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M/S 2 > Exam 2 - Cardio > Flashcards

Exam 2 - Cardio Flashcards

1
Q

White lead placement

A

R 2nd ICS, MCL

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2
Q

Green lead placement

A

R 8th ICS, MCL

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3
Q

Black lead placement

A

L 2nd ICS, MCL

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4
Q

Red lead placement

A

L 8th ICS, MCL

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5
Q

Brown lead placement

A

R 4th ICS, sternal border

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6
Q

Should you put a lead over a bone?

A

No

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7
Q

SA node BPM

A

60-100

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8
Q

AV node BPM

A

40-60

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9
Q

Ventricular rate if SA and AV nodes fail

A

20-40 bpm

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10
Q

what occurs during ventricular systole?

A

depolarization = contraction

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11
Q

what occurs during ventricular diastole?

A

rest, repolarization

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12
Q

what does and EKG determine?

A

electrical impulse

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13
Q

best lead to determine heart rhythm

A

lead 2

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14
Q

P wave shows…

A

atrial depolarization/contraction

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15
Q

QRS shows…

A

ventricular depolarization/contraction

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16
Q

T wave shows…

A

ventricular repolarization/relaxation

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17
Q

when is atrial repolarization lost?

A

in the QRS complex

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18
Q

red hash marks at the top of an EKG strip is ___ seconds

A

3 seconds

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19
Q

large squares on an EKG strip are ___ seconds

A

0.2 seconds

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20
Q

small squares on an EKG strip are ___ seconds

A

0.04 seconds

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21
Q

5 steps to determine rhythm analysis

A

determine regularity
calculate HR
examine P-QRS-T wave
measure intervals
identify rhythm

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22
Q

grid method for determining HR

A

1500 / # small boxes between R wave

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23
Q

scan method to determining HR

A

R waves in 6 seconds x 10

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24
Q

PR interval should be ___ - ___ seconds

A

0.12 - 0.2 seconds

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25
Q

QRS duration should be ___ - ___ seconds

A

0.04 - 0.1 seconds

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26
Q

what is the J point?

A

point at which the S wave returns to baseline and the ST segment begins

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27
Q

causes of bradycardia

A

electrical issues in the heart
OD of beta blockers
organic phosphate poisoning
hypothyroidism
OSA
hypo, hyperkalemia
hypoxia
hypothermia
increased ICP

sleeping adults, children
well-conditioned athletes
present in up to 35% of people < 25 y/o at rest

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28
Q

bradycardia treatment

A

drugs to speed the heart
pacemakers
atropine

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29
Q

causes of tachycaria

A

exercise
stimulants
–caffeine, cocaine, etc

fever
pain
fear, anxiety
CHF
acute MI
infection
sympathetic stimulation
shock
dehydration, hypovolemia
PE
nicotine

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30
Q

HR for infant (1-12 months)

A

100-160 bpm

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31
Q

HR for toddler (1-3 y/o)

A

90-150 bpm

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32
Q

HR for preschooler (4-5 y/o)

A

80-140 bpm

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33
Q

HR for school-aged (6-12 y/o)

A

70-120 bpm

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34
Q

HR for adolescent (13-18 y/o) and adults (18+ y/o)

A

60-100 bpm

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35
Q

HR for a sleeping child may decrease by ___%

A

10%

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36
Q

HR commonly seen with acute MI

A

bradycardia

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37
Q

vagal stimulation can cause bradycardia. What can cause vagal stimulation?

A

coughing
vomiting
straining during BM
sudden exposure of the face to cold water
carotid sinus pressure
-tight collar is worn

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38
Q

a decrease in CO will eventually result in ___ ___

A

hemodynamic compromise

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39
Q

s/sx of hemodynamic compromise

A

mental status change
low BP
chest pain
SOB
s/sx of shock
CHF
pulmonary congestion
decrease urinary output
cold, clammy skin

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40
Q

symptomatic bradycardia treatment

A

O2
IV access
atropine
transcutaneous pacing (TCS)

