Final - 9 Perfusion B (preload, afterload, contractility) Flashcards
Jugular venous distension is seen in this type of heart failure.
R sided HF
Normally about 2/3rds of the cardiac cycle, this consists of relaxation and filling the atria and ventricles.
diastole
Major electrolytes used in cardiac muscle conduction/contraction.
K+, Na+, Ca+
A sign of this is frothy pink-tinged sputum
pulmonary edema or pulmonary hypertension or embolisms?
Your patient describes how she wakes up at night, several hours into her sleep, feeling like she can’t breathe.
paroxysmal nocturnal dyspnea, or orthopnea or asthma?
This provides a graphic representation, or picture, of cardiac electrical activity.
ECG
There is no pulse present but regular electrical activity is noted on the monitor.
PEA
H’s & T’s
The Hearts primary “pacemaker” which can spontaneously and rhythmically generate electrical pulses at a rate of 60-100 beats/minute.
SA node
This type of dysrhythmia is identified as anything under 60 beats per minute.
bradycardia
The medication given/tried if a patient has angina (a)______
how to administer it (b)______
two major side effects(c)____,_____
a) What is Nitroglycerin?
b) Give up to 3 tablets, 3-5 minutes apart, under the tongue until symptoms resolve.
c) Major Side effects to watch for – headache – ahhhh! and low blood pressure – it
vasodilates.
It takes into account systolic and diastolic pressures. Assists in determining perfusion.
MAP
The nurse is discharging a client to home with a new diagnosis of atrial fibrillation. The nurse explains that which of the following is the most important symptom to report to the physician?
- Irregular pulse
- Fever
- Fatigue
- Hemoptysis
- hemoptysis
The nurse has finished reviewing the shift report on a cardiac unit. The nurse should plan to see which of the following assigned clients first?
- A client with hypertrophic cardiomyopathy who is reporting mild dyspnea.
- A client who had a cardiac catheterization and will be ambulating for the first time
- A client receiving antibiotics for bacterial infection and is reporting anxiety and chest pain
- A client who is recovering from a coronary artery bypass grafting (CABG) surgery with a temperature of 101 F.
- A client receiving antibiotics for bacterial infection and is reporting anxiety and chest pain
The nurse is caring for a client who had a permanent pacemaker inserted because of complete heart block. The nurse determines that which of the following outcomes indicates a successful procedure?
- Client ambulating in the hall within 4 hours of the procedure without dyspnea or chest pain
- Client’s ECG monitor demonstrates normal sinus rhythm
- Heart rate of 80 beats per minute, blood pressure 120/80
- Client’s ECG monitor shows paced beats at the rate of 68 per minute
- Client’s ECG monitor shows paced beats at the rate of 68 per minute
The nurse is caring for a client who has just returned from cardiac femoral angiography. Which of the following is important patient teaching?
- “You are recovering well sitting up at a 90 degrees is perfect.”
- “It is important for you to walk, so I will be back in 1 hour to walk with you.”
- “It is important to drink fluids after this procedure, to protect your kidney function. I will bring you a pitcher and I encourage you to drink.”
- “You will need to do the leg exercises that you practiced before the procedure to keep good circulation to your legs. After your exercises, you can rest.”
3.“It is important to drink fluids after this procedure, to protect your kidney function. I will bring you a pitcher and I encourage you to drink.”
The nurse is caring for a client with a history of renal failure and myocardial infarction. The nurse who is reviewing laboratory finding would call the doctor to report which of the following results?
- Potassium level of 5.0 mEq/L
- Sodium level of 145 mEq/L
- Calcium level of 7.0 mg/dL
- Phosphorous level of 3
- Calcium level of 7.0 mg/dL
Three lab diagnostics you would expect to check if a patient comes in and is suspected of a heart attack.
Troponin, CK, CK-MB, possibly BNP, CMP or BMP.
