med surg cardio Flashcards
what is cardiac output
total blood ejected/pumped by heart per min
total blood ejected/pumped by heart per min is what?
cardiac output
cardiac outpit is important because it measures
how much blood is reaching tissues
number of times heart contracts each min is measured by
heart rate
amount of blood ejected from left ventricle with each contraction is called
stroke volume
cardiac output formula
heart rate x stroke volume
decreased cardiac output indicates
decreased perfusion to vital organs
increased cardiac output indicates
more volume of blood to tissues
percentage of blood pumped from left ventricle after a contraction is measured by
ejection fraction
normal ejection fracture %
50-70% (I.e 50% means half of whats in ventricle is being pumped out)
where is blood returned at the end of diastole
the right side of the heart
what is the amount of blood returned to the right side of the heart called
preload
what is preload
amount of blood returned to right side of the heart
what does systolic blood pressure measure
afterload
what is afterload
pressure that left ventricle pumps against to circulate blood
fat from food are called
triglycerides
normal triglyceride levels
under 150 (triglycerides are signed to herb)
normal ldl lvls
under 100 (if ur in hell it’s cause u didn’t keep it 100)
normal hdl levels for men
over 55
normal hdl lvls for women
over 40
fragments of dissolved clots are called what
d dimers
normal d dimer range
under 0.5
high d dimers can indicate
clot present
disseminated intravascular coagulation (DIC)
peptide released when ventricles are stretched from too much fluid
BNP
normal BNP
under 100
what does high BNP indicate
congestive heart failure
normal cardiac output (L/min)
4-8 L/min
what kind of blood goes to right side of heart
deoxygented
right side of heart blood flow
vena cava>right atrium>tricuspid valve>right ventricle>pulmonary valve> pulmonary artery
left side of heart blood flow
pulmonary vein>left atrium>mitral (bicuspid) valve>left ventricle>aortic valve>aorta
heart conduction flow
sa node>av node>bundle of his>bundle branches>purkinje fibers (send a bitch back P)
what does the SA node control
heart rate
what rate does the SA node go
60-100bpm
what does the AV node do
controls HR if SA node malfunctions
what rate does the AV node go
40-60 bpm
what do the purkinje fibers do
controls HR if SA & AV node malfunction
what rate do purkinje fibers go
30-40
systolic murmurs
MR (mitral regurgitation)
PAYTON MANNING (physiological murmur)
AS (aortic stenosis)
MVP (mitral valve prolapse)
diastolic murmurs
ARMS (aortic regurgitation, mitral stenosis)
what to ask before giving pt nitro
are they taking cialis/viagra
what sound would early diastole (rapid ventricle filling) make when auscultating heart
S3
sound auscultated for late diastole (high atrial pressure)
S4
what does P wave in EKG show
Atrial contraction (depolorization)
what does the QRS complex show
ventricle contraction (depolorization)
what does T wave show
ventricles relaxing (repolorization)
what does the PR interval show
electrical activity from atria to ventricles
what does ST segment show
how long it takes between ventricular depolorization and repolarization (contraction)
what does QT interval show
time ventricles take to depolorize, contract and repolorize
where does white lead go in 5 lead placement
on the top right (white on right)
where does grey lead go in 5 lead placement
left top (smoke over fire)
where does the brown lead go in 5 lead placement
over heart
where does the red lead go in 5 lead placement
left lower (fire)
where does the green lead go in 5 lead placement
right lower (green goes last)
how many seconds is 1 large box on an EKG
0.20 seconds
how many seconds is 1 small box on an EKG
0.04 secs
how many seconds are 5 large boxes on an EKG
1 seconf
normal PR interval range
0.12-0.20 (3-5 small boxes)
normal QRS complex range
0.06-0.12 (1.5-3 small boxes)
what can widened or shortened QRS complex indicate
-PVCs (premature ventricular contraction)
-electrolyte imbalances
-drug toxicity
how to determine heart rate on EKG
count R waves and multiply by 10
how to treat pulseless V tach
defibrillation
mneumonic for left sided heart failure
DROWNING
left sided failure signs
dyspnea
rales
orthopnea
weakness
nocturnal paroxysmal dyspnea (wake up gasping for air)
increased HR
nagging cough
gaining weight
rigth sided heart failure mneumonic
SWELLING
signs of right sided heart failure
swelling of extremities
weight gain
edema (pitting)
large neck veins (JVD)
lethargy
irregular HR
nocturia (lying down helps kidney function)
girth (ascites)
weakened heart muscle is what kind of heart failure
systolic
stiff heart muscle is what kind of heart failure
diastolic heart failure (heart can’t relax)
when is BNP released
when there is increased pressure in ventricles
what to order to diagnose heart failure
-BNP
-chest xray
-echocardiogram
what to monitor in pt with heart failure
-I&Os
-daily weights
-edema
what to report in pt w heart failure
-edema
-weight gain
how should u modify heart failure pt fluid intake
-fluid restrictions
how should u modify heart failure pt sodium
lower sodium
how to modify HF pt fat intake
lower
how to modify HF pt cholesterol intake
lower
what position should HF pt be put in
semi fowlers
what causes CAD
artherosclerosis restricting blood flow to heart
what is artherosclerosis
fatty plaque in arteries
signs of CAD
