exam 4- cardiac 2 Flashcards
1
Q
Heart Failure
what falls
what is leading risk factors x2
A
Cardiac Output falls in hf
Leading risk factor- heart disease and a past mi
2
Q
Left sided heart failure- results in
what congestion
what output
A
pulmonary congestion
decreased cardiac output
3
Q
s/s of early left sided heart failure
x2
A
fatigue
activity intolerance
4
Q
s/s of late left sided heart failure
x6
A
syncope ,
dizziness,
dyspnea,
cough,
orthopnea
cynaosis
5
Q
right sided heart failure
what becomes distended
where does blood back up
A
Right ventricle and atria become distended
Blood backs up to systemic supply
6
Q
s/s of right sided heart failure
x2
A
depdedent edema
jvd- distended neck veins
7
Q
Hemodynamic Monitoring
evaluates what function/ response
can be used for
not used to
A
evaluate cardiac and circulatory function
and response to interventions-
Can be used for blood sampling
but not to give medications
8
Q
Hemodynamic Monitoring
placed where
monitors;
h
b
a p
c v p
p p
c o
A
catheter is placed into major blood vessel to monitor
.hr
.bp
.arterial pressure
.central venous pressure
Pulomary pressure
Cardiac output
9
Q
Hemodynamic Monitoring
measures what
converts to what
put where
A
Measure pressure within a vessel
converts to an electrical waveform
Catheter is threaded into radial artery or vein
10
Q
what is used to prevent clotting
what type
hemodynamic monitoring
A
IV fluids are used to prevent clotting
Normal Saline
11
Q
allows direct continuous monitoring of
what 3 pressures
Intra-arterial pressure monitoring (Art Line)-
A
allows direct continuous monitoring of
systolic,
diastolic,
and mean arterial pressures
12
Q
also draws
needs what
Intra-arterial pressure monitoring (Art Line)-
A
Can draw abg-
needs pressurized bag of saline that drips slowly but continually to get right reading
13
Q
why is map looked at
degree
tissue
average
A
degree of tissue pressure,
tissue perfusion
or average pressure is arteries during cycle
14
Q
what is map affected by
x4
A
blood volume
the ability of the heart to pump
vessel diameter
ability of heart to stretch
15
Q
what is normal map
is less then 50 then what
if over 105 then what
A
70-90
- if less then 50 then decreased tissue perfusion
- if over 105 then there is increase in atherosclerotic vessels or fluid overload
16
Q
Ways to find map-
A
cardiac output x svr
(systolic + 2x diastolic)/3
17
Q
Venous Pressure Monitor- CVP-
monitors what
placed where
ends up where
A
monitors fluid balance of a pt
placed into jugular / subclavian vein
goes into superior vena cava or rt atrium
18
Q
what is normal cvp
A
normal is 2-8 cm of h20
19
Q
low cvp means
low
s
a
d
A
low fluid volume
shock
anemia
dehydration
20
Q
high cvp means-
fluid
vaso
more
also seen in
A
fluid excess,
vasoconstriction,
more blood rushing back to heart,
also seen in cardiac tamponade
21
Q
cardiac tamponade-
what is it
does waht
A
fluid is built up in pericardial sac
puts pressure on heart
22
Q
Pulmonary Artery Pressure- Swanz-Ganz
evaluates what
Cath is lodged where
A
evaluates left ventricle and overall cardiac function
cath is lodged into pulmonary artery
23
Q
has multiple lumens that takes pressure from
x3
Pulmonary Artery Pressure- Swanz-Ganz
A
right atria,
pulmonary artery
left ventricle
24
Q
pressure increased with x2
Pulmonary Artery Pressure- Swanz-Ganz
A
left heart failure,
pulmonary congestgion
25
when is pressure decreased
Pulmonary Artery Pressure- Swanz-Ganz
pressure decreased with hypovolemia
26
normal pulmonary pressure
Pulmonary Artery Pressure- Swanz-Ganz
pulmonary pressure is 25/10
27
B
P
D
I
E
Potential Complications with hemodynamic monitoring devices
Bleeding
