Med-Surg: Cardiac Flashcards
1
Q
CV disorder Comorbidities (5)
A
diabetes renal failure anemia HTN pulm disease
2
Q
Left HF etiology (4 things)
A
systemic HTN
CAD
MI
structural heart changes
3
Q
LHF systolic HF causes… (4 things)
A
inadequate pumping
increased preload
increased afterload
DROP in ejection fraction
4
Q
LHF diastolic failure (3 things)
A
LV can’t relax
LV becomes stiff and can’t fill
decreased CO
5
Q
symptoms of LHF
A
decreased CO
Pulm Vascular Congestion
6
Q
decreased CO signs (8 things)
A
fatigue weakness slow cap refill cool, pale skin confusion, restlessness, syncope increased HR, palpitations S3 or S4 oliguria during day
7
Q
pulmonary vascular congestion signs (3 things)
A
crackles
frothy pink sputum
paroxysmal nocturnal dyspnea
8
Q
RHF etiology (3 things)
A
LVF failure
RV MI
pulm HTN
9
Q
RHF symptoms (6 things)
A
edema weight gain JVD polyuria thirst back pain
10
Q
NY Heart Assoc. Classifications
A
NYHA 1: mild, noticeable to the patient but not to other people
NYHA 2: some difficulty. Noticeable to observer
NYHA 3: moderate difficulty but can continue
NYHA 4: severe difficulty, patient cannot continue (will likely come into ER needing O2)
11
Q
AHA stages of HF development
A
- A: pt with risk factors but no LV impairment
- B: asymptomatic pt with LV hypertrophy and/or impaired LV function
- C: current or past symptoms of HF
- D: refractory HF eligible for transplant, inotropic and/mechanical support
12
Q
HF Compensation (4 things)
A
- SNS stimulation increased HR (beta) and bp (alpha)
- RAAS System activation electrolyte changes (Na+ increase, K+ decrease)
- BNP elevation: detects stretch in ventricles
- Myocardial Hypertrophy
13
Q
High output HF definition
A
- Heart is in a state in which output exceeds normal demand or capacity
14
Q
High Output HF etiology (5 things)
A
sepsis high fever profound anemia hyperthyroidism sustain high metabolic needs for any reason
15
Q
Lab assessment for HF (6)
A
o Electrolytes o BNP o CBC o Digoxin level (only if on digitalis o ABGs (maybe) o Thyroid function studies
16
Q
Assessments for HF
A
- Labs
- Radiographic assessment
- Electrocardiography (EKG)
- Echocardiography for valve damage and hypertrophy
- Pulmonary artery catheters (in ICU pts)
17
Q
Nursing Interventions for HF (9)
A
- Check RR, HR, BP, breath sounds, O2
- Supplemental oxygen
- Positioning
- Cap refill
- I&Os
- Rest periods
- Administer meds and monitor effects
- Diet therapy
- Daily weights
18
Q
to decrease preload in HF… (4 things)
A
- Diet therapy – reduce sodium
- Fluid restriction IF ORDERED
- Diuretics
- Nitrates for venous dilation
19
Q
to decrease afterload in HF…
A
ACE inhibitors (arterial dilation)
ARBs (arterial dilation)
ARNIs (vasodilation)
20
Q
to improve contractility in HF… (3)
A
Digitalis
beta-blockers
transplant, LVAD, Pacer, etc.
21
Q
to improve impaired gas exchange (4 things)
A
o Decrease activity
o Change position
o Give oxygen
o CPAP/CRT
22
Q
signs of worsening HF function (7)
A
- Rapid weight gain
- Decreased exercise tolerance
- Cough for than 3-5 days
- Increase in nocturia
- Dyspnea or chest pain at rest
- Increased edema
- *Advanced Directives
23
Q
Types of Vascular Disease (5)
A
HTN Arteriosclerosis PVD CAD Ischemic Brain Attack
24
Q
modifiable causes for HTN (7)
A
obesity physical inactivity excessive alc hyperlipidemia high salt/caffeine intake low K+, mg, Ca+ intake smoking
25
non-modifiable causes for HTN (4)
age 60+ or postmenopause
family history
African American
stress
26
Malignant HTN
rapidly elevating BP
| needs emergency treatment
27
secondary HTN
usually related to renal dysfunction, endocrine disorder, psychiatric disorders
28
Normal BP
SBP <120
| DBP <80
29
elevated BP
SBP 120-129
| DBP <80
30
Stage 1 HTN BP
SBP 130-139
| DBP 80-89
31
Stage 2 HTN BP
SBP 140+
| DBP 90+
32
Hypertensive Crisis
SBP 180+
| DBP 120 +
33
first line treatment for HTN
LIFESTYLE MODIFICATION
34
medication order for HTN
1st. diuretics
2nd. calcium channel blockers
2rd. ACE inhibitors
4th. ARBs
5th. Beta Blockers
35
when should you hold meds for HTN?
