Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Critical Care > EXAM 3: CHF > Flashcards

EXAM 3: CHF Flashcards

1
Q

What is CHF

A

Inability of the heart to provide sufficient blood to meet the O2needs of tissues and organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dystolic dysfunction

A

Defect in ventricular filling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

systolic dysfunction

A

Defect in ventricular ejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ejection fraction is defined as

A

amount of blood pumped by the left ventricle with each heartbeatand measures the strength of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Normal EF

A

60-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common reason for hospital admission in adults for CHF is over the age of…

A

65 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

American Heart Association (AHA) estimates that more than ______ new cases of HF per year

A

650,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of HF include:

A

Myocardial Disease: Cardiomyopathies

Congenital Heart Defects- VSD, ASD

Constrictive Pericarditis- bag sack around the heart, prevent the heart from doing its job

Valvular Heart Disease: Stenotic Valvular Disease & Aortic insufficiency

Increased Pressure Work- Systemic HTN
Pulmonary HTN, Coarctation of Aorta= most common in Peds

Increase Volume Work- AV Shunt, Excessive IV Fluids**- extra IV fluids, extra blood volume Ex: EJ of 15; 100cc/hour IV; making the EJ work harder than it’s suppose to; keep monitoring for the types of HF.

Increased Perfusion Work
Thyrotoxicosis; excessive releases of T3 and T4
Anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 2 Natriuretic peptides

A

Atrial Natriuretic Peptide (ANP)

Brain [Ventricles] Natriuretic Peptide [BNP]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Out of the 2 natriuretic peptides which one can be measured in the hospital?

A

BNP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which test confirms that patient is suffering from CHF?

A

Echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

counterregulatory mechanisms of NAP

A
  • Increase GFR and diuresis
  • Excretion Na+ (naturesis)
  • Vasodilation and decreased BP
  • Inhibition of aldosterone and renin secretion and interference with ADH release.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does Nitric Oxide and prostaglandin released from endothelium do?

A

Relaxes the arterial smooth muscle, resulting in vasodilation and decreased afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Complications of HF

A
  • Pleural Effusion- fluid outside the lungs but inside the thoracic cavity; when liver fails
  • Dysrhythmias- primary source of impulse SA node (located-RA)
  • Left Ventricular Thrombus- left side fails blood accumulated to the lungs
  • Hepatomegaly
  • Renal Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which diagnostic studies is used for BNP screening test?

A

Blood Work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which of the following are screening tests for CHF? Select all that apply

a. Echo
b. BNP
c. ECG
d. CXR
A

B, C, D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why are beta blockers used for CHF? (the purpose of it)

A

lower the BP and slows the HR; have direct effect of dilating the blood vessels; prevents it from getting worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which medication should you NOT give for CHF

A

diltiazem./verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Purpose of atenolol for CHF? purpose of why its given

A

protects the heart; slows the HR only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment for HF

A

-Diet
-Lifestyle changes
-Combination Drugs
Vasodilators, Diuretics, Inotropics (Enhances of cardiac contractility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Indications for heart transplantation

A

End-stage HF refractory to medical care
Severe, decompensated, inoperable, valvular heart disease
Recurrent life-threatening dysrhythmias not responsive to maximal interventions, including defibrillators
Any other heart abnormalities that severely limit normal function and/or have a mortality risk of more than 50% at 2 yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Absolute contraindications

A

Chronologic age over 70 yr or physiologic age over 65 yr
Life-threatening illness (e.g., malignancy/cancer) that will limit survival to <5 year despite therapy
Advanced cerebral or peripheral vascular disease not amenable to correction
Active infection, including HIV infection
Severe pulmonary disease that will likely result in the patient being ventilator dependent after transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Relative contraindications for heart transplantation (maybe you will get the heart)

A

Severe obesity
Psychologic impairment
Active substance abuse (e.g., alcohol, drugs, tobacco)
Uncontrolled diabetes with vascular and neurologic complications
Irreversible liver or kidney dysfunction not explained by HF
Evidence of noncompliance with accepted medical practices
Lack of social support network that can make long-term commitment for patient’s welfare
Unrealistic expectations by the patient or caregiver regarding transplant, its risks, and its benefits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Patho of HF

A

HF–> decrease SV–> Sympathetic Circulatory Reflexes and vasoconstriction which will Decreased Renal Blood Flow–>decrease in RAAS Salt and H2O retention, increase SV compensated HF–> increase in HR, Cardiac Contractility, ANP, BNP release which will decrease BP

Decompensated HF–> Overfilling of the ventricles and circulation decreased SV and development of peripheral and pulmonary edema; decrease diastolic filling time decreased SV; increased after load
increased pressure work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

RSHF

A 
Swelling of hands, legs, liver
Weight gain
Edema
Lethargic
Large neck vein (JVD)
Increase HR
Nocturia
Girth (Ascites)
26
Q

LSHF

A 
Dyspnea
Rales= crackles
Orthopnea
Weakness
Nocturnal paroxysmal dyspnea
Increase HR
Nagging cough
Gaining weight
27
Q

4 properties of cardiac conduction system

A

automaticity- initiate an impulse spontaneously and continuously
excitability- electrically stimulated
conductivity- transmit an impulse along a membrane in an orderly manner
contractility- respond mechanically to an impulse

