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NURS241 Med Surg 2 > Med Surg 2- Cardiac Exam > Flashcards

Med Surg 2- Cardiac Exam Flashcards

1
Q

Preload

A

Stretch just before systole

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2
Q

Afterload

A

blood ejected from ventricle

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3
Q

S1

A

mitral/tricuspid closing

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4
Q

S2

A

aortic/pulmonic closing

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5
Q

Cardiac cath performed for R side

A

PE, vagal response

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6
Q

Cardiac cath performed for L side

A

MI, stroke, bleeding

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7
Q

Cardiac cath perform for L and R side

A

edema, cardiac tamponade, hematoma

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8
Q

Cardiac cath post-op

A

bed rest, watch insertion site, VS, bleeding, pulses (pedal)

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9
Q

Troponin

A

protein released when heart is damaged
0-0.04
increased means that there is damaged muscle

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10
Q

BNP

A

released by ventricles in response to fluid overload
Over 900 is severe!

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11
Q

HF RF

A

CAD, HTN, smoking, obesity, sleep apnea

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12
Q

HF Compensatory mechanisms

A

Sympathetic NS, RAS activation, BNP increased, myocardial hypertrophy

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13
Q

HF labs

A

hypovolemia, check K, increased BNP, urinalysis (protein in urine), ABG’s (hypoxemia)

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14
Q

HF DX

A

Echo- shows blood flow, how the heart is doing
CXR- fluids

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15
Q

L sided HF

A

used to be called congestive HF, affects the lungs!

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16
Q

L sided HF causes

A

HTN, CAD, valvular disease
not all types have fluid accumulation

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17
Q

L sided HF S/S

A

dyspnea, fatigue, weakness, arm heaviness, CP, palpitations, cough worsened at night, tachypnea, cyanosis, pulmonary congestion

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18
Q

L sided HF severities

A

Severe L HF leads to pulmonary edema (crackles, dyspnea at rest, confusion)
Pink, frothy sputum is a life-threatening emergency!

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19
Q

R sided HF

A

R ventricle can’t empty completely

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20
Q

R sided HF causes

A

L ventricular failure, R ventricle MI, pulmonary HTN

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21
Q

R sided HF s/s

A

Peripheral edema, increased abd girth/ascites, dependent edema, hepatomegaly, JVD, weight gain

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22
Q

R sided HF interventions

A

Take a daily weight in the morning
O2, Is, TCDB, sit pt up with pillows underneath arms, reposition frequently, never massage pt’s legs

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23
Q

ACE and ARBS
Lisinopril, Valsartan

A

Lowers BP
major s/s to stop is swollen lips, can cause coughing
Get pt up slowly due to hypotension, avoid pregnancy

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24
Q

Beta Blockers

A

Lowers HR and BP
Start slowly for HF and don’t stop abruptly

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25
Q

Calcium CB
Nifedipine, Cardizem

A

Lowers HR and BP

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26
Q

Digoxin

A

Lowers HR
Therapeutic levels -.5-2.0
Hypokalemia leads to toxicity
s/s- blurred vision, mental changes, fatigue, anorexia

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27
Q

Dilators- Nitroglycerin

A

Lowers BP
Common s/s is headache, low NP
NO Viagra

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28
Q

Diuretics
Lasix, Spironolactone

A

Lowers BP
Spironolactone SPARES K, furosemide WASTES K

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29
Q

HF education

A

Diet- low sodium, 2L fluid/day
Risk for falls, change positions slowly
BP and BNP should not increase
Elevate legs with pillows
Daily Weights in morning
Sex only if 2 flights of stairs no SOB
Stockings daily
No canned/packaged foods or OTC

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30
Q

Acute pulmonary edema

A

LV fails to eject sufficient blood, increased pressure in lungs
fluid leaks across pulmonary capillaries (lungs airway)

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31
Q

Acute pulmonary edema s/s

A

crackles, dyspnea, SOB, tachycardia, cough with frothy, blood-tinged sputum, confused, cyanotic, agitating, increased RR, lethargic

