Exam 5: Units 9 and 10 Flashcards
amount of blood ejected from one ventricle in L/min
Cardiac Output
CO=
SV x HR
the volume of blood ejected by one ventricle per heartbeat
Stroke Volume
3 factors that determine stroke volume
Preload
Afterload
Contractility
the degree of stretching of the ventricular muscle when the heart is at the end of diastole
Preload
The resistance/pressure that the ventricle needs to overcome to eject the blood into the peripheral circulation during ventricular contraction
Afterload
force that the myocardium generates during contraction
Contractility
main cause of Coronary Artery Disease (CAD)
Atherosclerosis
chest pain with exertion that improves with rest
stable angina
random chest pain that occurs at rest and even more with exertion
unstable angina
“bad” cholesterol
LDL
LDL you want Low Levels
“good” cholesterol
HDL
most common complaint of Coronary Artery Disease
angina
s/s of coronary artery disease (PPPT)
Pressure in midsternal area
Pain - angina
Pain - radiating to left arm, jaw, or back
Tightness
a complication from CAD can lead to
an MI
possible areas of referred pain with angina
jaw
chest
shoulders
neck
arms
type of chest pain that occurs due to a temporary spasm in a coronary artery, reducing blood flow to the heart
variant angina
Prinzmetal’s angina
nitroglycerin prevents this and reduces this
prevents coronary artery vasospasm
reduces preload and afterload
= decreasing myocardial O2 demand
when giving nitroglycerin, monitor for
orthostatic hypotension
up to ____ doses of nitroglycerin may be taken in 5-minute intervals
3 doses - if pain is still not relieved, call 911 or go to hospital
common side effect of nitroglycerin
headache
The initial management of angina or MI include the administration of “MONA”
Morphine (opioids)
Oxygen
Nitrate
Aspirin
why would morphine be given during an MI
to treat moderate-severe pain
why would aspirin be given during angina or an MI
aspirin prevents vasoconstriction and has antiplatelet effects
one dx study for CAD
cardiac catheterization
=inserting a thin, flexible tube (catheter) through a blood vessel (groin or wrist) and guiding it to the coronary arteries to evaluate extent of the disease
Lab studies for CAD
“CHCC”
Cholesterol (Total, LDL, HDL)
Homocysteine
C-Reactive Protein
Cardiac Enzymes
amino acid in the blood that is produced when the body breaks down another amino acid (methionine) that is found in protein-rich foods like meat, fish, and dairy
homocysteine
(high levels of this can contribute to heart and artery disease)
role of statin medications
lower cholesterol levels
medical procedure used to open blocked or narrowed coronary arteries caused by atherosclerosis with a goal to improve blood flow to the heart
angioplasty
procedure where the surgeon takes a healthy blood vessel (from leg, chest, or arm) and uses it to create a bypass around the blocked or narrowed coronary artery
coronary artery bypass graft
NYHA class of HF: Slight limitation of physical activity and is comfortable at rest
Class II
NYHA class of HF: No limitation of physical activity
Class I
NYHA class of HF: Marked limitation of physical activity. Comfortable at rest, but exertion results in SOB and fatigue
Class III
NYHA class of HF: Unable to carry on any physical activity without discomfort
Class IV
Normal EF
55% - 70%
this compares the amount of blood in the heart to the amount of blood actually pumped out
Ejection fraction
a severe, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure
pulmonary edema
this amount of patients who have HF also have a comorbid condition
> 50%
HF prevalence increases with
age
condition where the heart muscle becomes weakened, thickened, or enlarged, affecting the heart’s ability to pump blood effectively
cardiomyopathy
*Most common cardiomyopathy
Significant dilation of the ventricles
Elevated ventricle volumes, but decreased EF
Dilated
Type of cardiomyopathy where the heart muscle size is increased, mass is increased, and ventricle size is reduced
Hypertrophic
Type of cardiomyopathy where the ventricular walls are rigid, impairing filling and ventricular stretch
Restrictive
Type of cardiomyopathy where the myocardium is progressively infiltrated and replaced with scar and adipose tissue leading to ventricle dilation, poor contractility, and arhythmias
Arrhythmogenic Right Ventricular
Right-sided HF can be caused by
Left-sided HF
both sides of the heart are failing
biventricular HF
peptide that’s released when the ventricle stretches from being filled with too much fluid
B-type Natriuretic Peptide (BNP)
expected level of BNP
<100
for HF, the nurse should elevate the head of the bed to
Flowler’s position
