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Med-Surg > Med-Surg: Cardiac > Flashcards

Med-Surg: Cardiac Flashcards

1
Q

CV disorder Comorbidities (5)

A 
diabetes
renal failure
anemia
HTN
pulm disease
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2
Q

Left HF etiology (4 things)

A

systemic HTN
CAD
MI
structural heart changes

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3
Q

LHF systolic HF causes… (4 things)

A

inadequate pumping
increased preload
increased afterload
DROP in ejection fraction

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4
Q

LHF diastolic failure (3 things)

A

LV can’t relax
LV becomes stiff and can’t fill
decreased CO

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5
Q

symptoms of LHF

A

decreased CO

Pulm Vascular Congestion

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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
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7
Q

pulmonary vascular congestion signs (3 things)

A

crackles
frothy pink sputum
paroxysmal nocturnal dyspnea

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8
Q

RHF etiology (3 things)

A

LVF failure
RV MI
pulm HTN

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9
Q

RHF symptoms (6 things)

A 
edema
weight gain
JVD
polyuria
thirst
back pain
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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)

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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
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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
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13
Q

High output HF definition

A
  • Heart is in a state in which output exceeds normal demand or capacity
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14
Q

High Output HF etiology (5 things)

A 
sepsis 
high fever
profound anemia
hyperthyroidism
sustain high metabolic needs for any reason
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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
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16
Q

Assessments for HF

A
  • Labs
  • Radiographic assessment
  • Electrocardiography (EKG)
  • Echocardiography for valve damage and hypertrophy
  • Pulmonary artery catheters (in ICU pts)
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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
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18
Q

to decrease preload in HF… (4 things)

A
  • Diet therapy – reduce sodium
  • Fluid restriction IF ORDERED
  • Diuretics
  • Nitrates for venous dilation
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19
Q

to decrease afterload in HF…

A

ACE inhibitors (arterial dilation)
ARBs (arterial dilation)
ARNIs (vasodilation)

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20
Q

to improve contractility in HF… (3)

A

Digitalis
beta-blockers
transplant, LVAD, Pacer, etc.

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21
Q

to improve impaired gas exchange (4 things)

A

o Decrease activity
o Change position
o Give oxygen
o CPAP/CRT

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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
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23
Q

Types of Vascular Disease (5)

A 
HTN
Arteriosclerosis
PVD
CAD
Ischemic Brain Attack
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24
Q

modifiable causes for HTN (7)

A 
obesity
physical inactivity
excessive alc
hyperlipidemia
high salt/caffeine intake
low K+, mg, Ca+ intake
smoking
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25
Q

non-modifiable causes for HTN (4)

A

age 60+ or postmenopause
family history
African American
stress

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26
Q

Malignant HTN

A

rapidly elevating BP

needs emergency treatment

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27
Q

secondary HTN

A

usually related to renal dysfunction, endocrine disorder, psychiatric disorders

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28
Q

Normal BP

A

SBP <120

DBP <80

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29
Q

elevated BP

A

SBP 120-129

DBP <80

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30
Q

Stage 1 HTN BP

A

SBP 130-139

DBP 80-89

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31
Q

Stage 2 HTN BP

A

SBP 140+

DBP 90+

32
Q

Hypertensive Crisis

A

SBP 180+

DBP 120 +

33
Q

first line treatment for HTN

A

LIFESTYLE MODIFICATION

34
Q

medication order for HTN

A

1st. diuretics
2nd. calcium channel blockers
2rd. ACE inhibitors
4th. ARBs
5th. Beta Blockers

35
Q

when should you hold meds for HTN?

A

HR <60

BP < 100/50

36
Q

Potassium replacement… NEVER

A

never give IV push

37
Q

normal K+ levels

A

3.5 - 5.0

38
Q

arteriosclerosis definition

A

thickening of arterial wall

39
Q

atherosclerosis definition

A

type of arteriosclerosis

formation of plaque within arterial wall

40
Q

contributors to atherosclerosis (8)

A 
high lipid levels
obesity
HTN
stress
smoking
African America 
Age 50-70
genetics
41
Q

atherosclerosis can lead to… (4)

A

HTN
CAD
cerebrovascular disease
peripheral arterial disease

42
Q

Prevention of atherosclerosis (6)