HR <60
| BP < 100/50
36
Potassium replacement... NEVER
never give IV push
37
normal K+ levels
3.5 - 5.0
38
arteriosclerosis definition
thickening of arterial wall
39
atherosclerosis definition
type of arteriosclerosis
| formation of plaque within arterial wall
40
contributors to atherosclerosis (8)
```
high lipid levels
obesity
HTN
stress
smoking
African America
Age 50-70
genetics
```
41
atherosclerosis can lead to... (4)
HTN
CAD
cerebrovascular disease
peripheral arterial disease
42
Prevention of atherosclerosis (6)
```
healthy BP
exercise
weight reduction
smoking cessation
stress management
drug therapy
```
43
DASH diet
used to stop HTN
| eating low fat foods, limit sweets, limit sodium, activity
44
Meds that decrease platelet aggregation (atherosclerosis)
```
aspirin
clopidogrel (plavix)
```
45
Lipid/cholesterol lowering meds for atherosclerosis (4)
statins
bile acid sequestrants
nicotinic acid
fibric acid
46
PAD and PVD definition
partial or full occlusions lead to inadequate flow to tissues
47
Signs of PAD/PVD (10)
```
intermittent claudication
pain, numbness, aching, heaviness of muscle
weak or absent pulses
slow wound healing
color changes in skin
decrease temp in one leg
poor nail growth
decrease hair on toes and legs
resting pain
ED
```
48
Atherosclerosis Interventions (3 things)
Balloon Percutaneous Transluminal angioplasty
rotational atherectomy
bypass/revascularization
49
Six P's for Acute Limb Ischemia
```
pain
pallor
pulselessness
paraesthesias
paralysis
poikilothermia (coolness)
```
50
Meds for Acute Limb Ischemia
*heparin therapy*
51
DVT risk factors (7)
```
prolonged sitting
bed rest
dehydration
post partum
use of OCs
pelvic, hip, knee surgery
trauma
```
52
DVT manifestations (5 things)
```
leg pain *unilateral
swelling extremity
erythema
low grade fever
Homan's sign
```
53
DVT prevention in hospital (3)
lovenox/heparin
hydration
out of bed order
54
acute DVT treatment
heparin bolus + drip
| ongoing monitoring for Coumadin PO after hep. drip
55
pseudoaneurysm definition
local dilation between media and adventitia layers
56
Aneurysm definition
localized dilation between intima and media layers
57
aneurysm dissection symptoms
sharp pain feels like tearing
| abdominal will be felt in back/flank
58
endocarditis definition
inflammation of the inner lining of the heart
- usually infectious
- can involve papillary muscles, chordae tendinae, valves can be involved
* high mortality rate
59
vegetation in endocarditis
can develop on valves, break off and travel to another location to establish there
60
endocarditis risk factors (8)
```
IV drug abuse
central line
valvular disease
congestive HF
systemic infection from any source
IV placement
abscess/lesion/rash
recent dental work
```
61
symptoms of endocarditis (10)
```
fatigue
fever
murmur
pallor
red, painless sports on palms and soles (Janeway lesions)
SOBOE
weakness
weight loss
embolic complications
```
62
3 goals for treatment of endocarditis
kill infection (if infectious)
fix/replace valve
treat symptoms
63
diagnostic tests for endocarditis (5)
```
clinical exam
positive blood cultures
CBC
chest x-ray
echocardiogram
```
64
treatment for endocarditis (4)
bed rest
nursing care similar to HF
long term IV antibiotics
valve replacment
65
what could mitral stenosis cause?
first affect LA --> pulm edema
66
what could pulmonary stenosis cause?
back up in RV and RV + systemic circulation
67
what could incompetent aortic valve lead to?
hypertrophy, coronary arteries will not be adequately perfused
68
Systolic Murmur
mitral regurg
pulmonic + aortic stenosis
systolic
69
diastolic murmur manifestations
mitral (or tricuspid) stenosis
aortic (or pulmonic) regurg
diastolic
70
treatment for valve disorders
medications - diuretics, ACEs, ARBs, BBs, ARNIs
| valve surgery - open heart/TAVR
71
what is better - valve repair vs. replacement?
valve repair is better
72
types of valve repair
commissurotomy: clip edges of stenotic valve
valvuloplasty: balloon breaks up calcifications
annuloplasty: put ring around valve to support closure
73
nursing interventions for valve disorders (7)
```
ongoing assessment - every system, every day
monitor vitals
assess murmur/heart sounds
signs of HF
supplemental O2
meds
monitor lab values
```
74
types of valves
bioprosthetic --> porcine, bovine or cadaver
| mechanical
75
pros and cons of mechanical valves
last longer
| anticoags for life
76
pros and cons of bioprosthetic valve
anticoags for 6 months
| don't last as long