term that refers to the force or strength of the heart’s contraction
inotropic
Small, battery-powered device implanted under the skin (near collarbone) that monitors the heart rhythm and delivers shocks/pacing to restore a normal heartbeat
Implantable Cardioverter Defibrillator
specialized device used to treat heart failure in a patient whose ventricles are not beating in sync
biventricular pacemaker
mechanical pump used to help the heart pump blood in patients with severe heart failure
Ventricular assist device (VAD)
as a pt with HF, notify the provider with this amount of weight gain
1-2 lb/day
3 lbs in 1 week
position a patient with pulmonary edema to
high-Fowler’s
nurse should do this with a pt with pulmonary edema
stay with the patient and notify the provider
deliver this to a patient with pulmonary edema to decrease anxiety, alleviate respiratory distress, and decrease venous return
IV morphine
deliver this to a patient with pulmonary edema to rapidly excrete fluids and improve CO
IV loop diuretics
life-threatening condition where the heart is unable to pump enough blood to meet the body’s needs
Cardiogenic shock
when monitoring a patient’s lung sounds during cardiogenic shock, the nurse should listen for
crackles and wheezing
this can result from accumulation of fluid in the pericardial sac
cardiac tamponade
IV morphine, diuretics, and nitroglycerin may be given to a patient experiencing cardiogenic shock in order to
decrease preload
IV vasopressors and/or positive inotropes may be given to a patient experiencing cardiogenic shock in order to
increase CO and maintain organ perfusion
Atrial Septal Defect is this kind of shunt defect
Left to Right
Tetralogy of Fallot is this kind of shunt defect
Right to Left
Tricuspid Atresia is this kind of shunt defect
Right to Left
Ventricular Septal Defect is this kind of shunt defect
Left to Right
Patent Ductus Arteriosis is this kind of shunt defect
Left to Right
Stenosis (pul. and aortic) and Coarctation of the Aorta are this kind of heart defect
obstructive
congenital heart defect where there is a hole in the septum separating the right and left atria, allowing blood to flow in between the two chambers
Atrial Septal Defect (ASD)
main symptom with Atrial Septal Defect
murmur - which is normal and to be expected
Tx for Atrial Septal Defect
Usually closes on its own
Surgical intervention if not
congenital heart defect with a hole in the septum between the right and left ventricles, allowing blood to flow between the two spaces
Ventricular Septal Defect (VSD)
a murmur with Ventricular Septal Defect is heard here
Loud murmur at the Left sternal border
Tx for Ventricular Septal Defect
(same as ASD)
usually closes on its own
surgical intervention if not
congenital heart defect with an opening that connects the aorta to the pulmonary artery
Patent Ductus Arteriosus (PDA)
3 symptoms of Patent Ductus Arteriosus
Rales (crackle-sounds)
Bounding pulses
Loud, machine-like murmur
—– “Loud like a DUCk”
Tx for Patent Ductus Arteriosus
Administer indomethacin (NSAID) to facilitate closure
which kind of heart defect is most deadly?
Right to Left
4 defects seen in Tetralogy of Fallot
1) Pulmonary stenosis
2) Right ventricular hypertrophy
3) Overriding aorta (misplaced aortic valve)
4) Ventricular septal defect (hole in septum)
sudden episode of severe cyanosis occurring in infants or children with Tetralogy of Fallot
TET Spell
Hypercyanotic Spell
TET Spells occur mostly during
Moments of stress
=crying
=hunger
= feedings
position the infant in this position if experiencing a TET spell
knees-to-chest (infants)
squatting position (younger children)
Surgical intervention for Tetralogy of Fallot
Shunt placement (until able to undergo primary repair)
Complete repair within 1st year of life
An infant with Tetralogy of Fallot should be fed this way until repair is done
Should be gavage-fed
Main impact on health with congenital heart defects
Failure to thrive
5 s/s hypoxia
Polycythemia (HIGH clotting risk)
Exercise intolerance
Hypercyanotic spells
Brain abscess
CVA
A patient with a congenital heart defect may be given this before a dental procedure
antibiotics
HTN occurs with this systolic and diastolic reading
Systolic: at or greater than 130
Diastolic: at or greater than 80
HTN can be diagnosed when high BP readings occur
2+ times at least 2 weeks apart
this kind of HTN accounts for most cases
Essential HTN (AKA Primary HTN)
Secondary HTN is caused by
other diseases (renal disease, example)
Treatment for secondary HTN occurs by
removing the underlying cause
4 mechanisms that regulate blood pressure (ARRV)
Arterial baroreceptors
Regulation of body-fluid volume
RAAS
Vascular autoregulation
receptors that are located in the carotid sinus, aorta, and left ventricle that control HR and BP and can cause vasodilation and vasoconstriction
Arterial baroreceptors
Type of regulation that maintains consistent levels of tissue perfusion
Vascular autoregulation
Pathway involving hormones and enzymes that is triggered by low BP with a goal to increase BP
RAAS
Normal BP
120/80
Pre-HTN BP
120-129 / <80
Stage 1 HTN BP
130-139 / 80-89
Stage 2 HTN BP
> 140 / >90
HTN Crisis BP
> 180 / >120
Hypotension BP
<100 / <60
poorly controlled HTN can cause
peripheral vascular disease
4 vital organs that HTN can damage
Heart
Lungs
Kidney
Eyes
This can develop in the heart muscle as a result of HTN
Left ventricular hypertrophy
labs and diagnostics will most likely identify this kind of HTN
secondary HTN
When using an EKG to evaluate for HTN, this finding will indicate ventricular hypertrophy
Tall R-waves indicates hypertrophy
Using a chest x-ray to diagnose HTN can show
cardiomegaly
HTN is usually asymptomatic, but if s/s show, these can include these 4:
Blurred vision
Headaches
Chest pain
Nosebleeds
often the first-line medications for HTN
Diuretics
medications are added to treat HTN if
lifestyle changes alone do not help
Hypertensive crisis occurs when
patients do not adhere to medication regimen
immediately give this during Hypertensive Crisis
IV drugs
s/s Hypertensive Crisis “HEAD”
Headache (severe)
Elevated BP
Altered LOC
Dizziness
3 IV drugs to consider/give to someone experiencing Hypertensive Crisis “BCD”
Beta-blockers
Calcium channel blockers
Dilators (nitro)
Peripheral Arterial Disease is mainly caused by
atherosclerosis
tissue damage/dysfunction due to a lack of oxygen being perfused to the organ or tissue
ischemia
tissue damage occurs _____ the arterial obstruction in PAD
below
elevated levels of homocysteine in the blood
hyperhomocysteinemia
substance produced in the liver in response to inflammation in the body
C-Reactive protein
These two levels will be elevated if PAD is present
Homocysteine
C-Reactive Protein
PAD causes this life-threatening problem
low/absence of oxygen to tissue
s/s PAD “LEG”
Leg pain
Extremity coldness
Gangrene/ulcers
A patient with PAD will have toenails that are
thick and slow-growing
reddish-purple discoloration of the skin that occurs in the lower extremities when the legs are hanging down or in a dangling position
Dependent rubor
“Rubor” - “Red”
a patient with PAD will have these kinds of pulses
weakened/diminished
a patient with PAD will have this kind of skin
shiny and hairless skin in the affected extremities
pain, cramping, or weakness in the legs that typically occurs during times of stress (exercise/walking) that goes away with rest, often indicating an arterial blockage
Intermittent claudication
a patient with PAD will have this kind of temperature in affected extremities
colder skin due to lack of heat
a patient with PAD will have these kinds of wounds/sores
Red sores with a regular round shape
Tissue death caused by lack of blood supply
gangrene
how should a nurse position a patient with PAD
dangle the extremities (dependent position)
a patient with PAD should avoid this kind of clothing
tight/restrictive clothing
Dx testing for both PAD and PVD
Doppler ultrasound and Ankle-Brachial Index (ABI)
Diagnostic testing for PAD and PVD that is used to assess the blood flow inside the blood vessels, also can detect issues like clots and valve dysfunction
Doppler Ultrasound
Diagnostic test used to diagnose PAD comparing the BP in the ankle and the BP of the brachial artery. A lower BP in the ankle can indicate a blockage somewhere
Ankle-Brachial Index (ABI)
6 P’s of acute limb ischemia
Pallor
Pain
Paresthesia (numbness/tingling)
Paralysis
Pulselessness
Poikilothermia (inability to regulate temp)
Which 2 P’s of acute limb ischemia are always the top two priorities?
Pain
Paresthesia (numbness/tingling)
Give a patient (with PAD) insulated socks and a warm environment in stead of
heating pads - PAD patients should not be using heating pads
2 kinds of medications given to a patient with PAD
Antiplatelets (aspirin)
Statins (Plavix)
intra-arterial procedure using a balloon and stent to open and help maintain the patency of the vessel
Percutaneous transluminal angioplasty
procedure where a laser is used to vaporize atherosclerotic plaque and open the artery
Laser-assisted angioplasty
procedure using a rotational device to scrape plaque from the inside of the patient’s peripheral artery
Mechanical Rotational Abrasive Atherectomy
Surgery used in patients who have severe claudication or for those who are losing a limb due to PAD.