28
Q

ECG has 12 recording leads

Bipolar positive and negative

A

leads I, II, and III

29
Q

ECG has 12 recording leads

Unipolar positive

A

leads aVR, aVL, and aVF

30
Q

ECG has 12 recording leads

Precordial Unipolar leads (V1 through V6)

A

V1: 4th intercostal space at the right sternal border
V2: 4th intercostal space at the left sternal border
V3: midway between V2 and V4
V4: 5th intercostal space, left midclavicular line
V5: 5th intercostal space, left anterior axillary line
V6: 5th intercostal space, midaxillary

31
Q

Description of the P wave

A

0.06-0.12 sec

32
Q

PR interval

A

0.12-0.20

33
Q

T wave

A

0.16 sec; ventricular repolarization; should be upright

34
Q

ST segment

A

represents the time between ventricular depolarization

diastole repolarization

35
Q

sinus bradycardia causes

A
  • may be a normal sinus rhythm in aerobically trained athletes and in some people during sleep
  • Carotid sinus massage, Valsalva maneuver, hypothermia, increased intraocular pressure, vagal stimulation, and certain drugs (e.g., β-blockers, calcium channel blockers)
  • Common disease states associated with sinus bradycardia are hypothyroidism, increased intracranial pressure, and inferior myocardial infarction (MI)
36
Q

sinus bradycardia tx

A
  • IV atropine
  • If its ineffective then give dobutamine or epinephrine to speed the HR
  • permanent pacemaker therapy is needed
37
Q

sinus tachycardia causes

A

-Physiologic and psychologic stressors such as exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial ischemia, heart failure (HF), hyperthyroidism, anxiety, and fear

38
Q

sinus tachycardia tx

A
  • first treat underlying cause such as fever, pain, anxiety
  • clinically stable patients= vagal maneuvers
  • In addition, IV βB, adenosine, CCB such as (e.g., diltiazem [Cardizem]) can be given to reduce HR and decrease myocardial O2 consumption?
  • In clinically unstable patients, synchronized cardioversion is used
39
Q

Causes of PAC

A

-can result from emotional stress or physical fatigue or from the use of caffeine, tobacco, or alcohol
hypoxia
-electrolyte imbalances and disease states such as hyperthyroidism chronic obstructive pulmonary disease (COPD) and heart disease, including CAD and valvular disease

40
Q

PAC tx

A
  • treat underlying cause such as caffeine or sympathomimetic drugs may be needed
  • β-Blockers may be used to decrease PACs
41
Q

PSVT/ SVT tx

A
  • vagal stimulation
    1) IV adenosine (drug of choice)
    2) BB, CCB, amiodarone
    3) synchronized cardioversion if the pt becomes hemodynamically unstable
42
Q

Atrial flutter tx

A
  1. radiofrequency catheter ablation (tx of choice)
  2. BB, CCB, amiodarone
    Emergency- electrical cardioversion
43
Q

PSVT HR and rhythm

A
  • HR is 150 to 220 beats/minute and rhythm is regular or slightly irregular
  • P wave is often hidden in the preceding T wave
  • PR interval may be shortened or normal
  • QRS complex is usually normal
44
Q

Manifestations of PSVT

A

Hypotension
Palpitations
Dyspnea
Angina

45
Q

prolonged episode of PSVT

A

decrease CO, decrease SV

46
Q

recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus in the right atrium or, less commonly, the left atrium

A

atrial flutter

47
Q

Atrial flutter is associated with

A

CAD, Hypertension, Mitral valve disorders
Cor pulmonale, Cardiomyopathy
Pulmonary embolus
Chronic lung disease
hyperthyroidism
Use of drugs such as digoxin, quinidine, and epinephrine

48
Q

atrial flutter rate

A

rate is 200 to 350 beats/minute

49
Q

Atrial flutter rhythm

A

-regular and ventricular rhythm is usually regular

50
Q

Prevention of HF

A

Reduce signs and symptoms
Reduce fluid overload
Improve exercise tolerance
Prolong life

51
Q

RSHF management

A
  • 2 pillows
52
Q

LSHF management

A
  • sticking head out the window, windows open
  • sitting upright
  • left lateral position
53
Q

If artifact occurs

A

check the connections in the equipment and make sure they’re all placed together

54
Q

The dysrhythmia may be paroxysmal (i.e., beginning and ending spontaneously) or persistent (lasting more than 7 days)

A

A Fib.

55
Q

Atrial fibrillation usually occurs in a patient with

A 
CAD
valvular heart disease
cardiomyopathy
hypertensive heart disease
HF
Pericarditis
It often develops acutely with thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances, stress, and heart surgery
56
Q

In A fib, When the ventricular rate is between 60 and 100 beats/minute

A

atrial fibrillation with a controlled ventricular response

57
Q

priority for patients with atrial fibrillation

A

Ventricular rate control

58
Q

The goals of treatment of atrial fibrillation include

A
  • a decrease in ventricular response (to less than 100 beats/minute)
  • prevention of stroke
  • conversion to sinus rhythm, if possible
59
Q

Atrial fibrillation longer than 48 hours tx

A

anticoagulation therapy with warfarin is needed for 3 to 4 weeks before the cardioversion and for several weeks after successful cardioversion.

60
Q

Medication Alternatives to warfarin are available for anticoagulation therapy in patients with nonvalvular atrial fibrillation

A

dabigatran (Pradaxa)
apixaban (Eliquis)
rivaroxaban (Xarelto)

Critical Care (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions