Exam 2- cardio & acid base Flashcards
1
Q
acids
A
release hydrogen ions when dissolved in water
increase H+ lower pH- more acidic
2
Q
Bases
A
Bind with free hydrogen ions when in water
less H+ higher pH- more alkaline
3
Q
Buffers
A
when dissolved in water can act as acids of bases depending on the pH of the body
4
Q
What pH levels can result in death
A
pH of 7 or less and 7.8 or more
5
Q
1st line of defense for acid-base regulation
A
chemical
buffer system
takes seconds
6
Q
2nd line of defense acid-base regulation
A
respiratory
hypo/hyperventilation
changes pH with 02
takes minutes
7
Q
3rd line of defense acid-base balance
A
renal
kidneys/urine
changes pH with bicarbonate
takes 24-48 hours
8
Q
Arterial blood gas (ABGs)
A
collected in the arteries
Allen’s test
9
Q
Allen’s test
A
checks blood flow in the hands
10
Q
pH
A
7.35-7.45
11
Q
PaCO2
A
45-35
12
Q
HCO3
A
21-28
13
Q
PaO2
A
80-100
not needed to calculate acid balance but is included in ABGs
14
Q
Metabolic acidosis
A
low pH low HCO3
15
Q
metabolic alkalosis
A
high pH high HCO3
16
Q
respiratory acidosis
A
low pH high PaCO2
17
Q
respiratory alkalosis
A
high pH low PaCO2
18
Q
Causes of acidosis
A
starvation fever hypoxia ingesting alcohols kidney failure liver failure dehydration Respiratory- airway obstruction, COPD, asthma
19
Q
Causes of alkalosis
A
oral antacids too much sodium bicarbonate TPN vomiting NG suctioning respiratory- hyperventilating, mechanical ventilation, high altitudes
20
Q
myocardium
A
the heart muscle
21
Q
each beat of the heart pumps?
A
60 mL of blood or 5L/min
22
Q
what are the 4 chambers of the heart?
A
right atrium, left atrium, right ventricle, left ventricle
23
Q
what are the two types of valves in the heart?
A
Atrioventricular (AV) valves and semilunar valves
24
Q
what are the two AV valves in the heart?
A
tricuspid, mitral
25
What are the two semilunar valves in the heart?
aortic, pulmonic
26
Where is the tricuspid valve in the heart?
between RA and RV
27
Where is the mitral valve?
between LA & LV
28
What is the job of the AV valves?
act as funnels and help move blood from atrium to ventricle during diastole
during systole close to prevent backflow of blood into atrium
29
Where is the pulmonic valve?
separates RV and pulmonary artery
30
Where is aortic valve?
separates LV and aorta
31
What is the job of semilunar valves?
prevent backflow into ventricles during diastole
32
Superior and inferior vena cava?
bring deoxygenated blood from the body to RA
33
From the RA blood..
goes through tricuspid valve and to RV
34
then RV...
closes tricuspid, opens pulmonic, and propels blood into pulmonary artery
35
Pulmonary artery...
takes blood to the lungs
36
The lungs...
reoxygenate the blood
37
Pulmonary vein...
brings oxygenated blood to LA
38
blood in the LA...
goes through mitral valves and to LV
39
LV...
closes mitral valve, opens aortic valve, and propels blood into aorta and to the body
40
Mean arterial pressure (MAP)
must be at least 60 mm Hg
41
Cardiac output
the amount of blood pumped from left ventricle each minute
42
Formula for finding cardiac output
cardiac output= heart rate X stroke volume
43
Cardiac output ranges from?
3-6 L/min
44
Cardiac index
determined by dividing CO by body surface area
| normal range 2.8-4.2 l/min/m2
45
Heart rate
the number of times ventricles contract per minute
46
Normal resting heart rate
60-100 beats/min
47
Stroke volume
amount of blood ejected by left ventricle during each contraction
48
Preload
degree of myocardial fiber stretch at end of diastole and before contraction
49
Afterload
the pressure or resistance ventricles must overcome to eject blood through semilunar valves and into peripheral blood vessels
50
Myocardial contractility
ability of the heart to contract
| cardiac muscle strength
51
What effects myocardial contractility?
acidosis and hypoxia
52
Blood pressure
force of blood exerted on vessel walls
53
What three mechanisms mediate and regulate BP?