Bypass grafts are sued to reroute the circulation around the occlusion
Arterial revascularization surgery
Priority action of arterial revascularization surgery
maintain adequate circulation in the repaired artery
During revascularization surgery, the location of these pulses should be marked and the pulse strength should be tested
dorsalis or pedal pulses
Assess for this in the effected limb after revascularization surgery to ensure increased blood flow
Warmth
Redness
possible edema
This can be severe following revascularization surgery due to the reintroduction of blood flow
pain
2 potential complications of arterial revascularization surgery
Graft occlusion
Compartment syndrome
medical emergency (complication of revascularization SRE) that occurs when pressure builds up within a muscle compartment that can restrict blood flow
Compartment Syndrome
a bypass graft (following revascularization SRE) becomes blocked or clogged
Graft occlusion
a graft occlusion often happens within ______ following revascularization surgery
within the first 24 hours
inadequate venous return from the veins can result in
blood stasis
Peripheral Venous Disease (PVD) is AKA
Venous Insufficiency
Venous insufficiency occurs secondary to
incompetent valves
inflammation of the vein caused by a blood clot
thrombophlebitis
PVD does not cause
deoxygenation to tissues - arteries are still working properly
a patient with PVD will have this around their ankles
yellow/brown discoloration around the ankles
a patient with PVD will have this kind of pain
Dull/aching pain
a patient with PVD will have this kind of pulse
bounding pulse (may be absent due to edema)
a patient with PVD will have this kind of temperature feeling in the extremity
warm
brown/yellow discoloration of the skin as a result of PVD is AKA
Stasis dermatitis
a patient with PVD will have these kinds of wounds/ulcers
shallow and irregularly-shaped
a nurse should position a patient with PVD like this
elevate the extremity
non-invasive test used to measure changes in volume in an organ/limb with a goal to assess blood flow
plethysmography
non-invasive procedure combining a doppler ultrasound and a traditional ultrasound used to assess blood flow and visualize blood vessels in real-time
Duplex ultrasound
a patient with PVD should elevate the legs for this long
20 minutes, 4-5 times a day
a patient with PVD should avoid doing this with their legs
avoid crossing their legs
a patient with PVD should wear these
elastic compression stockings
A patient with PAD will have lesions appear in this location
Ends of toes
Lateral ankles
Dorsal feet
A patient with PVD will have lesions in this location
Medial parts of lower legs
Medial ankles
Thrombus formation in a deep vein can lead to
DVT or PE
this occurs when a DVT thrombus becomes dislodged and travels to a pulmonary vessel
Pulmonary Embolism
3 things to do if your patient has a PE
Notify provider immediately
Call a Rapid
Never leave the patient alone
3 s/s of a PE
SOB
Restlessness
Chest Pain
when assessing a patient with DVT, they may have pain/tenderness in these two areas
calf or groin
when assessing a patient with DVT, a nurse may feel this over the affected blood vessel
hardness
changes in circumference of the calf or thigh over time due to fluid overload
localized edema
avoid doing these 2 things as a therapeutic technique for a patient with DVT
Avoid putting a pillow under the knee
DO NOT massage the affected limb
Main kind of medication given to patients with a DVT
Anticoagulants
procedure where a filter is placed in the inferior vena cava that catches blood clots - goal is to prevent a PE
Inferior Vena Cava Interruption Surgery
enlarged, twisted, and superficial veins
varicose veins
varicose veins are more common in
females
this sign can dislodge a blood clot in DVT
Homan’s sign - dorsiflexing of the foot
clients with varicose veins often report these 3 things
Muscle cramping
Aches/pains after sitting
Pruritus
This test places a client in a supine position with the legs elevated. A doctor applies pressure in the upper thigh and asks the patient to stand, then they assess the amount of time it takes for the veins to refill in a standing position
Trendelenburg test
irritating chemical solution injected into the vein to produce localized inflammation, which will close the lumen of the vessel over time
sclerotherapy
removal of large varicose veins that cannot be treated with less-invasive procedures
Vein-stripping
heat from a laser used to close a dilated vein
Laser treatment
a small catheter with radio frequency electrode is inserted, scars, and closes the dilated vein
Radio Frequency Energy