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32
Q

Acute pulmonary edema interventions

A

High Folwer’s with feet dangling, hemodynamic monitoring, IVF’s, foley

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33
Q

Acute pulmonary edema meds

A

morphine sulfate
sublingual nitro q5min, max 3 doses
furosemide/ bumetanide IV push over 1-2 min
VS q30min-1hr

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34
Q

Cardiomyopathy

A

chronic disease of heart
Dilated, hypertrophic, restrictive

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35
Q

Cardiomyopathy s/s

A

orthopnea, crackles, edema, dyspnea on exertion, nocturnal dyspnea, a-fib in som

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36
Q

Cardiomyopathy interventions

A

palliative care, possible heart transplant, digoxin, diuretics, vasodilators, ACE

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37
Q

Cardiac Tamponade

A

fluid accumulation in pericardium that puts pressure on heart, sudden decrease in cardiac output
Medical emergency!

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38
Q

Cardiac Tamponade s/s

A

JVD, paradoxical pulse, tachycardia, muffled heart sounds, hypotensions

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39
Q

Pericardiocentesis

A

removes fluids and relieves pressure on the heart

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40
Q

Mitral Stenosis

A

narrowing of valve L-side
rheumatic fever!

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41
Q

Mitral Stenosis s/s

A

orthopnea, dyspnea on exertion, dry cough, palpitations, paroxsymal nocturnal dyspnea

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42
Q

Mitral Regurgitation

A

opening/valve that doesn’t flow, blood goes back into atrium

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43
Q

Mitral Regurgitation causes

A

mitral valve prolapse, rheumatic heart disease, MI, endocarditis

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44
Q

Mitral Regurgitation s/s

A

fatigue, extra heart sound, chronic weakness, anxiety, A-fib, RR changes

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45
Q

Mitral valve prolapse

A

valve leaflets enlarge and prolapse into L atrium during systole
confirmed by echo

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46
Q

Mitral valve prolapse s/s

A

Most people asymptomatic
CP, palpitations, exercise intolerance, late systolic murmur at apex

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47
Q

Aortic stenosis

A

narrowing of aortic valve, disrupts flow from L ventrilce
disease of “wear and tear”
can develop R sided HF

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48
Q

Aortic regurgitation

A

backflow into L ventricle, results from rheumatic conditions

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49
Q

Aortic regurgitation s/s

A

Can be asymptomatic for years
dyspnea, angina, tachycardia, palpitations, fatigue, syncope on exertion, orthopnea, murmur

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50
Q

Aortic regurgitation DX

A

CXR, echo, ECG

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51
Q

Aortic regurgitation meds

A

Prophylactic antibiotic, diuretics, beta blockers, digoxin, O2

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52
Q

Aortic regurgitation management

A

Nonsurgical- drug therapy, rest, anticoagulant
Surgical- heart valve replacement, autograft

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53
Q

Endocarditis

A

Inflammation INSIDE the heart

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54
Q

Endocarditis causes

A

Dirty needles, dental visits, heart surgery, untreated strep throat

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55
Q

Endocarditis s/s

A

Clos in heart/brain, development HF, splinter hemorrhages (clots under fingernails)
Lungs have fluid (crackles)
Overheated (fever)
Too little O2/cardiac output, clubbing fingers
Roth spots (in retina), Osler’s nodes (palms/soles), Janeway lesions (nontender red spots)

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56
Q

Endocarditis treatment

A

Antibiotics (PICC)- penicillin, cephalosporins
Valve repair/replacement/drain
Chordae tendineae

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57
Q

Endocarditis education

A

Monitor for infection- temp for 6 wks
Oral care
Let all providers know (dentist)
Dentist- antibiotics

