Eventually pulmonary congeation
118
Q

S&S of Aortic Regurgitation

A
  • Can be Asymptomatic for 20 years

* potentially serious/teach follow up care

119
Q

Where is the best place to listen to a mitral regurgitation murmur?

A

*5th LICS MCL

120
Q

When the Mitral valve doesn’t open all the way this is known as______ and occurs during______.

A
  • Mitral stenosis

* Diastole - (Between S2 and S1)(Lub-Dub-Murmer)(rumbling sound)

121
Q

During Mitral stenosis what are some changes to the leaflets (flaps of valve) that causes them to not open completely?

A
  • Thickened/Rigid
  • Calcified
  • Stiff/Fused
  • Decrease in size
122
Q

S&S of Mitral stenosis?

A
  • heart failure may occur
  • Cardiac output decreas
  • Dysrythmias increase (AFIB in 50%)
123
Q

Where is the best place to listen to Mitral stenosis murmur?

A

5th intercostal space & midclavicular line

124
Q

What are the three types of cardiomyopathy?

A
  • Dilated
  • Hypertrophic
  • Restrictive
125
Q

complications from dilated cardiomyopathy?

A
  • Dsyrhthmias

* CHF

126
Q

complications from restrictive cardiomyopathy?

A

*CHF

127
Q

complications of hypertrophic cardiomyopathy?

A
  • CHF
  • Cardiac arrest
  • Syncope
  • SUDDEN DEATH
128
Q

Signs and symptoms of left sided heart failure

A

LEFT - FORCED

  • Fatigue
  • Orthopnea
  • Rales/Restlessness
  • Cyanosis/Confusion
  • Extreme weakness
  • Dyspnea
129
Q

Signs and symptoms of right sided heart failure

A

RIGHT - BACONED

  • Bloating
  • Anorexia
  • Cyanosis/Cool legs
  • Oliguria
  • Nausea
  • Edema
  • Distended neck veins
130
Q

Diagnosing cardiomyopathy?

A
  • S+S of CHF
  • Cardiac catheterization
  • CXR
  • EKG
  • ECHO
131
Q

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?

A
  • Dilated/congestive cardiomyopathy (DCM)

* Left ventricle

132
Q

Predisposing factors of DCM?

A
  • ETOH
  • COCAINE
  • Pregnancy
  • VIRAL INFECTIONS (coxsackie B, HIV)
  • MI
133
Q

Treatment for DCM?

A
  • Treat symptoms of heart failure
  • Diuretics
  • Vasodilators
  • Positive iontropic drugs (digoxin)
  • Control dysrhtymias
  • Heart transplant
134
Q

_____ is a disease of the heart that involves abnormal growth of muscle fibers that causes thickened and stiff walls of the _____ and ______.

A
  • Hypertrophic cardiomyopathy (HCM)

* Ventricles and Septum

135
Q

In LV hypertrophy what happens to the LV?

A
  • LV shrinks w or w/o LA dilation
  • limits from filling, less blood in means less blood out.
  • can block aortic valve
136
Q

Signs and symptoms of Hypertrophic Cardiomyopathy?

A
  • SOB, DOE
  • Chest pain
  • Afib
  • Palpitations
  • Systolic murmurs
  • Syncope
  • Asymptomatic
  • SUDDEN DEATH
137
Q

HCM is often seen in?

A

Young adults and athletes who are genetically disposed

138
Q

What kind of medications do you want to AVOID when treating HCM? Why?

A
  • 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
Q

Earliest sings of hypoxia?

A

restlessness and agitation

140
Q

If a client is experiencing if SVT or Ventricular dysrhythmias with HCM, what would you want to give?

A

Antidysrhythmic e.g. Amiodarone

141
Q

In HCM if the client experiences AF, you might give a _______ to decrease risk of_______

A
  • anticoagulant

* Emboli

142
Q

First line of drugs used to assist with HCM? Why?

A

Beta blockers (first line) e.g. Propranolol: myocardial↓O2 consumption & workload

143
Q

second line of drugs used to assist with HCM? Why?

A

CCB, consult provider on type) ↑ LV relaxation and filling

144
Q

a condition where the ventricular walls become rigid and hard, causing high pressure in ventricles and issues with refilling/stretch.

A

Restrictive cardiomyopathy

145
Q

what happens to ejection fraction during RCM? CO?

A
  • Stays normal (50% to 70%) or decreases

* CO decreases

146
Q

Causes of RCM?

A
  • radiation exposure

* scarring from surgery

147
Q

Treatment of RCM?

A
  • Treat symptoms of heart failure
  • Diuretics
  • Vasodilators
  • Positive iontropic drugs (digoxin)
  • Control dysrhtymias
  • Heart transplant
148
Q

Prognosis for RCM?