autonomic nervous system, kidneys, endocrine system
54
Systolic BP
amount of pressure or force generated by LV to distribute blood into the aorta with each contraction
55
Diastolic BP
amount of pressure or force against arterial walls during the relaxation phase of the heart
56
Baroreceptors and BP
are stimulated when arterial walls are stretched by increase in BP resulting in a decrease in BP
57
Chemoreceptors and BP
sensitive to hypoxemia
| When stimulated they activate vasoconstriction and increase BP
58
Stretch receptors and BP
sensitive to volume or pressure changes
When hypovolemic they sense the decrease in volume and stimulate sympathetic nervous system to increase HR and vasoconstrict; increasing BP
59
Kidneys and BP
when renal blood flow or pressure decreases the kidneys retain sodium and water; increasing BP
60
3 factors in BP
cardiac output, peripheral resistance, HR
61
formula for BP
BP= cardiac output X peripheral resistance
62
nonmodifiable risk factors
uncontrollable
| age, gender, ethnic origin, family hx of CVD
63
who is at a higher risk for CAD? (men or woman)
men
64
Modifiable risk factors
controllable
| cigarette smoking, physical inactivity, obesity, psychological variables
65
Cigarette smoking and assessment
```
number of cigarettes smoked daily
duration of the smoking habit
age when started smoking
hx in packs-years
Ask people who do not smoke whether they have ever smoked and when they quit
```
66
packs-years
number of packs per day multiplied times number of years smoked
67
Sedentary lifestyle and assessment
ask pt about type of exercise performed
how long a period they have participated in the exercise
frequency and intensity of exercise
68
Recommended exercise guidlines
150 minutes of moderate exercise or 75 minutes of vigorous exercisse
69
what is BMI of obesity
greater than 30
70
psychological factors and assessment
observe pt and assess how they respond to stressful situation
71
CVD/heart history and assessment
ask about previous treatment of CVD
specifically recurrent tonsillitis, streptococcal infection, and rheumatic fever
Ask about any known congenital heart defects
72
Nutritional hx and assessment
Have pt recall food and fluid intake during a 24 hour period
Ask about any dietary restrictions
amount and type of alcohol consumption
73
Pain/discomfort and assessment
ask pt to identify when symptoms were first noticed
assess how often symptoms occur
what activities was pt doing when it first occurred
ask how the pain feels- sharp, dull, crushing
ask to grade pain from 0-10
ask what makes pain better or worse
74
Dyspnea and assessment
ask about factors that make it better or worse
what level of activity produces dyspnea
body position when dyspnea occurred
75
Dyspnea on exertion
associated with activity
76
Orthopnea
dyspnea when lying flat
77
Paroxysmal nocturnal dyspnea
develops after lying down several hours
pt wakes up abruptly and may feel like they are suffocating and panic
sit up right and dangle legs off the side of the bed
78
Fatigue and assessment
Ask about time of day experienced
| ask about activities the patient can perform
79
syncope
brief loss of consciousness
80
Near-syncope
dizziness with the inability to remain upright
81
how much weight change shows a fluid change of 1 L
2,2 lbs or 1 kg
82
general appearance and assessment
```
assess general build and appearance
skin color
distress level
level of consciousness
shortness of breath
position
verbal responses
```
83
Extremities and assessment
assess hands, arms, feet, and legs for skin changes, vascular changes, clubbing, and edema
84
What are vascular changes in extremities?
```
paresthesia
muscle fatigue and discomfort
numbness
pain
coolness
loss of hair distribution
```
85
pitting edema
the skin can be indented
86
orthostatic (postural) hypotension
occurs when blood pressure is not adequately maintained while moving from lying to sitting or standing
87
What are the minimum blood pressure changes to classify as orthostatic hypotension
decrease of more than 20 mmHg in systolic or decrease of more than 10 mmHg in diastolic
and 10-20% drop in heart rate
88
Paradoxical blood pressure
exaggerated decrease in systolic pressure by more than 10 mm Hg during inspiratory phase of respiration
89
Pulse pressure
difference between systolic and diastolic values
90
Hypokinetic pulse
weak pulse
91
Hyperkinetic pulse
large "bounding" pulse
92
Bruits
swishing sound from blood flow in narrowed arteries
93
S1
The first heart sound
| created by the closure of mitral and tricuspid valves
94
S2
the second heart sound
| created by the closing of aortic and pulmonic valves
95
What should you do if you have difficulty hearing heart sounds?