58
Q

Endocarditis DX

A

Blood cultures, echo, TEE, new murmur,

59
Q

Pericarditis

A

inflammation OUTSIDE the heart

60
Q

Pericarditis causes

A

Acute exacerbations
Heart attack
Autoimmune disorders
Infection
Renal failure

61
Q

Pericarditis s/s

A

oppressive pain aggravated by breathing (inspiration), coughing, or swallowing, pain in L side of neck/shoulder worse lying down or inhaling

Acute: increased WBC, ST elevation, A-fib
Chronis- s/s of R sided HF

62
Q

Pericarditis treatment

A

treat cause!
NSAIDs, steroids if no relief in 48-72hrs
Sit up/forward
Pericardiocentesis

63
Q

HTN

A

chronic high BP, usually 140/90
Malignant/HTN crisis- emergency!

64
Q

HTN causes

A

Stress, smoking, sedentary lifestyle
Obesity, oral BC
Diet, disease
African men and age

65
Q

HTN s/s

A

Achy had/ abd bruit
Blurred vision
Chest pain
Dizziness

HTN crisis- morning headaches, uremia, blurred vision, dyspnea
semi-fowler’s, BP q5-10min, EKG, IV meds, O2

66
Q

HTN DX

A

Echo, ECG, EKG, urinalysis- protein, RBC, BUN, creatinine, increased BNP and cholesterol

67
Q

HTN education

A

Diet- low sodium/calories/cholesterol
Reduce alc and caffiene
Exercise- walking 30min/day
Stop smoking/alc
Stress reduction

68
Q

HTN meds

A

HTN crisis- labetalol, calcium channel blockers, dilators, ICU
anticoagulants, lovastatin (no grapefruit)

69
Q

Arteriosclerosis

A

thickening/hardening of arterial wall associated with aging

70
Q

Atherosclerosis

A

type of arteriosclerosis with plaque formation within arterial wall, leading RF of cardiovascular disease

71
Q

Arteriosclerosis monitoring s/s

A

monitor BP in both arms, palpate major sites of body, extremity temp, long cap. refill, bruit, cholesterol

72
Q

Arteriosclerosis meds

A

statins, ezetimibe (lower cholesterol), combo drugs, PCSK9 inhibitors

73
Q

PAD

A

alters natural flow of blood through arteries/veins, plaque unstable more lower extremities

74
Q

PAD s/s

A

Stage 1- bruit/aneurysms, pedal pulses absent
Stage 2- claudication: muscle pain, cramping/burning during exercise relieved by rest
Stage 3- pain resting at night, pain relieved putting extremity in dependent position
Stage 4- ulcers/blackened tissue on toes

75
Q

PAD DX

A

Labs- lipids, HDL/LDL
MRA- best assess blood flow
ABI, Doppler, stress test

76
Q

PAD interventions

A

gradually/slowly increase exercise, warmth/heat (NOT DIRECT), prevent long cold exposure, no smoking/alc/tight clothes

77
Q

PAD management

A

HANG FEET DOWN
Non-surgical- axillofemoral bypass
Surgical- Angioplasty with stents
Post-op- warmthness/redness/edema expected, pain 1st sign of occlusion
Nurse check pulses before transfer to another floor!

78
Q

PAD meds

A

anticoagulants, antiplatelets
reduce MI/stroke, vascular death

79
Q

Acute Arterial Insufficiency

A

embolus most common cause
Thrombectomy or Embolectomy

80
Q

Acute Arterial Insufficiency s/s

A

6 P’s

81
Q

Acute Arterial Insufficiency drugs

A

TPA (clot bluster), 1:1, watch adverse signs

82
Q

Acute Arterial Insufficiency management

A

monitor for compartment syndrome –> fasciotomy

83
Q

Varicose Veins

A

distended, protruding veins that appear darkened and tortuous, can be caused by vein wall weaking/dilating

84
Q

Varicose Veins treatment

A

compression socks, exercise, elevation, surgical removal of veins

85
Q

Abd Aortic Aneurysm s/s

A

asymptomatic; pain steading gnawing may last for days or hours in abd/flank/back, abd mass pulsatile

86
Q

Abd Aortic Aneurysm management

A

monitor growth of aneurysm, maintain normal BP to reduce risk of rupture, frequent US/CT to monitor size
Resection of aneurysm- high mortality risk!

