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concept 4 > med surg cardio > Flashcards

med surg cardio Flashcards

1
Q

what is cardiac output

A

total blood ejected/pumped by heart per min

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2
Q

total blood ejected/pumped by heart per min is what?

A

cardiac output

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3
Q

cardiac outpit is important because it measures

A

how much blood is reaching tissues

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4
Q

number of times heart contracts each min is measured by

A

heart rate

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5
Q

amount of blood ejected from left ventricle with each contraction is called

A

stroke volume

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6
Q

cardiac output formula

A

heart rate x stroke volume

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7
Q

decreased cardiac output indicates

A

decreased perfusion to vital organs

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8
Q

increased cardiac output indicates

A

more volume of blood to tissues

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9
Q

percentage of blood pumped from left ventricle after a contraction is measured by

A

ejection fraction

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10
Q

normal ejection fracture %

A

50-70% (I.e 50% means half of whats in ventricle is being pumped out)

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11
Q

where is blood returned at the end of diastole

A

the right side of the heart

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12
Q

what is the amount of blood returned to the right side of the heart called

A

preload

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13
Q

what is preload

A

amount of blood returned to right side of the heart

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14
Q

what does systolic blood pressure measure

A

afterload

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15
Q

what is afterload

A

pressure that left ventricle pumps against to circulate blood

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16
Q

fat from food are called

A

triglycerides

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17
Q

normal triglyceride levels

A

under 150 (triglycerides are signed to herb)

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18
Q

normal ldl lvls

A

under 100 (if ur in hell it’s cause u didn’t keep it 100)

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19
Q

normal hdl levels for men

A

over 55

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20
Q

normal hdl lvls for women

A

over 40

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21
Q

fragments of dissolved clots are called what

A

d dimers

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22
Q

normal d dimer range

A

under 0.5

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23
Q

high d dimers can indicate

A

clot present
disseminated intravascular coagulation (DIC)

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24
Q

peptide released when ventricles are stretched from too much fluid

A

BNP

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25
Q

normal BNP

A

under 100

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26
Q

what does high BNP indicate

A

congestive heart failure

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27
Q

normal cardiac output (L/min)

A

4-8 L/min

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28
Q

what kind of blood goes to right side of heart

A

deoxygented

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29
Q

right side of heart blood flow

A

vena cava>right atrium>tricuspid valve>right ventricle>pulmonary valve> pulmonary artery

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30
Q

left side of heart blood flow

A

pulmonary vein>left atrium>mitral (bicuspid) valve>left ventricle>aortic valve>aorta

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31
Q

heart conduction flow

A

sa node>av node>bundle of his>bundle branches>purkinje fibers (send a bitch back P)

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32
Q

what does the SA node control

A

heart rate

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33
Q

what rate does the SA node go

A

60-100bpm

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34
Q

what does the AV node do

A

controls HR if SA node malfunctions

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35
Q

what rate does the AV node go

A

40-60 bpm

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36
Q

what do the purkinje fibers do

A

controls HR if SA & AV node malfunction

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37
Q

what rate do purkinje fibers go

A

30-40

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38
Q

systolic murmurs

A

MR (mitral regurgitation)
PAYTON MANNING (physiological murmur)
AS (aortic stenosis)
MVP (mitral valve prolapse)

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39
Q

diastolic murmurs

A

ARMS (aortic regurgitation, mitral stenosis)

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40
Q

what to ask before giving pt nitro

A

are they taking cialis/viagra

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41
Q

what sound would early diastole (rapid ventricle filling) make when auscultating heart

A

S3

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42
Q

sound auscultated for late diastole (high atrial pressure)

A

S4

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43
Q

what does P wave in EKG show

A

Atrial contraction (depolorization)

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44
Q

what does the QRS complex show

A

ventricle contraction (depolorization)

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45
Q

what does T wave show

A

ventricles relaxing (repolorization)

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46
Q

what does the PR interval show

A

electrical activity from atria to ventricles

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47
Q

what does ST segment show

A

how long it takes between ventricular depolorization and repolarization (contraction)

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48
Q

what does QT interval show

A

time ventricles take to depolorize, contract and repolorize

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49
Q

where does white lead go in 5 lead placement

A

on the top right (white on right)

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50
Q

where does grey lead go in 5 lead placement

A

left top (smoke over fire)

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51
Q

where does the brown lead go in 5 lead placement

A

over heart

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52
Q

where does the red lead go in 5 lead placement

A

left lower (fire)

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53
Q

where does the green lead go in 5 lead placement

A

right lower (green goes last)