Pneumothorax-especially in ones that have central line ot heavy catheter that goes directly into heart
Dysrhythmias- irritates heart
Infection
Embolism
28
calibration-
measuring when
maintaining what
monitor what
nursing consideration with hemodynamic monitoring devices
Calibration- measure when in the right atria and in right place
Measuring between breathes
Maintain pressure in flush solution
Monitor trends- sharp changes may not be accurate
29
what checks placement
what technique
assess
removing line- pressure how long/ take what into consideration
nursing consideration with hemodynamic monitoring devices
CXR to check placement
Aseptic technique
Assess site
Removing line- apply pressure for 5-15 minutes and take any anticoagulants into consideration
30
Cardiac Transplantation
Criteria-
what age
likely for what
<65,
and is likely to have 1 year to live after
31
Surgical procedure-heart transplants
hypothermic- needs what to prevent what
may need
surgery can cause
Hypothermic –need to rewarm slowly after to prevent severe electrolyte shifts
May need permanent or temp pacemaker
Surgery can cause short term memory loss
32
post op concerns-heart transplants
Infection- put on
put on antibiotics
33
Concern for rejection- heart transplants
placed on
rejection how long after
post op concerns
placed on immunosuppressants
Rejection can happen immediate ot months later
34
post op concerns-Rejection s/s
x4
heart transplants
dyspnea,
fatigue,
edema
a fib
35
post op concerns-Denervation-
may have
put on
heart transplants
may have slow response to stress and activity-
put on anticoagulants and steroids after-
36
post op concerns-denervation
what therapy
complete
up to date
medical
heart transplants
cardiac therapy,
complete incentive spirometer
, stay up to date on vaccines
medical asepsis
37
post op concerns goal
heart transplants
Goal is to discharge pt home
38
Infective Endocarditis
is what
involves
is it contagious
stems from
Inflammation of endocardium-
Usually involves valves
Non contagious
Can stem from bacterial, fungal ot viral infections
39
can cause
often develops
Infective Endocarditis
Can cause sepsis
Often develops on previously damages heart
40
risk factors-Infective Endocarditis
c
disease
I
m
use
poor
past
congenital heart defects
heart disease
ischemia
mi
drug use
poor dental health,
past central line
41
Infective Endocarditis s/s
f
m
c
m
p
s h
fever over 101,5
Malaysia
Chills
Murmur
petechiae
Splinter hemorrhages- red or black lines on nail beds
42
Infective Endocarditis Complications-
e
p
h f
large
what clots
emboli,
petechiae,
heart failure,
large pe ,
renal/ cerebral clots
43
Infective Endocarditis Treatments-
long term- how long
sent home w
may need what
long term iv antibiotics- 2-8 weeks,
sent home with a picc line
, may need repair to damaged valves
44
Infective Endocarditis
Placed on antibiotics when
before what
before what
before dental appointments
before other surgeries if history of heart disease
45
Infective Endocarditis After discharge
its important to report
t
c
night
a
s
temp,
cough,
night sweats,
anorexia
sob
46
Myocarditis what is it
Inflammation of heart muscle
47
Myocarditis Causes include
I
what response
t
d
- infection,
immune repsosne,
toxins
drugs
48
Myocarditis s/s asymptomic or
x3
Fever
fatigue
dyspnea
49
MyocarditisTreatments-
x4
antibiotics,
antivirals,
immunosuppressants
antiinflammatories
50
Pericarditis
what is it
Inflammation of pericardium
51
Causes of pericarditis
x3
cancer,
post mi injury,
renal failure
52
PericarditisS/S-
what respitory
what hr
pain when
what temp
f r
dyspnea,
tachycardia,
sharp pain w inspiration,
low grade fever,
friction rub,
53
Pericarditis tx
x2
antibiotics
anti-inflammatories
54
Pericardial Effusion- what is it
fluid around pericardial sac
55
Causes of pericardial effusion
worsening
impending
worsening of pericarditis
impeding heart contraction
56
Pericardial Effusion-
S/S- if fluid develops slow-
If fluid develops fast- x3
few s/s
cough, dyspnea, pain
57
Cardiac Tamponade-
what is it
is it severe
complication of pericarditis/percardial effusion
it is a MEDICAL EMERGENCY
58
Causes-Cardiac Tamponade
increased/prevents
every time heart pumps what happens
increased fluid or blood around their heart that prevents heart from pumping-
every time heart pumps, it fills up sac a little more and hart pumps less and less
59
S/S-Cardiac Tamponade-
paradoxical
heart sounds
d
hr
rr
j
decreased
bp
paradoxical pulses –hr will decrease with every inspiration
decreased/muffled heart sounds,
dyspnea,
tachycardia,
tachypnea,
jvd
decreased loc,
decreased bp
60
Treatment-Cardiac Tamponade-
emergent what
needle does what
iv fluids does what
emergent pericardiocentesis or pericardial window-
needle into sac to draw out fluid-
pt will require iv fluids to maintain bp and bv
61
Cardiogenic Pulmonary Edema
accumulation
is it severe
Accumulation of fluid in interstitial tissue and alveoli of lungs caused by heart failure
Medical emergency-requires immediate recognition or treatment
62
when can Cardiogenic Pulmonary Edema develop
Can be developed after mi that causes heart failure
63
S/S- Cardiogenic Pulmonary Edema
x3
severe dyspnea,
orthopnea(sob when lying flat),
pink frothy sputum
64
Cardiogenic Pulmonary Edema
position where with what
does what
improves
Nursing care
- position upright with legs dangling,
decreases the venous return,
improves breathing
65
Morphine-Cardiogenic Pulmonary Edema
eases
decreased
eases breathing
, decreases anxiety
66
Cardiogenic Pulmonary Edema
does what
IV Diuretics
urinate out excess fluid
67
Cardiogenic Pulmonary Edema
why Oxygen-
maintain perufsion
68
Rheumatic Heart Fever
what is ir
Systemic inflammatory disease
69
Rheumatic Heart Fever what Causes it
abnormal immune response to a strep infection- not usually a big deal
70
Rheumatic Heart Fever Complication
- rheumatic heart disease
71
Rheumatic Heart Fever Risk factors-
x3
malnutrition ,
low social economy status,
genetic
72
Rheumatic Heart Fever S/S-
what temp
pain x2
skin
hr
fever,
joint pain,
skin rash,
chest pain,
tachycardia
73
Valve Diseases
interferes w
Two main types
Interferes with blood flow to and from the heart
two main types are stenosis and regurgitation
74
Most common cause valve disorder
x2
is rhematic heart disease
congenial heart defect
75
Stenosis is when
when valve
what sounds
Valve Diseases
when valve leaflets fuse and cannot open and close or become narrow and rigid
low pitched murmurs
76
Regurgitation-
when valves
ends up
valve disorders
when valves open okay but do not close completely
ends up being backed up
77
Mitral Stenosis
is what
obstructs what
Narrowing of mitral valve-
obstructs blood flow from left atria to left ventricle
78
Mitral Stenosis Causes-
x2
rheumatic fever
endocarditis
79
Mitral Stenosis S/S-
d
h
severe
c
m
dyspnea w excerption,
hemaptosis,
severe jvd,
crackles
murmur
80
Mitral Stenosis Complications-
what happens
increase
increase
pt can experience
why might women not know
is backup of fluid into pulmonary system which
increase pressure
increases ascites//
pt can experience clots-
women may not know that they have this until they are pregnant
81
Mitral Regurgitation
what happens/where
what dilates
causes what
in some cases what w what
Blood backflows into left atria-
left atria dilates
causes increased preload
in some case heart failure w pulmonary congestion and edema
82