87
Q

Abd Aortic Aneurysm post-op

A

VS, don’t raise bed higher than 45 to decrease pressure, watch occlusion/rupture, renal failure b/c they clamp off kidneys during surgery

88
Q

Thoracic Aortic Aneurysm s/s

A

back pain, SOB b/c aorta can’t pump blood, hoarseness/difficulty swallowing, sudden excruciating back/chest pain = rupture!

89
Q

Thoracic Aortic Aneurysm interventions

A

managing rupture (hypovolemic shock, give fluids), BP/HR

90
Q

Thoracic Aortic Aneurysm repair

A

watch VS, complications, cardiac dysrhythmia, resp. distress

91
Q

Aortic Dissection

A

EMERGENCY- sudden tear in aortic intimia, opening way for blood to enter aortic wall
Pain-tearing/ripping/stabbing
IV fluids, beta blockers, eliminate pain, going to surgery

92
Q

Normal Sinus rhythm

A

60-100
Continue to monitor, document

93
Q

Supraventricular tachycardia

A

100-280
Sustained- CP, palpitations, SOB, anxiety, syncope
Nonsustained- asymptomatic, occasional palpitations
Treatment- adenosine (N/V, bradycardia, pauses), follow with NS bolus

94
Q

Sinus Bradycardia

A

Less than 60
Causes- meds, hypoglycemia, blockage causing MI
S/S- cyanotic, cool, clammy, SOB, dizziness, CP, confusion
Interventions- O2, fluids, atropine, possible pacemaker, IVF

95
Q

Sinus Tachycardia

A

Greater than 100
Causes- caffeine, stress, anxiety, meds, pain, electrolyte imbalance
S/S- chest pressure/pain, SOB, dizziness leading to syncope, dehydration
Interventions- O2, treat underlying

96
Q

A-Fib

A

Atria quivering, increased risk stroke/clots
RF- HTN, TIA
Causes- congestive HF, mitral valve, rheumatic heart disease, CAD
S/S- palpitations, anxiety, CP, dizzy, SOB
Interventions- cartizem (prevent CP), anticoag, cardioversion

97
Q

Ventricular Tachycardia

A

140-180, fatal 3-5 min, spikt tombtone EKG
Pulse- O2, assessments, EKG, cardioversion, amiodarone
Pulseless- CPR, shock, epinephrine, lidocaine IV (treats arrythmia)

98
Q

Ventricular Fibrillation

A

Tombstone EKG, fatal 3-5 min
Causes- MI< trauma, overdose, electrolyte imbalance
S/S- pulseless, not awake
Interventions- CPR, epinephrine, defibrillation

99
Q

Asystole

A

flatline
Interventions- check pt 1st, CPR, epinephrine

100
Q

DVT

A

clot in a deep vein

101
Q

DVT s/s

A

Calf pain/cramping
One sided swelling
Wwarm and red, localized edema
SOB and chest pain -call doctor

102
Q

DVT treatment

A

Don’t walk, elevate
Surgery- thrombectomy, IVC fiter

103
Q

DVT education

A

Calf exercises
Hydration
Ambulate
No long sitting
Ted hose/SCDs

104
Q

DVT meds

A

Heparin- PTT 20-40sec
Antidote protamine sulfate
Complications- bleeding, walk with assistance

Lovenox

Coumadin- INR 0.8-1.1
Antidote Vitamin K
No leafy greens b/c of vit. K

105
Q

DVT DX

A

US, doppler, elevated D-Dimer

106
Q

Buerger’s Disease

A

caused by smoking!
recurring inflammation of intermediate and small arteries/veins of extremities
results in thrombus/ vessel occlusion