have pt lean forward or roll to their left side
96
Paradoxic splitting
abnormal splitting of S2
97
S3
Ventricular gallop
| normal finding in people younger than 35 y/o
98
S4
atrial gallop
99
Systolic murmur
occurs between S1 and S2
100
Diastolic murmur
occurs between S2 and S1
101
Pericardial friction rub
occurs with movements of the heart during cardiac cycle
| sign of inflammation, infection, or infiltration
102
Troponin
a myocardial muscle protein released into bloodstream with injury to myocardial muscle
indicates cardiac necrosis or acute MI
103
Homocysteine
an amino acid that is produced when proteins break down
104
Highly sensitive C-reactive protein
marker of inflammation
< 1 is desired
> 3 increase risk for heart disease
105
Total cholesterol
<200 mg/dL
106
Triglyceride
males 40-160
| females 35-135
107
HDL
males > 45 mg/dL
females > 55 mg/dL
fish, oils, avocado, nuts, seeds
108
LDL
< 130 mg/dL
< 70 mg/dL for cardiovascular patients
deep fried foods, bacon
109
Microalbuminuria
small amounts of protein in urine
110
Cardiac catheterization
Done in a cath lab
can enter right or left side of the heart
right side entry through right atrium via superior or inferior vena cava-most commonly performed-entry through femoral or radial
left side entry into left ventricle via aorta- through femoral, brachial, or radial
Can put a stent in during procedure
111
Cardiac catheterization
| prre-op
Chest x-ray, CBC, coagulation studies, 12 lead ECK
Clear liquids up to 2 hours prior
no solids or other liquids 6 hours prior
If allergic to iodine; antihistamine or steroid can be given
112
Cardiac catheterization
| follow-up
remain in bed 2-6 hours
supine or elevated 30 degrees
keep insertion site extremity straight
VS every 15 minutes for 1 hour; every 30 for 2 hours; then every 4 hours
assess peripheral pulses in affected extremity and skin temp and color with every vital check
assess insertion site for bloody discharge or hematoma formation
monitor urinary output and ensure sufficient fluids
113
Exercise electrocardiography
stress test
Assess cardiovascular response to increase workload
If someone can not run or is paralyzed done with medications
114
Stress test
| pt prep
plenty of rest night before
light meal 2 hours prior
avoid smoking and drinking alcohol or caffeine drinks day of the test
beta blockers and calcium channel blockers held day of the test
115
Stress test
| pt exercises until one of the following...
a predetermined HR is reached and maintained
chest pain, fatigue, dyspnea, vertigo, hypotension, dysrhythmias occur
significant ST-segment depression or T-wave inversion occurs
The 20 minute protocol is completed
116
Stress test
| follow-up
monitor ECG and BP until completely recovered
| avoid hot showers for 1-2 hours after test
117
Ischemia
occurs when insufficient oxygen is supplied to meet the requirements of myocardium
118
Angina pectoris
chest pain caused by temporary imbalance between the coronary arteries' ability to supply oxygen and cardiac muscle's demand for oxygen
does not cause permanent damage
119
Stable angina
| management/treatment?
quiet calm environment
position of comfort; semi-fowlers
oxygen
first med to give is nitroglycerin
if pain goes away with NTG and troponin is negative it was angina
if pain doesn't go away with NTG and troponin is increased it was MI
If NTG doesn't help give morphine until a plan is made
120
If someone has stable angina they are at greater risk for?
increase risk for MI- daily antiplatelets (aspirin, clopidogrel)
121
Nitroglycerin/Nitrates
```
dizziness can occur with drop in BP
monitor BP and for headache
Do not administer to pts taking meds for sexual dysfunction
instruct pt to lie down when taking
take every 5 minutes up to 3 times
```
122
Nitroglycerin/Nitrates
| examples?
