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medsurg 2 > Exam 2- cardio & acid base > Flashcards

Exam 2- cardio & acid base Flashcards

1
Q

acids

A

release hydrogen ions when dissolved in water

increase H+ lower pH- more acidic

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2
Q

Bases

A

Bind with free hydrogen ions when in water

less H+ higher pH- more alkaline

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3
Q

Buffers

A

when dissolved in water can act as acids of bases depending on the pH of the body

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4
Q

What pH levels can result in death

A

pH of 7 or less and 7.8 or more

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5
Q

1st line of defense for acid-base regulation

A

chemical
buffer system
takes seconds

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6
Q

2nd line of defense acid-base regulation

A

respiratory
hypo/hyperventilation
changes pH with 02
takes minutes

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7
Q

3rd line of defense acid-base balance

A

renal
kidneys/urine
changes pH with bicarbonate
takes 24-48 hours

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8
Q

Arterial blood gas (ABGs)

A

collected in the arteries

Allen’s test

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9
Q

Allen’s test

A

checks blood flow in the hands

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10
Q

pH

A

7.35-7.45

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11
Q

PaCO2

A

45-35

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12
Q

HCO3

A

21-28

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13
Q

PaO2

A

80-100

not needed to calculate acid balance but is included in ABGs

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14
Q

Metabolic acidosis

A

low pH low HCO3

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15
Q

metabolic alkalosis

A

high pH high HCO3

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16
Q

respiratory acidosis

A

low pH high PaCO2

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17
Q

respiratory alkalosis

A

high pH low PaCO2

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18
Q

Causes of acidosis

A 
starvation
fever
hypoxia
ingesting alcohols
kidney failure
liver failure
dehydration
Respiratory- airway obstruction, COPD, asthma
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19
Q

Causes of alkalosis

A 
oral antacids
too much sodium bicarbonate
TPN
vomiting
NG suctioning
respiratory- hyperventilating, mechanical ventilation, high altitudes
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20
Q

myocardium

A

the heart muscle

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21
Q

each beat of the heart pumps?

A

60 mL of blood or 5L/min

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22
Q

what are the 4 chambers of the heart?

A

right atrium, left atrium, right ventricle, left ventricle

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23
Q

what are the two types of valves in the heart?

A

Atrioventricular (AV) valves and semilunar valves

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24
Q

what are the two AV valves in the heart?

A

tricuspid, mitral

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25
Q

What are the two semilunar valves in the heart?

A

aortic, pulmonic

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26
Q

Where is the tricuspid valve in the heart?

A

between RA and RV

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27
Q

Where is the mitral valve?

A

between LA & LV

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28
Q

What is the job of the AV valves?

A

act as funnels and help move blood from atrium to ventricle during diastole
during systole close to prevent backflow of blood into atrium

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29
Q

Where is the pulmonic valve?

A

separates RV and pulmonary artery

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30
Q

Where is aortic valve?

A

separates LV and aorta

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31
Q

What is the job of semilunar valves?

A

prevent backflow into ventricles during diastole

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32
Q

Superior and inferior vena cava?

A

bring deoxygenated blood from the body to RA

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33
Q

From the RA blood..

A

goes through tricuspid valve and to RV

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34
Q

then RV…

A

closes tricuspid, opens pulmonic, and propels blood into pulmonary artery

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35
Q

Pulmonary artery…

A

takes blood to the lungs

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36
Q

The lungs…

A

reoxygenate the blood

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37
Q

Pulmonary vein…

A

brings oxygenated blood to LA

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38
Q

blood in the LA…

A

goes through mitral valves and to LV

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39
Q

LV…

A

closes mitral valve, opens aortic valve, and propels blood into aorta and to the body

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40
Q

Mean arterial pressure (MAP)

A

must be at least 60 mm Hg

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41
Q

Cardiac output

A

the amount of blood pumped from left ventricle each minute

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42
Q

Formula for finding cardiac output

A

cardiac output= heart rate X stroke volume

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43
Q

Cardiac output ranges from?

A

3-6 L/min

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44
Q

Cardiac index

A

determined by dividing CO by body surface area

normal range 2.8-4.2 l/min/m2

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45
Q

Heart rate

A

the number of times ventricles contract per minute

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46
Q

Normal resting heart rate

A

60-100 beats/min

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47
Q

Stroke volume

A

amount of blood ejected by left ventricle during each contraction

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48
Q

Preload

A

degree of myocardial fiber stretch at end of diastole and before contraction

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49
Q

Afterload

A

the pressure or resistance ventricles must overcome to eject blood through semilunar valves and into peripheral blood vessels

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50
Q

Myocardial contractility

A

ability of the heart to contract

cardiac muscle strength

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51
Q

What effects myocardial contractility?

