fnp exam 3 Flashcards
which side of the heart has higher pressure and more muscle to pump to the body?
left side of heart
what do the coronary vessels do?
provide oxygenation to the heart muscle
arteries carry blood ____ from the heart and are filled with _____ blood (what is the one exception?)
away, oxygen
pulmunary artery carries DEOXYGENATED blood to the lungs
veins carry blood _____ the heart and carry ______ blood (what is the one exception?)
to, deoxygenated
pulmonary vein carries oxygen rich blood from the lungs to the heart
what and where is the SA node?
Natural pacemaker of the heart located in the right atrium
What does the AV node do?
delays conduction to allow ventricles to fill with blood on systole
What do the bundle of HIS/Purkinjie fibers do?
carry signal through the ventricles
Starlings Law (in a healthy person)
the more volume in the ventricles before contraction, the higher the stroke volume. this is because the ventricles will be stretched and “bounce back” more forcefully
classic ischemic or MI-related chest pain symptoms
pressure, tightness, or squeezing
what EKG changes should trigger immediate ER referral?
ST-segment changes, new-onset left bundle branch block, presence of Q waves, ST elevations
what symptoms should be sent to the ER?
nausea, dizziness, sweating, shortness of breath, pain radiating to the jaw or arm, crushing chest pressure
MICE criteria for possible HF
Male
Infarction history (MI)
Crepitations
Edema in ankles
Acute MI labs and normal values
CK-MB normal 0.24 IU/L
Myoglobin normal 50-85 ng/mL
Troponin 0-0.5 ng/mL
Stable angina definition
predictable and consistent pain on exertion lasting around 5-10 minutes
unstable angina definition
less frequent, lasts longer than 20 minutes
Variant/Prinzmetal Angina
Pain occurs at rest with reversible ST changes
First line meds for Stable Angina
(Beta Blocker or Calcium Channel Blocker) + nitrates
Labs to get for HLD
Lipid panel, CBC, CMP with liver labs, TSH, CRP/ESR
Tests to order for HLD
EKG, Treadmill stress test, Nuclear stress test, Echo, US, CT (calcium CT), Coronary angioplasty (refer to cards)
First line of therapy for HLD
Dietary modifications (Dash diet, mediterranean diet, AHA diet)
Gold standard for HLD meds
statins
Left sided heart failure is usually due to what? and causes what symptoms? and is also called what kind of HF?
-due to uncontrolled HTN which causes left ventricular hypertrophy
-causes back up into the lungs (pulm s/s)
-also called SYSTOLIC HF
who are statins for?
someone with
-CVD,
-CVD risk > 7.5%
-LDL > or equal to 190
-DM & LDL > or equal to 70
what is LDL goal in DM or CV risk?
<70
Normal Lipid Panel
Total Cholesterol: <200
LDL <100 (<70 in DM or CV risk)
HDL >40
TG <150
What level of triglycerides is LDL unreliable?
> 500
How frequently to monitor liver function after starting a statin
before, then 4-6 weeks after starting, then every 6-12 months
Can you use a statin in pregnancy?
NO! Category X
What is the EF of Reduced function HF and Preserved function HF?
RF <40%
PF >50%
Left side HF causes and s/s
causes: left ventricular hypertrophy from uncontrolled HTN causing weaker systole
s/s: backs up in lungs! (dyspnea, hemoptysis, fatigue, cough, orthopnea, paroxysmal nocturnal dyspnea, crackles S3 (kentucky)
Right side HF causes and s/s:
causes: usually from compensation from Left HF, usually a problem with diastole
s/s: backs up in extremities, edema, nausea, right upper abdominal pain or fullness, JVD, hepatomegaly, S4 sound (tennessee)
Labs for HF
CMP, BNP, Trop, Lipids, CMP, A1C
DM meds that helps HF
SGLT2 inhibitor
Meds needed for HF
diuretics, ACEi with BB (not for HR <60), statin
What weights do pt need to monitor and call Dr. about?
If >2lbs in one day or >5lbs in one week
when to admit patients?
hypoxia, gross fluid overload, pulmonary edema
symptoms of reduced blood flow that could be from a murmur:
reduced blood flow, Chest pain, dyspnea, palpitations, SOB, exercise intolerance, light headedness
Mnemonic for areas of the heart
All People Enjoy Time Magazine (aortic, pulmonic, Erbs point, tricuspid, mitral)
Mnemonic for Systolic murmurs
MR. Peyton Manning AS MVP
-mitral regurgutation
-physiologic murmur
-aortic stenosis
-mitral valve prolapse (click)
Mnemonic for diastolic murmurs
ARMS
-aortic regurgitation
-mitral stenosis
Aortic Stenosis
systolic murmur common in elderly, heard in the 2nd/3rd intercostal space
Smart/Mart inhalers
-ICS (inhaled corticosteroid) with formoterol (long acting beta agonist)
-used as maintenance treatment plus whenever needed for symptom relief
AIR inhalers
-anti inflammatory reliever that contains an ICS (inhaled corticosteroids) and SABA (short acting beta agonists)
-Takes whenever needed for symptom relief
bacterial bronchitis treatment
Macrolide (mycins) or amoxi-clav (augmentin)
bacterial infection with emphysema treatment
doxy, bactrim, clarithromycin, cefaclor
Gold grades and severity
1: Mild FEV1 > 80%
2: Moderate FEV1 50-80%
3: Severe FEV1 30-50%
4: Very Severe FEV1 <30%
If eosinophil level is >300, what do you add to COPD therapy?
add ICS to current LABA + LAMA therapy
Pertussis abx
Macrolides or bactrim if >2 months old and unable to take macrolides
red flag labs for pertussis
Leukocytosis > 30,000
how many weeks to repeat CXR after pneumonia dx to document clearance?
6 weeks
What test is not recommended for dx CAP?
sputum culture
CURB-65 tool
C-confusion
U- BUN >19.6
R- respirations >30 breaths/min
B- blood pressure <90/60
65- or older
Cancer screening in older adults criteria and test
test: low-dose CT
criteria: ages 55-80 years who smoke 30 pack years or have quit in the past 15 years
what cardiac med can asthmatics not take?
Beta Blockers
what labs is it important to monitor when taking statins
Liver function
Statins that are available as low intensity
-statin
Lova
Simva
Prava
Statins that are available as high intensity
-statin
Atorva
Rosuva