If you hear an S3 sound, fluid is _____ in (benign in youth, athletes, & pregnant women) = can indicate HF or volume overload = report!
sloshing
S4: blood being pushed against stiff _____ _____ (sound: “a stiff wall”)
L ventricle
____ has larger impact on MI than _____
transmural has larger impact on MI than subendocardial
affected area includes all layers/wall of heart
transmural or Q wave
involves layer below the endocardium
subendocardial or non-Q wave
Ischemia: inverted _____ wave = not enough O2
T
Injury: elevated _____ wave
ST
Infarction: abnormal _____ wave
Q
Necrosis of MI begins in _____-_____ minutes after total occlusion (only if it affects all areas)
20-30
T/F: you can die from both stemi and nstemi
T
difference between nstemi & unstable angina
when you do you cardiac markers & lab values un unstable, they don’t elevate, but they do elevate in nstemi
difference between stemi & nstemi
Stemi: ST segment elevated & results from fully-occluded coronary artery
Nstemi: ST segment depressed & normally both results from a partially or intermittently occluded coronary artery
is unstable angina an MI
no
are stemi & nstemi both an MI
yes
it take _____-_____ hrs for those lab & cardiac markers to elevate
2-3 hrs
atypical clinical manifestation of acute MI:
- diabetes
- elderly
- females
- diabetes: may not experience any pain or discomfort
- elderly: jaw pain, fainting, no pain
- females: indigestion relieved with antacids
_____ wave is a sign of a previous MI: results of absence of electrical activity (doesn’t show up immediately, takes several hours to days)
Can go away if we re-perfuse them (chances of making them go away are _____)
Standard ECG: records depolarization & repolarization along with the designated pass it uses (Na+, K+, & Ca+)
- Q
- rare
In past, was one of most sensitive and reliable indicators of all cardiac enzymes in diagnosing an MI. 50% of CK-MBs rise in the 2-3 hours after onset of chest pain, peaks in 24 hours, and returns to normal in next 24-40 hours.
CPK
measures damage to heart muscle tissue
CK-MB
A protein released by damaged myocardial cells. More sensitive than CK-MB
Troponin
Rises in 3 hours after an MI, peaks at 14-18 hours, returns to normal in 5-7 days, and is NOT affected by skeletal muscle damage or kidney disease.
Troponin I
May be present 21 days after an MI, but is sensitive to skeletal muscle damage and kidney disease.
Troponin T
Not as reliable an indicator of acute MI damage as Troponin or CK-MB. _____ takes longer to peak and stays elevated longer, so it may be used to diagnose a past MI.
LDH
Treatment of Occluded Vessels: _____ minutes (door to cath lab)
90
- thrombolytics & antiplatelets
balloon inflated inside artery is a
stent
normal CO
4-8
normal CI
2.5-4
amt. blood pumped by heart of L ventricle in one contraction
SV
will a vasodilator decrease or increase afterload
decrease
How much fluid is in a ventricle right before the next contraction
preload
The pressure that a ventricle has to pump against
afterload
flow x resistance
pressure
The force with which the heart pumps blood
contractility
s/s decreased contractility
weak, thready pulse
tx of decreased contractility
inotropic meds (digoxin, epi, dopamine)
causes of increased contractility
dig, epi, dopamine
tx of increased contractility
beta-blockers & Ca+ channel blockers
Portion/percentage of ventricular end-diastolic volume that is pumped from the ventricles in one beat
ejection fraction
normal ejection fraction
60%
normal PP
~40
s/s cardiac tamponade
S/S D: distended jugular veins R: respiratory tract & lungs clear O: O2 sat low W: weak rapid pulses (thread) N: no pulse (death is a complication E: ECG-QRS complexes short & uneven D: decreased CO & BP during inspiration
BECKS Triad B: Big JVD E: Extreme Low BP C: Can’t hear heart sounds (muffled) Pulseless Paradoxes
purpose of therapeutic hypothermia
cool pt to bring metabolic things down
complications of therapeutic hypothermia
bradycardia (do no give beta-blockers, Ca+ channel blockers, or amniodarone)
Therapeutic Hypothermia
_____ = v. fib (so temp. is very controlled, very important not to let them shiver! = may paralyze them)
31
cool quick, warm slowly
complication with dissecting aoritc aneurysm
rupture = lots of bleeding, possible death
what is teh heart-lung machine used for
CABG
- *when you pt. comes back, you should expect some
1. coagulopathy problems (hypre, or hypo)
2. fluid & electrolyte shifts = lots of blood draws to monitor fluids