107
Q

Buerger’s Disease s/s

A

Black fingers/toes, claudication in feet and lower extremities worse at night, decreased pulses, cool/cyanotic in dependent positons, gangrene

108
Q

Buerger’s Disease education

A

Avoid cold, stop smoking, drugs for vasodilation

109
Q

Chronic Venous Insufficiency

A

result of prolonged venous HTN that stretches veins and damages valves
can lead to leg edema, ulcers, dermatitis

110
Q

Chronic Venous Insufficiency treatment

A

elevate legs 4-5times/day q20 min, wear compression socks, don’t cross legs sitting or standing

111
Q

CAD

A

included chronic stable angina, acute coronary syndromes
Development
Fatty Streak- can happen at age 15
Raised Fibrous Plaque- can happen at age 30
Complicated Lesion stage

112
Q

Ischemia

A

insufficient O2 is supplied to meet requirements of myocardium

113
Q

Infarction

A

Necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissue

114
Q

Angina s/s

A

substernal chest pain, radiates to Larm (Rarm in women), relieved by NTG or res, lasting less than 15 minutes

115
Q

Stable angina

A

chronic stable angina, classic angina
Paroxysmal, occurs with physical exertion
Relieved by rest or nitroglycerin

116
Q

Stable angina

A

preinfarction(cell death) angina or new onset
More prolonged and severe
Needs to be treated immediately
Chest pain when resting

117
Q

Variant angina

A

Prinzmetal’s angina, vasospastic angina
Occurs at rest
Result of spasm

118
Q

MI s/s

A

substernal chest pain/pressure, radiates to L-arm, pain or discomfort in jaw, back, shoulder or abd, longer than 30 minutes, N/V, clutching of sternal/substernal chest, SNS stimulation, elevated temp, JVD, crackles, women gastro pain

119
Q

MI lab

A

troponin, chest x ray, echo, EKG, stress test

120
Q

MI goals

A

decrease pain, decrease myocardial oxygen demand, and increase perfusion (Myocardial oxygen supply)

121
Q

MI interventions

A

pg. 757, Morphine, Oxygen, Nitroglycerin(3 times q5 min, no Viagra), Aspirin 325 mg chewable tablets as first med given (take 3 if at home and having)

122
Q

NSTEMI

A

non ST elevated heart attack
Can have ischemia
Slightly elevated troponin

123
Q

STEMI

A

ST elevated MI, emergency!
Rupture of fibrous atherosclerotic plaque leading to platelet aggregation and thrombus formation at the site of rupture
Thrombus causes an abrupt 100% occlusion to coronary artery- emergency!
Heart catheterization

124
Q

MI RF

A

AA/Hispanic, sex, hyperlipidemia, smoking, stress, HTN, physical inactivity, metabolic syndrome, obesity- women waist greater than 35 inches, men greater than 40 inches, DM

125
Q

PTCA/Stent

A

Reopen the clotted coronary artery and restore perfusion
Goal-> performed within 90 min of acute STEMI
Post op- bleeding, cardiac monitor
Complications- acute closure of artery, bleeding- apply pressure and call RR, pain, ST elevation, hypotensions, dysrhythmia

126
Q

CABG

A

pg. 769 open heart surgery!
Occluded coronary arteries are bypassed with the pt own venous or arterial blood vessels or synthetic grafts
Indicated when pt does not respond well to medical management of CAD

127
Q

CABG pre-op

A

shower with chlorhexidine, antibiotics q1hr before surgery, BG less than 200, VS/labs, EKG, consent, echo

128
Q

CABG post-op

A

intubated in ICU afterwards, ventilator 3-6 hours, mediastinal tubes, pleural chest tubes, pacer wires (decrease arrhythmias), cardiac tamponade huge compilation (HTN, JVD, muffled heart sounds), pain control

129
Q

CABG complications

A

arrhythmia. F&E imbalance, bleeding, hypotension/ hypertension, hypothermia, confused, (check LOC 30-60 min until awake then q2-4 hours), respiratory problems