sublingual tablets- Nitrostat, Nitroquick
Sublingual spray- Nitrolingual
Transdermal Nitroglycerin- minitran, Nitro-dur, Nitrek
Isosorbide dinitrate
Isosorbide mononitrate
123
Antiplatelets
```
report unusual bleeding or bruising
avoid OTC pain meds that contain aspirin
Take with food
Assess for ringing in ears (aspirin)
do not stop without doctor say so
EX- aspirin, Clopidogrel
```
124
Hypertension
can cause stroke, MI, kidney failure, death
| American heart association recommend below 130/80
125
Essential hypertension
not caused by and existing health problem but contributes to other health problems
common risk factors- obesity, smoking, stress, family hx
126
Secondary hypertension
caused by specific diseases and drugs like
renal disease, aldosteronism, Cushing's syndrome
medications- estrogen, glucocorticoids, sympathomimetics, cyclosporine, erythropoietin
127
Hypertensive crisis
severe type of elevated BP that rapidly progresses and is considered a medical emergency
symptoms- morning headache, blurred vision, dyspnea
interventions- semi fowlers, oxygen, IV beta blocker or nicardipine, BP every 5-15 minutes
128
Hypertension
| signs and symptoms?
headache
facial flushing (redness)
dizziness
fainting
129
Hypertension
| lifestyle modifications?
```
restrict dietary sodium
reduce weight as needed
DASH diet- heart healthy diet
increase physical activity
abstain or decrease alcohol consumption
stop smoking
reduce stress
```
130
Hypertension
| Drug therapy?
```
diuretics
beta blockers
calcium channel blockers
angiotensin-converting enzyme (ACE) inhibitors
angiotensin II receptor blockers (ARBs)
```
131
Diuretics
give during the day to avoid night peeing
decrease intake of potassium with potassium-sparing
for loop and thiazide agents increase potassium intake and use with caution in patient with diabetes and gout
common ex- spironolactone (potassium-sparing)
furosemide, bumetanide (loop)
hydrochlorothiazide, chlorothiazide (thiazide)
132
Beta Blockers
assess HR and BP before administration
do not administer if HR < 50-60 beats/min
hold if systolic < 90-100 mm Hg
monitor for orthostatic hypotension
use with caution with diabetes
can cause fatigue, depression, sexual dysfunction
common ex- atenolol, metoprolol
133
Calcium channel blockers
monitor pulse and BP before taking
avoid grapefruit and grapefruit juice
common ex- verapamil, amlodipine
134
Angiotensin-converting enzyme (ACE) inhibitors
report dry cough
monitor BP
if systolic < 100 contact provider before giving
common ex- lisinopril
135
Angiotensin II receptor blockers (ARBs)
avoid foods high in potassium
monitor BP
if systolic < 100 contact provider before giving
common ex- losartan, valsartan
136
Arteriosclerosis
thickening or hardening of arterial wall
137
Atherosclerosis
involves formation of plagues within the arterial wall
138
Atherosclerosis
| nutrition therapy?
increase vegetables, fruits, and whole grains
low-fat dairy products, poultry, fish, legumes, vegetable oils, nuts
limit sweets, sugar-sweetened beverages, and red meats
5-6% calories from saturated fats; limiting trans fats
139
What medications are prescribed for atherosclerosis?
HMG-CoA reductase inhibitors (statins)
140
HMG-CoA reductase inhibitors
statins
reduces total cholesterol
take at night
use with lifestyle modifications
limit grapefruit
side effects- abdominal bloating, flatulence, diarrhea and/or constipation
ex- lovastatin, atorvastatin, simvastatin
ezetimibe and simvastatin- Vytorin (combination drug)
141
Right sided heart failure
key symptom is peripheral edema
only nonoxygenated blood is affected so no symptoms of low oxygen
blood backflow seeps out of the vein and into tissues
when peripherals are full backflow blood begins to go to abdominal cavity leading to ascites
Causes- left ventricular failure, right ventricular MI, pulmonary HTN
142
Left sided heart failure
oxygenated blood is affected so may see symptoms of low oxygen
blood backflow goes back to the lungs and sits there
will eventually develop right sided HF because when lungs can't hold anymore they start pushing back on the right side of the heart
Causes- HTN, CAD, valvular disease
143
Heart failure
| improving gas exchange
```
ventilation assistance
monitor respiratory rate
auscultate breath sounds
high fowlers
maintain oxygen saturation of 92%
```
144
Digoxin
```
second line of defense
increase contractility; decreases HR
slows conduction through AV nodes
inhibits sympathetic activity
antacids interfere with absorption
take same time everyday
check pulse before taking
scheduled lab test
```
145
Heart failure
| drug regimen
HTN drugs- beta blockers, ACE inhibitors, ARBs, diuretics, calcium channel blockers
digoxin