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41
Q

tachycardia rate in adults

A

101 - 180 bpm

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42
Q

tachycardia rate in infants

A

> 200 bpm

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43
Q

tachycardia in child > 5/yo

A

> 160 bpm

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44
Q

tachycardia treatment

A

treat the underlying cause

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45
Q

ACS is aka ___ ___

A

MI

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46
Q

volume of blood ejected per minute

A

CO

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47
Q

end of diastolic volume (relaxation/preload) MINUS end of systolic volume

A

SV

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48
Q

preload amount is about ___ mL

A

130 mL

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49
Q

amount of blood at end of systolic is about ___ mL

A

60 mL

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50
Q

primary reason for decrease in supply of O2 to the heart muscle is narrowing of the arteries cause by ___

A

atherosclerosis

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51
Q

artery is ___% occluded before symptoms occur

A

75%

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52
Q

types of angina

A

silent
nocturnal
prinzmetal’s
chronic
unstable

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53
Q

2 most common types of angina

A

chronic
unstable

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54
Q

silent angina is commonly seen in pts with ___

A

DM

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55
Q

silent angina is seen on which 2 diagnostic test?

A

EKG
stress test

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56
Q

is there chest pain with silent angina?

A

no

will report “feeling bad”
nausea, fatigue

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57
Q

nocturnal angina occurs mostly ___ ___

A

at night

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58
Q

what is nocturnal angina r/t

A

nothing

“just occurs”

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59
Q

Prinzmetal’s angina is cause d/t ___

A

vasospams

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60
Q

when does Prinzmetal’s angina occur

A

at rest

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61
Q

do you have to have CAD to have Prinzmetal’s angina?

A

No

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62
Q

Prinzmetal’s angina is associated with ___ and ___ ___

A

migraine
Raynaud’s phenomenon

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63
Q

Prinzmetal’s medication choice

A

CCB

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64
Q

Prinzmetal’s will have __ elevation on an EKG

A

ST

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65
Q

T or F. Prinzemetal’s variant angina is reversible

A

True

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66
Q

CP that occurs intermittently over a long period with the SAME pattern of onset, duration, and intensity of symptoms

A

Chronic Stable angina

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67
Q

How long does chronic stable angina last?

A

only a few minutes; will subside when the precipitating factor is removed

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68
Q

T or F. Pain at rest is normal for chronic stable angina.

A

False

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69
Q

Chronic stable angina medication choice

A

Nitro

70
Q

arteries must be clogged __ to __% before surgery

A

90-95%

71
Q

angina precipitating factors

A

physical exertion
temp extremes
strong emotions
eating a heavy meal
tobacco use
sexual activity
stimulants (caffeine)

72
Q

angina pain assessment acronym

A

PQRST

73
Q

PQRST

A

Precipitating factors
Quality of pain
Radiation of pain
Severity
Timing

74
Q

cardiac lab indicators with angina

A

troponin

75
Q

cardiac tests to know

A

cardiac cath (gold standard)
echo
EKG
stress test
holter monitor

76
Q

cholesterol should be < ___

A

< 200

77
Q

triglycerides should be < ___

A

< 150

78
Q

HDL should be > ___

A

> 60

79
Q

LDL should be > ___

A

> 50

80
Q

CK-MB range

A

0-3

81
Q

myoglobin should be < or equal to ___

A

< or equal to 90

82
Q

troponin should be < ___

A

< 0.04

83
Q

LDH range

A

122-222

84
Q

post-op care for PCA

A

observe site for bleeding, hematoma
BP, HR
keep flat 2-4 hours after procedure
continue IVF, encourage water to flush dye

85
Q

how often to assess temperature and neurovascular check after PCA

A

q15 minutes x1 hour
q30 minutes x1 hours
q1h x4 hours

86
Q

ASA contraindication

A

GI bleed
allergy to ASA
asthma pt with sensitivity to NSAIDs

87
Q

what med to administered as soon as a MI is suspected

A

ASA

88
Q

first line treatment for angina episode

A

Nitrates (short-acting)

89
Q

nitro education

A

do not take with viagra
monitor for orthostatic hypotension
keep accessible at all times
may take prophylactically
should tingle when under tongue
must replaced q6months

90
Q

nitro side effects

A

HA
dizzy
flushing

91
Q

long-acting nitrate examples

A

Isordil (isosorbide dinitrate)
Imdur (isosorbide monitrate)

Nitro bid
Nitro dur

92
Q

long-acting nitrate side effects

A

HA (decrease over time)
*educate to take Tylenol

93
Q

how long does nitro bid work?