Mitral Regurgitation Causes
x2
- mi
rhematic heart disease
83
Mitral Regurgitation S/S-
x4
what murmur
fatigue,
weakness,
dyspnea on excertion,
edema,
high pitched murmur
84
Mitral Prolapse
Benign- more common in who
- more common in women then men
85
Mitral Prolapse
Can be asymptomatic but pt can have signs of
x2
what murmur
-
Atypical chest pain
Dizziness
High pitched clicking murmur
86
Aortic Stenosis
does what
more common in who
Obstructs blood flow from left ventricle to aorta
More common in males
87
Aortic Stenosis Causes
x3
- rhermatic heart disease,
aging
congenital defects
88
Aortic Stenosis S/S-
x4
what pulses
dyspnea,
syncopy,
orthopenia,
murmur,
decreased pedal pulses
89
Aortic regurgitation/ insufficiency
what happens
what does that increase
Blood flows back into left ventricle from aorta
Increases work load of heart
90
Aortic regurgitation/ insufficiency Causes-
x3
trauma,
congesintal diseases,
rheumatic heart disease
91
Aortic regurgitation/ insufficiency
S/S-
can be asymtpmatic
d
f
angina when
p
t h
what murmur
dyspnea on excretion,
fatigue,
angina at night,
palpitations,
throbbing head,
blowing murmur
92
Tricuspid Stenosis
obstructs what
Obstructs blood flow from right atria to right ventricle-
93
Tricuspid Stenosis Causes
x2
- rhemaitic heart disease,
iv drug use
94
Tricuspid Stenosis S/S-
what cvp
x2
what murmur
increased cvp
, jvd,
fatigue,
low pitched murmur
95
Tricuspid Regurgitation
what happens
Blood flows back into right atria leading to right heart failure
96
S/S- tricuspid regurgitation
increased
d
what co
what dysrthmia
increased venous congestion,
dyspnea,
low cardiac output,
a fib
97
Pulmonic Stenosis
obstructs what
Obstructs blood flow from right ventricle to lungs-
98
Pulmonic Stenosis S/S-
d
f
e
a
h m
dyspnea on exertion,
fatigue,
edema,
ascites,
heart murmur
99
Pulmonic Regurgitation
blood flows where
decreasing
leading to
Blood flows back to right ventricle,
decreasing blood flow to lungs
Leads to right sided heart failure
100
Pulmonic Regurgitation
s/s
x2
what murmur
jvd,
dependent edema,
high pitched blowing murmur,
101
Pulmonic Regurgitation
Can be caused by
endocarditis
102
digoxin
increases
Treatment for Valve Disorders
- increased force of contraction
103
Diuretics
decreases
Treatment for Valve Disorders
- decrease fluid volume
104
Ace inhibitors-
decreases
Treatment for Valve Disorders
decrease preload and afterload
105
Vasodilators
decreases
Treatment for Valve Disorders
- decrease afterload
106
Anticoagulant
prevent
Treatment for Valve Disorders
- prevent thrombi and emboli
107
Percutaneous balloon valvotomy-
ballon placed wher
enlarged how long
used to treat
treatment of choice when
Treatment for Valve Disorders
Ballon is placed into valve
enlarged for 90 seconds to enlarge opening
Used to treat stenois valves
Treatment of choice in old pateints and those who are poor surgical candiates
108
Valvuloplasty-
re
does what( repairs / removes/ patches)
Surgical Treatment for Valve Disorders
Reconstruction or repair of the valves
does what
Repairs floppy valves,
removes excess tissuess
patches holes
109
natural Valve replacement
what types
decreases risk
can last
Treatment for Valve Disorders
porcine, bovine or cadaver-
decrease risk of clots
can last up to 15 yrs
110
mechanical Valve replacement
lasts
risk
requires
Treatment for Valve Disorders
last longer then natural
risk for clots-
requires anticoagulation for rest of life
111
mechanical valve replacement
used when :
life expectancy
pt can be
Used when pts life expectancy is greater then 10 yrs
pt can be anticoagualted
112
Post-op Nursing Care valve disorders
avoid what
for how long
need to take