130
Q

Cardiac rehab

A

Phase 1- diagnosis during admission, activity tolerance, education
Phase 2- after discharge 4-6wks, education/support/diet/exercise
Phase 3- maintain cardio stability and long-term conditioning

131
Q

CABG discharge

A

prevent further risks, anxiety, meds (nitro, beta blockers, ASA, ACE), exercise/cardiac rehab, no sex 4-6wks, NSAIDS increase chance of MI/stroke, activity should be tapered (intermidite claudication), diet, RF

132
Q

Cardiogenic shock pg. 733 chart, 765 drug alert/critical rescue

A

heart muscle isn’t healthy, can’t get perfusion b/c heart can’t pump as well (impaired)
Necrosis of more than 40% of Lventricle

133
Q

Cardiogenic shock s/s

A

Tachycardia, hypotension, BP <90 or 30 less than pt baseline, urine output less than 30mL/hr, cool, clammy, SOB, hyperventilation, decreased pulses, confusion, restless/agitated, pressure/chest pain, pulmonary congestion

134
Q

Cardiogenic shock interventions

A

elevate legs to get blood back at heart, ABC’s, fluid replacement- use PA catheter for PAWP, Vasopressor- constrict to pump blood (Dopamine, Dobutrex), HCO3 if ph <7.3 (buffers the acid), treat arrhythmias quickly, diuretics PRN, balloon pump to help the aorta do its job

135
Q

Digoxin

A

decreases heart rate by increases myocardial contractility
Given for heart failure, A-FIb
RF dig toxicity- hypokalemia, advanced age, imparired renal function
s/s- N/V, diarrhea, anorexia, syncope, bradycardic, diaphoresis, hypotension, mental status changes, blurred vision, diplopia
Monitor potassium
Normal digoxin level 0.5-2

136
Q

Nitrates

A

Vasodilation dilation, decreases blood pressure
Mechanism of action- vasodilation, reduces preload and afterload, decreases myocardial oxygen demand
Give for CP, MI, angina
S/s- Orthostatic hypotension, dizziness, headache
Routes
PO- regular management
Sublingual- needs to be dissolved (Can take 3 times q5 min)
Transdermal- clean/hairless skin, take off when defibrillating, take off patch after 12-14 hours, rotate sites
IV- Slow infusion then titrate until pain is gone, check B/P every 3-5 minutes
Do not give to people on Viagra
Take on first onset of chest discomfort
Call 911 if no relief after 3 doses
Pg 775

137
Q

Beta-Blockers

A

block epinephrine and norepinephrine
Assess HR and BP before giving
Decreases stress on heart
First choice for treatment for stable angina
Drug interactions
Nitrates, anti-diabetics, antacids, antidysrhythmics, calcium channel blockers, anti-hypertensives

138
Q

Calcium channel blockers

A

allows heart to relax
Allows blood vessels relax
Give to patients with Afib and CAD
Decreases afterload and increased myocardial oxygen supply, decreases angina
Helps relax heart and increase perfusion

139
Q

Heparin

A

prevents blood clots, thrombus formation,
Monitor PTT, normal 25-35
Antidote protamine sulfate
Always follow heparin protocol
Get lab values, PTT q6hr, CBC you want platelets, tell provider critical labs
IV pump must be used for infusion
Watch s/s of bleeding, stop infusion

140
Q

Coumadin

A

prevents blood clots/PE
Monitor INR 0.8-1.1, PT 11-12.5
Expected INR to be higher b/c you’re thinning their blood
Antidote vitamin K
Discharge instructions- assess bleeding/bruising, electric razor, hold pressure if bleeding, help when walking, take at same time everyday, tell dentist about med, don’t stop abruptly
Avoid NSAIDs, oral contraceptives, antidepressants, herbs - ginger, garlic, ginseng, St. John’s wort, ginkgo, high-fat and vitamin K-rich foods

NURS241 Med Surg 2 (3 decks)

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