A

3-6 hours

94
Q

nitro bid considerations re: placement

A

flat, muscular area
avoid hair, scars
keep above umbilicus

95
Q

nitro dur last how long?

A

24 hours

96
Q

preferred drug for angina managment

A

beta blockers

97
Q

who should not take beta blockers?

A

asthmatics

98
Q

beta blocker side effects

A

hypoglycemic unawareness
bradycardia
hypotension
wheezing
GI symptoms
weight gain
sexual dysfunction

99
Q

what is given if beta blockers can not be administered

A

CCB

100
Q

CCB potentates which drug during the first week of therapy?

A

Digoxin

101
Q

when are ACE-I Rx?

A

pts at high risk for a cardiac event

102
Q

ACE-I side effects

A

cough
angioedema
hyperkalemia
hypotension
dizzy
rash
loss of taste

103
Q

what is administered if ACE-I can not be taken?

A

ARB

104
Q

Na current inhibitor example

A

Ranexa (ranolazine)

105
Q

Na current inhibitor contraindication

A

Prozac (fluoxetine)

106
Q

Na current inhibitor side effects

A

nausea
weakness
constipation

107
Q

manifestations of ACS

A

prolonged, not immediately reversible ischemia

108
Q

these 4 things are associated with once stable angina

A

atherlosclerotic plaque ruptures
platelet aggregation
vasoconstriction
thrombus

109
Q

ACS risk factors

A

age
gender
heredity
HTN
DM
abnormal lipids
smoking
obesity
physical inactivity
diet

110
Q

ACS risk factors unique to women

A

premature menopause
oral contraceptive use
HRT

111
Q

ACS can create these types of feelings

A

pressure
anxious
restless
feeling sense of doom

112
Q

atypical ACS s/sx in women

A

indigestion
heartburn
SOB
N/V
back, jaw pain

113
Q

results from cardiac disorders that impair the ventricles ability to fill the blood and effectively pump it out

causes a decrease in CO, tissue perfusion

A

CHF

114
Q

CHF risk factors

A

HTN, CAD, MI, angina, diseased valves
DM
COPD, pulmonary fibrosis
age, race
HIV, AIDS
too much Vitamin E
^ metabolic demand
septicemia
anemia
hyper, hypothyroidism
obesity
cardiomyopathy
arrhythmias
alcohol, drug OD
radiation, chemo
children with congenital heart defects

115
Q

what are the 2 types of L sided HF

A

Systolic
Diastolic

116
Q

what is systolic HF

A

when the ventricle fails to contract adequately to eject a sufficient amount of blood into the arterial system

117
Q

EF should < ___% indicates HF

A

< 40%

want EF to be 60%

118
Q

what is diastolic HF

A

heart cannot completely relax in diastole
ventricle can not adequately fill

119
Q

L sided HF s/sx are r/t

A

pulmonary problems

120
Q

what extra heart sound is heart with L sided HF

A

S3 gallop

121
Q

Cause of R sided HF

A

L sided HF
COPD

122
Q

R sided HF present s/sx of

A

fluid overload

123
Q

how to assess for JVD

A

sit pt up in a chair at 45 degrees

124
Q

CHF complications

A

liver failure (d/t prolonged R CHF)
pleural effusion
PE
PNA
Respiratory acidosis
Hepatomegaly
Splenomegaly
malnutrition
dysrhythmias
cardiogenic shock
sudden cardiac death

125
Q

BNP measures what?

A

pulmonary congestion

126
Q

BNP should be < ___

A

< 100

127
Q

BNP 100-300 is indicative of

A

HF

128
Q

BNP >300 is indicative of

A

mild HF

129
Q

BNP >600 is indicative of

A

moderate HF

130
Q

BNP >900 is indicative of

A

severe HF

131
Q

what is atrial natriuretic factor (ANF)?

A

antibody protein to help infection

hormone that promotes dilation; atrial stretch

132
Q

What ANF range is indicative of HF

A

22-77

133
Q

will troponin be affected during CHF

A

No

134
Q

Why does albumin need to be WNL during CHF

A

Albumin transports proteins. Meds are distributed via protein

135
Q

What does EF show?