A

Poor, half die within 2 years.

149
Q

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.

A

Hemodynamic monitoring

150
Q

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.

A

Mean arterial pressure

151
Q

What is the normal range for MAP? What does it mean if its lower or higher?

A

70-100

  • Low=decreased blood flow through organs
  • High=increased cardiac workload.
152
Q

What happens to the right atrium if there is an issue with the right ventricle?

A

Pressure increases

153
Q

_____ is used to directly measure central venous pressure in ______ and ______.

A
  • Central venous catheter
  • Right atrium
  • Superior vena cava
154
Q

Where does the tip of the CVC rest within the body?

A

Lower third of superior vena cava

155
Q

Two purposes of CVP catheter?

A
  • Measure right atrial pressure (indicates alterations with RV)
  • Blood volume and adequacy of central venous return
156
Q

CVPC is an IV route for?

A
  • Blood draws
  • Fluids
  • Medications
157
Q

normal CVP range? (right atrial pressure)?

A

2-6 mm Hg

158
Q

A CVP reading above____ is considered high and may indicate?

A
  • 12*

* Heart failure, Hypervolemia

159
Q

A CVP reading below____ is considered low and may indicate?

A
  • 2*

* Hypovolemia*

160
Q

complications from a CVPC?

A
  • Infection
  • Thrombosis
  • Air embolism
  • Pnemothorax
  • Infiltration
161
Q

Normal cardiac output?

A

4-8 L/min

162
Q

Normal pulmonary artery pressure (PAP)?

A

9-18 mm Hg

163
Q

Normal range for PCWP

A

6 - 12 mmHg

164
Q

arterial insufficiency to contracting muscles brought on by exercise
(generally walking a predictable distance) and relieved by rest

A

Claudication

165
Q

The restoration by surgical means of blood flow to an organ or a tissue, as in bypass surgery.

A

arterial revascularization

166
Q

Bypass may be constructed from autologous:___, ____, ____

A
  • Vein
  • Artery
  • Synthetic
167
Q

Atherosclerosis is a progressive disorder; surgery is?

A

palliative, providing relief from debilitating symptoms

168
Q

occlusive disease of Distal aortic and iliofemoral arteries (Leriche’s syndrome), claudication of buttock, hip or thigh.

A

Aortoilliac disease

169
Q

When is an arterial revascularization surgery indicated?

A

disease becomes disabling, rest pain is present or if there is ischemic ulcers.

170
Q

Most common type of surgery to corrected lower extremity arterial obstruction.

A

Femoral-Popliteal Bypass Surgery

171
Q

Reasons for Femoral-Popliteal Bypass Surgery

A
  • PAD

* Blockage secondary to atherosclerosis

172
Q

What does a femoral-popliteal bypass surgery entail?

A

*Replace occluded vessel with synthetic or autgeonous vein
OR
*Open with balloon and place stent

173
Q

FPBS preop nursing interventions

A
  • Mark distal pulses
  • ECG
  • *Assess for infections
  • Administer meds
  • Education
174
Q

FPBS postop nursing interventions

A
  • 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
Q

used to predict the severity of peripheral arterial disease (

A

Ankle Brachial index

176
Q

A slight drop in the ABI with exercise means

A

PAD is probably present

177
Q

How is an ABI test done? when is it repeated?

A
  • 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
Q

A normal resting ankle-brachial index is______, meaning what? Anything lower than ______ or lower could signify PAD.

A
  • 1.0-1.4
  • blood pressure at the ankle is the same or greater than the pressure at in the arm
  • 0.9
179
Q

What causes coronary artery disease?

A

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
Q

Visualization of vessels (selective) or chambers via contrast media to see blockages

A

Angiography

181
Q

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?

A
  • AngioPLASTY

* Balloon, Stent, atherectomy

182
Q

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.

A

STENT

183
Q

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.

A

Atherectomy

184
Q

Inflates and crushes plaque against the vessel wall

A

Balloon

185
Q

After a stent is placed, what happens with the tissue?

A

Tissue forms over it starting within a few days and fully after a month

186
Q

What medications are typically given after stent placement and why?

A

Antiplatelet medication like aspirin and clopidogrel to prevent blood clots by decreasing “stickiness” (unless stent is already impregnated with medication

187
Q

The degree of coronary artery stenosis is assessed during

A

cardiac cath

188
Q

peripheral arterial pressure is assessed with

A

an A line

189
Q

reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client.

A

pulmonary capillary wedge pressure

190
Q

Nursing Outcomes for Percutaneous Transluminal Coronary Angioplasty

A
  • Anxiety level reduced
  • Coronary output maintained
  • Tissue perfusion is maintained
  • Knowledge level increased
191
Q

Reason for a CABG?