A

acidosis and hypoxia

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52
Q

Blood pressure

A

force of blood exerted on vessel walls

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53
Q

What three mechanisms mediate and regulate BP?

A

autonomic nervous system, kidneys, endocrine system

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54
Q

Systolic BP

A

amount of pressure or force generated by LV to distribute blood into the aorta with each contraction

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55
Q

Diastolic BP

A

amount of pressure or force against arterial walls during the relaxation phase of the heart

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56
Q

Baroreceptors and BP

A

are stimulated when arterial walls are stretched by increase in BP resulting in a decrease in BP

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57
Q

Chemoreceptors and BP

A

sensitive to hypoxemia

When stimulated they activate vasoconstriction and increase BP

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58
Q

Stretch receptors and BP

A

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

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59
Q

Kidneys and BP

A

when renal blood flow or pressure decreases the kidneys retain sodium and water; increasing BP

60
Q

3 factors in BP

A

cardiac output, peripheral resistance, HR

61
Q

formula for BP

A

BP= cardiac output X peripheral resistance

62
Q

nonmodifiable risk factors

A

uncontrollable

age, gender, ethnic origin, family hx of CVD

63
Q

who is at a higher risk for CAD? (men or woman)

A

men

64
Q

Modifiable risk factors

A

controllable

cigarette smoking, physical inactivity, obesity, psychological variables

65
Q

Cigarette smoking and assessment

A 
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
Q

packs-years

A

number of packs per day multiplied times number of years smoked

67
Q

Sedentary lifestyle and assessment

A

ask pt about type of exercise performed
how long a period they have participated in the exercise
frequency and intensity of exercise

68
Q

Recommended exercise guidlines

A

150 minutes of moderate exercise or 75 minutes of vigorous exercisse

69
Q

what is BMI of obesity

A

greater than 30

70
Q

psychological factors and assessment

A

observe pt and assess how they respond to stressful situation

71
Q

CVD/heart history and assessment

A

ask about previous treatment of CVD
specifically recurrent tonsillitis, streptococcal infection, and rheumatic fever
Ask about any known congenital heart defects

72
Q

Nutritional hx and assessment

A

Have pt recall food and fluid intake during a 24 hour period
Ask about any dietary restrictions
amount and type of alcohol consumption

73
Q

Pain/discomfort and assessment

A

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
Q

Dyspnea and assessment

A

ask about factors that make it better or worse
what level of activity produces dyspnea
body position when dyspnea occurred

75
Q

Dyspnea on exertion

A

associated with activity

76
Q

Orthopnea

A

dyspnea when lying flat

77
Q

Paroxysmal nocturnal dyspnea

A

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
Q

Fatigue and assessment

A

Ask about time of day experienced

ask about activities the patient can perform

79
Q

syncope

A

brief loss of consciousness

80
Q

Near-syncope

A

dizziness with the inability to remain upright

81
Q

how much weight change shows a fluid change of 1 L

A

2,2 lbs or 1 kg

82
Q

general appearance and assessment

A 
assess general build and appearance
skin color
distress level 
level of consciousness
shortness of breath
position
verbal responses
83
Q

Extremities and assessment

A

assess hands, arms, feet, and legs for skin changes, vascular changes, clubbing, and edema

84
Q

What are vascular changes in extremities?

A 
paresthesia
muscle fatigue and discomfort
numbness
pain
coolness
loss of hair distribution
85
Q

pitting edema

A

the skin can be indented

86
Q

orthostatic (postural) hypotension

A

occurs when blood pressure is not adequately maintained while moving from lying to sitting or standing

87
Q

What are the minimum blood pressure changes to classify as orthostatic hypotension

A

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
Q

Paradoxical blood pressure

A

exaggerated decrease in systolic pressure by more than 10 mm Hg during inspiratory phase of respiration

89
Q

Pulse pressure

A

difference between systolic and diastolic values

90
Q

Hypokinetic pulse

A

weak pulse

91
Q

Hyperkinetic pulse

A

large “bounding” pulse

92
Q

Bruits

A

swishing sound from blood flow in narrowed arteries

93
Q

S1

A

The first heart sound

created by the closure of mitral and tricuspid valves

94
Q

S2

A

the second heart sound

created by the closing of aortic and pulmonic valves

95
Q

What should you do if you have difficulty hearing heart sounds?