A

% blood pumped out of the heart compared to amount of blood left in the chamber

60% = 60% of the blood is pushed out of the chamber

136
Q

heart healthy diet

A

1.5-2 G of sodium
low fat
limit fluid per MD order

137
Q

how much for HF pts to exercise weekly

A

3-5 x’s

30-40 minutes
pace out events
avoid extreme weather
wait 2 hours after meals

138
Q

when is sx needed for CHF

A

end-stage HF

valve replacement
HF transplant

139
Q

what to monitor for/educate with ACE-I

A

BUN
Crt
angioedema
dry cough

140
Q

When to administer catopril or moexipiril

A

1 hour before meals

141
Q

ACE-I, ARB dry cough education

A

drink water
sip on lozenge (sugar free if diabetic)
should not last > 10 days

142
Q

what electrolyte imbalance can ACE-I cause?

A

hyperkalemia

143
Q

diuretics fluid restriction

A

limit 2000 mL/daily

drink 6-8 glasses daily

144
Q

therapeutic serum digoxin level

A

0.5-2

145
Q

which electrolyte imbalance can cause digitalis toxicity

A

hypokalemia

146
Q

foods high in K+

A

fresh OJ, tomato juice
fruits
raisins
dates
figs
prunes
spinach
cauliflower
potatoes
peanuts
almonds

147
Q

s/sx of digitalis toxicity

A

anorexia
N/V
abdominal pain
weakness
vision changes (blurred vision)
-diplopia, yellow, green, white halos
new on-set dysrhythmias

148
Q

what to not take at the same time as digoxin

A

antacids

149
Q

Sympathomimetic agents (inotropin, dobutrex) drug-drug interactions

A

tricyclics
MAOIs

150
Q

S/E of phosphodiesterase inhibitors (inocor, primacor)

A

hiccups
dysrhythmias
hypotension
hepatotoxicity
jaundice
thrombocytopenia
hypoxemia
hypokalemia
anorexia

151
Q

BiDil is a combo of which 2 drugs?

A

hydralazine + isosorbide

152
Q

who is BiDil typically Rx’d for?

A

severe HTN in African Americans

153
Q

caution given BiDil with which drug group

A

MAOI

154
Q

Do not give BiDil if a pt has taken which drugs?

A

Viagra
Cialis
Levitra

155
Q

BiDil assessment

A

VS
fluid volume status

156
Q

CHF weight gain to report

A

3# over 2 days
3-5 # over a week

157
Q

abnormal accumulation of fluid in interstitial tissue and alveoli of the lungs

A

pulmonary edema

158
Q

causes of pulmonary edema

A

acute MI
acute CHF
valvular disease

fluid overload
inhaled toxins
near drowning
respiratory distress syndrome

159
Q

s/sx of pulmonary edema

A

dyspnea, SOB, AMU
orthopnea
cyanosis
cool, clammy; diaphoretic
productive cough
crackles
pink, frothy sputum
JVD

160
Q

what are the 2 types of aneurysms

A

A: ascending
B: descending

161
Q

when is an aneurysm surgically treated

A

> 6cm in male
5 cm in female

162
Q

lifting restrictions with an aneursym

A

no more than 5#

163
Q

aortic aneurysms are classified by their ___

A

shape

164
Q

review the different shapes of aneurysms

A

review the different shapes of aneurysms

165
Q

what is considered a small aneurysm?

A

4-5.5 cm

166
Q

how does a endovascular graft work?

A

blood flows through the graft >
aneurysm wall will begin to shrink

**must meet strict criteria to be a caniate

167
Q

sexual activities guidelines should be referred to the

A

doctor

168
Q

aortic dissection occurs more commonly in which gender?

A

men

most frequently 60-70 y/o

169
Q

Is an aortic dissection a type of aneurysm?

A

No

it is a false lumen which blood flows

170
Q

aortic dissection s/sx

A

sudden, severe anterior CP that radiates down spine or abdomen
sharp, “worst ever”
mimic MI
elderly - confused, vague symptoms

171
Q

what is cardiac tamponade?

A

blood escapes from dissection into pericardial sac

172
Q

s/sx of cardiac tamponade

A

hypotension
narrowed pulse pressure
distended neck veins
muffled heart sounds

M/S 2 (10 decks)

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