-ischemia
-angina pectoris
inadequate blood supply to heart is called
ischemia
how to diagnose CAD
lipid panel
ECG
what to check in CAD lipid panel
LDL
HDL
Total cholesterol
triglycerides
What to look for on CAD EKG
ST or T wave changes
pooling of blood in extremities is called
peripheral venous disease
what causes PVD
blocked vein (blood cant get to heart)
pain reported w PVD
dull
achy
constant
will PVD pt have edema
yes from blood pooling
what kind of temp will PVD pt extremities be
warm (from blood)
what color will PVD pt skin be
brown/yellow
brown/yellow skin caused by PVD is called
stasis dermatitis
how will PVD wounds look
irregularly shaped shallow wounds (venous stasis ulcers)
what causes gangrene
insufficient amounts of blood
will PVD pt have gangrene
no (there’ll be increased blood pooling)
how should PVD pt extremities be placed
elevated
what positions worsen PVD
-dangling
-standing/sitting for long periods
blood not being able to get to distal extremities because of atherosclerosis is called
peripheral arterial disease
what causes PAD
blocked artery
when will PAD pt report their pain is worst
at night (rest pain)
will PAD pt have edema
no
how will extremity temp be in PAD pt
cool (no blood)
how will skin on PAD pt extremities be
pale
hairless
dry scaly
thin
how will PAD pt wounds look
regularly shaped
red sores w round appearance
will PAD pt have gangrene
yes (lack of blood)
what position should PAD pt extremities be in
dangled
what can cause peripheral vascular disease
-smoking
-DM
-high cholesterol
-HTN
meds for PVD
aspirin
clopidogrel
statin meds
surgeries for PVD
angioplasty
CABG
endarterectomy
meds for PAD
vasodilators
antiplatelets
should u use heating pads for PAD pt
no
clothing restrictions for PAD pt
no tight clothes
whats the point of PVD treatments
keep the vein open
whats the point of PAD treatments
get blood moving
skin care for PAD pt
moisturize
PVD pt pulse
may not be palpable
when would stable angina occur
exertion
when would unstable angina occur
at rest and frequently
when would prinzmetal/variant angina occur & EKG changes
at rest w reversible ST elevation
where can angina pain radiate to
neck
jaw
shoulders
signs of angina
-chest pain
-fatigue
-weakness
-SOB
-pallor
-diaphoresis
what is the purpose of angina interventions
decrease oxygen demand on heart
meds for angina
nitrates
calcium channel blockers
beta blockers
antiplatelets/anticoagulatns
why do u give nitrates for angina
lower ischemia
vasodilate (increase blood to heart)
why do u give calcium channel blockers for angina
relaxes blood vessels
increase oxygen to heart
decreases heart workload
why do u give beta blockers for angina
decreaees heart oxygen consumption
what kind of chest pain will MI pt have
sudden crushing radiating
will MI chest pain resolve with rest and meds
no
where will pain radiate to in MI
left arm
mid back/shoulder
heartburn
s/s of MI
-SOB
-N/V
-sweating
-pale/dusty skin
MI s/s in women
-fatigue
-shoulder blade discomfort
-SOB
how to diagnose MI
ECG
Troponin
stress test
EKG signs of MI
ST changes
T wave inversion
how to know if MI is caused by no O2 on EKG
ST elevation
how to know if MI is caused by decreased O2 on EKG
ST depression
what is the best indicator of an acute MI
troponin
anti HTN meds MNEUMONIC
ABCDD (ABC DOUBLE D’s)
antiHTN meds classes & their suffixes
ace inhibitors (-pril)
beta blockers (-olol)
calcium channel blockers (-dipine, -amil)
digoxin
diuretics (-thiazide)
how can a BP cuff thats too large affect reading
false low reading
how can BP cuff thats too small affect reading
false high BP
can u take arm BP of pt with hx of blood clots
no
can u take arm BP of pt w mastectomy
no
when are elevated CK lvls detectable after an MI
3-6 hrs
how long is CK-MB (creatine kinase-myocardial band) elevated after a MI
2-3 days
when are troponin T detectable after an MI
2-3 hrs
how long are troponin T lvls elevated after an MI
10-14 days (*T=2 weeks)
when is troponin I detectable after an MI
2-3 hrs
how long is troponin I elevated after an MI
7-10 days
when is myoglobin detectable after an MI
2-3 hrs
how long is myoglobin elevated after MI
24 hrs
troponin T expected range
less than 0.1 (*T= ten)
troponin I expected range
less than 0.03
myoglobin expected range
less than 90 (my green goblin is from the 90s)
what to tell pt before echocardiogram, who asks how long it will take
non invasive wont take longer than an hr
what position should pt be in during echocadiogram
left side
A client who has heart failure should be on a fluid restriction of
2 L per day
how g of sodium can a HF pt have a day
3 g
why cant HF pt cook w baking soda
high in sodium
what causes flattened t waves
hypokalemia
prolonged st and qt intervals are caused by
hypocalcemia
what ekg dysrhytmias happen with digoxin toxicity
av block
v-fib
v-tach
Absent P waves can indicate
atrial fibrillation and sustained ventricular tachycardia
Depressed ST segments can indicate
hypokalemia and ventricular hypertrophy
varying p-p intervals (distance between p waves) indicates
sinus arrythmia (regularly irregular sinus rhythm)
Elevated ST segments can indicate
hyperkalemia and pericarditis.
The appearance of ventricular dysrhythmias following thrombolytic therapy is a sign of
reperfusion of the coronary artery
Pericarditis is usually seen on an ECG as
an ST-T spiking
Chest discomfort associated with pericarditis will decrease when the client sits
upright or leans forward