A

have pt lean forward or roll to their left side

96
Q

Paradoxic splitting

A

abnormal splitting of S2

97
Q

S3

A

Ventricular gallop

normal finding in people younger than 35 y/o

98
Q

S4

A

atrial gallop

99
Q

Systolic murmur

A

occurs between S1 and S2

100
Q

Diastolic murmur

A

occurs between S2 and S1

101
Q

Pericardial friction rub

A

occurs with movements of the heart during cardiac cycle

sign of inflammation, infection, or infiltration

102
Q

Troponin

A

a myocardial muscle protein released into bloodstream with injury to myocardial muscle
indicates cardiac necrosis or acute MI

103
Q

Homocysteine

A

an amino acid that is produced when proteins break down

104
Q

Highly sensitive C-reactive protein

A

marker of inflammation
< 1 is desired
> 3 increase risk for heart disease

105
Q

Total cholesterol

A

<200 mg/dL

106
Q

Triglyceride

A

males 40-160

females 35-135

107
Q

HDL

A

males > 45 mg/dL
females > 55 mg/dL
fish, oils, avocado, nuts, seeds

108
Q

LDL

A

< 130 mg/dL
< 70 mg/dL for cardiovascular patients
deep fried foods, bacon

109
Q

Microalbuminuria

A

small amounts of protein in urine

110
Q

Cardiac catheterization

A

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
Q

Cardiac catheterization

prre-op

A

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
Q

Cardiac catheterization

follow-up

A

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
Q

Exercise electrocardiography

A

stress test
Assess cardiovascular response to increase workload
If someone can not run or is paralyzed done with medications

114
Q

Stress test

pt prep

A

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
Q

Stress test

pt exercises until one of the following…

A

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
Q

Stress test

follow-up

A

monitor ECG and BP until completely recovered

avoid hot showers for 1-2 hours after test

117
Q

Ischemia

A

occurs when insufficient oxygen is supplied to meet the requirements of myocardium

118
Q

Angina pectoris

A

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
Q

Stable angina

management/treatment?

A

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
Q

If someone has stable angina they are at greater risk for?

A

increase risk for MI- daily antiplatelets (aspirin, clopidogrel)

121
Q

Nitroglycerin/Nitrates

A 
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
Q

Nitroglycerin/Nitrates

examples?

A

sublingual tablets- Nitrostat, Nitroquick
Sublingual spray- Nitrolingual
Transdermal Nitroglycerin- minitran, Nitro-dur, Nitrek
Isosorbide dinitrate
Isosorbide mononitrate

123
Q

Antiplatelets

A 
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
Q

Hypertension

A

can cause stroke, MI, kidney failure, death

American heart association recommend below 130/80

125
Q

Essential hypertension

A

not caused by and existing health problem but contributes to other health problems
common risk factors- obesity, smoking, stress, family hx

126
Q

Secondary hypertension

A

caused by specific diseases and drugs like
renal disease, aldosteronism, Cushing’s syndrome
medications- estrogen, glucocorticoids, sympathomimetics, cyclosporine, erythropoietin

127
Q

Hypertensive crisis

A

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
Q

Hypertension

signs and symptoms?

A

headache
facial flushing (redness)
dizziness
fainting

129
Q

Hypertension

lifestyle modifications?

A 
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
Q

Hypertension

Drug therapy?

A 
diuretics
beta blockers
calcium channel blockers
angiotensin-converting enzyme (ACE) inhibitors
angiotensin II receptor blockers (ARBs)
131
Q

Diuretics

A

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
Q

Beta Blockers

A

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
Q

Calcium channel blockers

A

monitor pulse and BP before taking
avoid grapefruit and grapefruit juice
common ex- verapamil, amlodipine

134
Q

Angiotensin-converting enzyme (ACE) inhibitors

A

report dry cough
monitor BP
if systolic < 100 contact provider before giving
common ex- lisinopril

135
Q

Angiotensin II receptor blockers (ARBs)

A

avoid foods high in potassium
monitor BP
if systolic < 100 contact provider before giving
common ex- losartan, valsartan

136
Q

Arteriosclerosis

A

thickening or hardening of arterial wall

137
Q

Atherosclerosis

A

involves formation of plagues within the arterial wall

138
Q

Atherosclerosis

nutrition therapy?

A

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
Q

What medications are prescribed for atherosclerosis?

A

HMG-CoA reductase inhibitors (statins)

140
Q

HMG-CoA reductase inhibitors

A

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
Q

Right sided heart failure

A

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
Q

Left sided heart failure

A

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
Q

Heart failure

improving gas exchange

A 
ventilation assistance
monitor respiratory rate
auscultate breath sounds
high fowlers
maintain oxygen saturation of 92%
144
Q

Digoxin

A 
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
Q

Heart failure

drug regimen

A

HTN drugs- beta blockers, ACE inhibitors, ARBs, diuretics, calcium channel blockers
digoxin

medsurg 2 (1 decks)

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