Pt avoid dental procedures 6 months after procedure-
need to take prophylactic antibiotics before dentists
113
Cardiomyopathy
disorder
makes
Disorder of heart muscle-
Makes a poor pump
114
what causes Cardiomyopathy
x4
what bp
what damage
Drugs
Etoh
Infection
Toxins
Hypertension
Damage from past mi
115
Dilated Cardiomyopathy S/S-
heart x3
others x3
enlarged heart,
heart failure,
additional heart sounds
dysrtyhmias,
sob,
fatigue,
116
Dilated Cardiomyopathy
Treatment
may require
may require
-may require defibrillator dt dysrymtias,
may require heart trasnplant
117
Hypertrophic Cardiomyopathy
is what
Enlarged heart muscle
118
Hypertrophic Cardiomyopathy S/S-
x3
dyspnea,
syncope,
dysrtymias
119
Hypertrophic Cardiomyopathy Treatment-
c
a
b
b t
possible
possible
calcium channel blockers,
antiarymics
beta blockers,
blood thinners
,
possible pacemaker,
possible surgical removal ,
120
Restrictive Cardiomyopathy
what walls
cannot
rigid walls
cannot receive a new heart
121
Restrictive Cardiomyopathy S/S-
x2
what heart failure
dyspnea,
fatigure,
right heart failure
122
Restrictive Cardiomyopathy Tx-
managing
what restriction
managing heart failure,
exercise restriction,
123
Restrictive Cardiomyopathy Tx-meds
d
a
b
a
v
digoxin
ace inhibitors,
beta blcokers,
anticoagulatns
vasodialters,
124
Aortic Aneurysm
abnormal
most common in who
major risk factor-
Abnormal dilation and weakening of blood vessels
Most common in men over 50
risk factor- hypertension
125
Thoracic aortic aneurysm- Causes
increased
decreased
can be caused by
-increased pressure of distending aorta and other organs,
decreased blood flow to heart, brain, and upper body,
can be caused by hypertension
126
Thoracic aortic aneurysm- S/S
what pain
other x3
what edema x2
back pain,
stridor,
hoarseness,
jvd
facial or neck edema,
127
Abdominal aortic aneurysm
Causes-
what age
s
increased age, greated then 70
smoker
128
Abdominal aortic aneurysm S/S-
what pain
pulse where
what in abdomen
what abdimen size
c
what pain in extremities
cyanosis where
lumbar pain,
pulse in abdomen
, bruit in abdomen,
increasing abdominal size,
claudication,
ischemic pain in extremities
cyanosis in extremities
129
dont do what in Abdominal aortic aneurysm
Do not palpate pulsating mass- needs to be reported
130
abdominal aortic aneurysm
check
decreased
Check pedal pulses,
decreased blood flow to lower extremities, before and after repair
131
Aortic dissection-
is what
dt what
tearing of a blood vessel
dt weakned area
132
Aortic dissection- what causes
x2
-hypertension/
trauma
133
Aortic dissection- s/s
what pain
what pulses where
s
severe back pain- like knife twisting
, absent or weaken pulses in upper extremities,
syncope
134
Treatments aortic dissection
what med is main one
lower hr/bp
what indefinitely
beta blockers-hr
ccb- -bp
anticoagulants indef
135
when surgery aortic dissection
if
aneurysms what size
if systematic
aneurysm is greater then 5-6 cms-
136
2 types of surgery aortic dissection / aneurysm
graft placed where
stent placed where
graft placed outside to strengthen exterior wall,
stent is placed inside the vessel through femoral
137
b
stay
no
what med
m
Care of a Client With Suspected Aneurysm
Bedrest
stay Calm
No straining
Beta blockers
Monitoring
138
Care of a Client With Suspected Aneurysm examination
-vs, pulses, skin color and
temp, assess for
abdominal masses that pulsate
139
pediatric chf s/s early
what easily
wt
hr
rr
i
tiring easily,
wt loss or no wt gain,
tachycardia,
tachypnea,
irritablity
140
pediatric chf s/s later
n f
r
c
nasal flaring,
retractions
cough
141
Pediatric CHF Diagnosis-
obtain
c
e
e
obtain vs, lung sounds,
chest xray,
echocardiogram,
ecg
142
Goal of Treatment for Pediatric CHF