A

severe coronary artery disease

192
Q

In CABG Diseased or occluded artery is _____, in order create unobstructed blood flow. There can be ___to___bypassed.

A
  • Bypassed

* 1 to 4

193
Q

What is used as a graft in CABG?

A

Saphenous vein or internal mammary artery

194
Q

Educate patients before a CABG (PER ORDER) stop anticoagulants (including NSAIDs, ASA. etc.) _____ preop,
diuretic _____ preop and digitalis _____preop.

A
  • 1 week
  • 2 to 3 days
  • 12 hours
195
Q

What complications need to be monitored for in a CABG post op?

A
  • 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
Q

_____is a dilation of an artery, which forms a sac, in one or all _______.

A
  • Aneurysm

* Arterial wall layers

197
Q

cause of AAA?

A

a weakness and stretching of the artery wall,

198
Q

classification of AAA - spindle shape, whole artery circumference.

A

Fusiform

199
Q

classification of AAA - out-pouching on one side of artery.

A

saccular

200
Q

classification of AAA - separation of arterial wall layers forms blood filled cavity.

A

Dissecting

201
Q

Once an aneurysm reaches ___in diameter,
it is usually considered necessary to treat to prevent rupture.

A

5 cm

202
Q

Risk factors for AAA?

A
  • MALE
  • SMOKERS
  • FAMILY HISTORY
203
Q

half of the AAA dissections in women happen during?

A

pregnancy

204
Q

location for AAA?

A

below renal and above the iliac bifurcation.

205
Q

Symptoms of AAA?

A

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
Q

Assessment of AAA?

A
  • 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
Q

Which diagnostic test shows exact location of AAA?

A

Aortography

208
Q

in AAA you want to assess for _____phlebitis post op. What are the S+S?

A

Thrombophlebitis

*redness, warmth, tenderness over vein, edema if deep vein

209
Q

What position is client placed in after AAA surgery?

A

Flat

210
Q

Decreased cardiac output and tissue hypoxia in the presence of adequate intravascular volume.

A

cardiogenic shock - no problem with blood volume, but problem with the heart itself.

211
Q

is frequently used to assess left ventricular filling, represent left atrial pressure, and assess mitral valve function

A

PCWP

212
Q

Normal cardiac index range?

A

2.5-4

213
Q

Hemodynamic criteria for cardiogenic shock

A
  • SBP < 90 mm Hg for at least 30 min
  • PCWP > 18 mm Hg
  • Low cardiac Index <2 L/ min (reflects shock state)
214
Q

Evidence of hypoperfusion as a result of cardiogenic shock?

A
  • oliguria
  • Acidosis
  • Cool and clammy skin
  • Altered mental status- Early - hyper alert/agitated, late - lethargy, coma, death
215
Q

Cause of cadiogenic shock?

A

Most issues with heart - MI most common

216
Q

Fluid volume management during cardiogenic shock?

A

Can give fluids to promote CO, pcwp should be kept below 18 to avoid pulmonary congestion

217
Q

O2 management in cardiogenic shock?

A

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
Q

SIgns of renal function decrease during cardiogenic shock?

A

Less than 30 ml/hr urine output

Elevated bun and creat

219
Q

Drugs for cardiogenic shock?

A

Dig, Dopamine, dobutamine, norepi, Nitropusside

220
Q

Pacemaker codes?

A
  • Paced: A= Atrium, V=Ventricle, D= Atrium & Ventricle
  • Sensed: A= Atrium, V=Ventricle, D= Atrium & Ventricle
  • Response: T= Triggered, I= Inhibited, D= both
221
Q

Pacemaker method - competitive, fires at a preset rate regardless of the client’s rate and rhythm.

A

Fixed rate(Asynchronous)

222
Q

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.

A

Demand (syncrhonous)

223
Q

When is a pacemaker used?

A

when intrinsic pacing fails to provide perfusing rhythm.

224
Q

The atria are paced, when the intrinsic atrial rhythm falls below the pacemaker’s threshold.

A

AAI

225
Q

he ventricles are paced, when the intrinsic ventricular rhythm falls below the pacemaker’s threshold.

A

VVI

226
Q

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.

A

VDD

227
Q

The pacemaker records both atrial and ventricular rates and can pace either chamber when needed.

A

DDD

228
Q

As above, but the pacemaker has a sensor that records a demand for higher cardiac output and can
adjust the heart rate accordingly.

A

DDDR

229
Q

ICD with shock capability only

A

ICD-S

230
Q

ICD with bradycardia pacing as well as shock capability

A

ICD-B

231
Q

ICD with tachycardia and bradycardia pacing, plus shock capability

A

ICD-T

Nursing 231 - Exam 2 (4 decks)

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