A 
healthy BP
exercise
weight reduction
smoking cessation
stress management 
drug therapy
43
Q

DASH diet

A

used to stop HTN

eating low fat foods, limit sweets, limit sodium, activity

44
Q

Meds that decrease platelet aggregation (atherosclerosis)

A 
aspirin
clopidogrel (plavix)
45
Q

Lipid/cholesterol lowering meds for atherosclerosis (4)

A

statins
bile acid sequestrants
nicotinic acid
fibric acid

46
Q

PAD and PVD definition

A

partial or full occlusions lead to inadequate flow to tissues

47
Q

Signs of PAD/PVD (10)

A 
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
Q

Atherosclerosis Interventions (3 things)

A

Balloon Percutaneous Transluminal angioplasty
rotational atherectomy
bypass/revascularization

49
Q

Six P’s for Acute Limb Ischemia

A 
pain
pallor
pulselessness
paraesthesias
paralysis
poikilothermia (coolness)
50
Q

Meds for Acute Limb Ischemia

A

heparin therapy

51
Q

DVT risk factors (7)

A 
prolonged sitting
bed rest
dehydration
post partum
use of OCs
pelvic, hip, knee surgery
trauma
52
Q

DVT manifestations (5 things)

A 
leg pain *unilateral
swelling extremity
erythema
low grade fever
Homan's sign
53
Q

DVT prevention in hospital (3)

A

lovenox/heparin
hydration
out of bed order

54
Q

acute DVT treatment

A

heparin bolus + drip

ongoing monitoring for Coumadin PO after hep. drip

55
Q

pseudoaneurysm definition

A

local dilation between media and adventitia layers

56
Q

Aneurysm definition

A

localized dilation between intima and media layers

57
Q

aneurysm dissection symptoms

A

sharp pain feels like tearing

abdominal will be felt in back/flank

58
Q

endocarditis definition

A

inflammation of the inner lining of the heart

  • usually infectious
  • can involve papillary muscles, chordae tendinae, valves can be involved
  • high mortality rate
59
Q

vegetation in endocarditis

A

can develop on valves, break off and travel to another location to establish there

60
Q

endocarditis risk factors (8)

A 
IV drug abuse
central line
valvular disease
congestive HF
systemic infection from any source
IV placement
abscess/lesion/rash
recent dental work
61
Q

symptoms of endocarditis (10)

A 
fatigue
fever
murmur
pallor
red, painless sports on palms and soles (Janeway lesions)
SOBOE
weakness
weight loss
embolic complications
62
Q

3 goals for treatment of endocarditis

A

kill infection (if infectious)
fix/replace valve
treat symptoms

63
Q

diagnostic tests for endocarditis (5)

A 
clinical exam
positive blood cultures 
CBC
chest x-ray
echocardiogram
64
Q

treatment for endocarditis (4)

A

bed rest
nursing care similar to HF
long term IV antibiotics
valve replacment

65
Q

what could mitral stenosis cause?

A

first affect LA –> pulm edema

66
Q

what could pulmonary stenosis cause?

A

back up in RV and RV + systemic circulation

67
Q

what could incompetent aortic valve lead to?

A

hypertrophy, coronary arteries will not be adequately perfused

68
Q

Systolic Murmur

A

mitral regurg
pulmonic + aortic stenosis
systolic

69
Q

diastolic murmur manifestations

A

mitral (or tricuspid) stenosis
aortic (or pulmonic) regurg
diastolic

70
Q

treatment for valve disorders

A

medications - diuretics, ACEs, ARBs, BBs, ARNIs

valve surgery - open heart/TAVR

71
Q

what is better - valve repair vs. replacement?

A

valve repair is better

72
Q

types of valve repair

A

commissurotomy: clip edges of stenotic valve
valvuloplasty: balloon breaks up calcifications
annuloplasty: put ring around valve to support closure

73
Q

nursing interventions for valve disorders (7)

A 
ongoing assessment - every system, every day
monitor vitals
assess murmur/heart sounds
signs of HF
supplemental O2
meds
monitor lab values
74
Q

types of valves

A

bioprosthetic –> porcine, bovine or cadaver

mechanical

75
Q

pros and cons of mechanical valves

A

last longer

anticoags for life

76
Q

pros and cons of bioprosthetic valve

A

anticoags for 6 months

don’t last as long

Med-Surg (1 decks)

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