Make heart work more effectively by decreasing workload
143
Medications- pediatric CHF
d
a
b
d
digoxin,
ace inhibitors,
beta blockers,
diuretics
144
Nursing Care for Pediatric CHF
o
r
n
support
Oxygen-
Rest
nutrition- small frequent high calorie feeding
Support to family
145
Nursing Care for Pediatric CHF
monitor
w
e
what level
what vs
weight
Electrolytes
Digoxin level- digoxin toxicity
Heart rate-should be held at a higher rate then adults
146
Congenital Heart Disease
develops when in peds
Usually develops during first 8 weeks of gestation
147
Causes congenital heart disease
g
d
can be from mothers->
genetics,
/down syndrome,
or can be from mothers-smoking, etoh, lithium use of dilatin or infection, advanced maternal age and diabetic mother
148
early detection congenital heart disease pediatric
what affected at birth
inc/dec
can disrupt
will have what in first few days
sp02 affected at birth
increased/decreased pulmonary blood flow
can disrupt blood flow to systemic supply
will have life threatening symptoms in first few days of life
149
Patent Ductus Arteriosus- PDA in peds
opening where
ends up w
opening between aorta and pulmonary artery
ends up w mixture of atrial and venous blood in pulmonary arteries
150
Patent Ductus Arteriosus- PDA
s/s
d
t
t
waht pulses
what murmur
dyspnea,
tachycardia,
tacypena,
bounding pulses
grinding machine murmur
151
Patent Ductus Arteriosus- PDA
Treatment-
iv what
what may be considered
many do what
iv idolmethacin- can stimulate closure in premature pts,
surgical closure may be considered if experiencing chf symtpms,
many close on their own
152
Atrial Septal Defect
what is it
Shunting of blood from left to right
153
Atrial Septal DEfect
what in young children
what in older children
Usaly no s.s in young children
older children may develop chf
154
Atrial Septal defect tx
what by 4
if s/s of chf-require what
spontaneous closure by 4
Is s/s of chf then they require closure surgery
155
Ventricular Septal Defect
hole where
s/s
hole between ventricle so blood mixes
s.s- chf
156
Ventricular Septal Defect
Tx
most close by when
or need what
-most close by 6 months,
or need patch that is done through vessel
157
Tetralogy of Fallot
4
decreased
4 separate defects- pumonic stenosis, right ventricular hypertrophy, ventricular septal defect and overriding aorta
Decrased pulmonary blood flow
158
Tetralogy of Fallot
h
c
poor
__fingers
toddlers do what
will see what lab
hypoxia,
cynosis,
poor growth
, clubbing of fingers
Toddlers will squat
Will see polycythemia- decrease o2 and increase rbc production
159
Tetralogy of Fallot Tx-
keep
admisnter
put
keep child calm,
Administer 02,
put knees to chest
160
Aortic Stenosis in peds
narrowed
causes
Narrowed aortic valve-
causes decreased blood flow to systemic system
161
Aortic Stenosis in peds S/S- can be asymptomatic, or can have symptoms of a
m
narrow
weak
murmur,
narrow pulse pressure,
weakned pulses
162
Aortic Stenosis in peds Tx-
x2
balloon dilation
valve replacement
163
Coarctation of Aorta in peds
narrowing
Narrowing of descending aorta
164
Coarctation of Aorta in peds S/S-
m
c
h
what pulses
murmur,
chf,
hypotension,
weakened lower extremity pulses
165
Coarctation of Aorta in peds
Tx-
x2
balloon dilation
surgery
166
Nutrition
high
high
small
dont nurse longer then how long
Home Care for Infants Awaiting Surgery
-high calorie,
high concertation,
small feedings
Nurse no longer then 30 minute because they cannot breath and infant puts a lot of effort into eating
167
Home Care for Infants Awaiting Surgery
Prevent infection- dont do what
-don’t expose to crowds,
168
Home Care for Infants Awaiting Surgery
Rest
-need to rest a lot as infant