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54
Q

how many seconds is 1 large box on an EKG

A

0.20 seconds

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55
Q

how many seconds is 1 small box on an EKG

A

0.04 secs

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56
Q

how many seconds are 5 large boxes on an EKG

A

1 seconf

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57
Q

normal PR interval range

A

0.12-0.20 (3-5 small boxes)

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58
Q

normal QRS complex range

A

0.06-0.12 (1.5-3 small boxes)

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59
Q

what can widened or shortened QRS complex indicate

A

-PVCs (premature ventricular contraction)
-electrolyte imbalances
-drug toxicity

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60
Q

how to determine heart rate on EKG

A

count R waves and multiply by 10

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61
Q

how to treat pulseless V tach

A

defibrillation

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62
Q

mneumonic for left sided heart failure

A

DROWNING

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63
Q

left sided failure signs

A

dyspnea
rales
orthopnea
weakness
nocturnal paroxysmal dyspnea (wake up gasping for air)
increased HR
nagging cough
gaining weight

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64
Q

rigth sided heart failure mneumonic

A

SWELLING

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65
Q

signs of right sided heart failure

A

swelling of extremities
weight gain
edema (pitting)
large neck veins (JVD)
lethargy
irregular HR
nocturia (lying down helps kidney function)
girth (ascites)

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66
Q

weakened heart muscle is what kind of heart failure

A

systolic

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67
Q

stiff heart muscle is what kind of heart failure

A

diastolic heart failure (heart can’t relax)

68
Q

when is BNP released

A

when there is increased pressure in ventricles

69
Q

what to order to diagnose heart failure

A

-BNP
-chest xray
-echocardiogram

70
Q

what to monitor in pt with heart failure

A

-I&Os
-daily weights
-edema

71
Q

what to report in pt w heart failure

A

-edema
-weight gain

72
Q

how should u modify heart failure pt fluid intake

A

-fluid restrictions

73
Q

how should u modify heart failure pt sodium

A

lower sodium

74
Q

how to modify HF pt fat intake

A

lower

75
Q

how to modify HF pt cholesterol intake

A

lower

76
Q

what position should HF pt be put in

A

semi fowlers

77
Q

what causes CAD

A

artherosclerosis restricting blood flow to heart

78
Q

what is artherosclerosis

A

fatty plaque in arteries

79
Q

signs of CAD

A

-ischemia
-angina pectoris

80
Q

inadequate blood supply to heart is called

A

ischemia

81
Q

how to diagnose CAD

A

lipid panel
ECG

82
Q

what to check in CAD lipid panel

A

LDL
HDL
Total cholesterol
triglycerides

83
Q

What to look for on CAD EKG

A

ST or T wave changes

84
Q

pooling of blood in extremities is called

A

peripheral venous disease

85
Q

what causes PVD

A

blocked vein (blood cant get to heart)

86
Q

pain reported w PVD

A

dull
achy
constant

87
Q

will PVD pt have edema

A

yes from blood pooling

88
Q

what kind of temp will PVD pt extremities be

A

warm (from blood)

89
Q

what color will PVD pt skin be

A

brown/yellow

90
Q

brown/yellow skin caused by PVD is called

A

stasis dermatitis

91
Q

how will PVD wounds look

A

irregularly shaped shallow wounds (venous stasis ulcers)

92
Q

what causes gangrene

A

insufficient amounts of blood

93
Q

will PVD pt have gangrene

A

no (there’ll be increased blood pooling)

94
Q

how should PVD pt extremities be placed

A

elevated

95
Q

what positions worsen PVD

A

-dangling
-standing/sitting for long periods

96
Q

blood not being able to get to distal extremities because of atherosclerosis is called

A

peripheral arterial disease

97
Q

what causes PAD

A

blocked artery

98
Q

when will PAD pt report their pain is worst

A

at night (rest pain)

99
Q

will PAD pt have edema

A

no

100
Q

how will extremity temp be in PAD pt

A

cool (no blood)

101
Q

how will skin on PAD pt extremities be

A

pale
hairless
dry scaly
thin

102
Q

how will PAD pt wounds look

A

regularly shaped
red sores w round appearance

103
Q

will PAD pt have gangrene

A

yes (lack of blood)

104
Q

what position should PAD pt extremities be in

A

dangled

105
Q

what can cause peripheral vascular disease

A

-smoking
-DM
-high cholesterol
-HTN

106
Q

meds for PVD

A

aspirin
clopidogrel
statin meds

107
Q

surgeries for PVD

A

angioplasty
CABG
endarterectomy

108
Q

meds for PAD

A

vasodilators
antiplatelets

109
Q

should u use heating pads for PAD pt

A

no

110
Q

clothing restrictions for PAD pt

A

no tight clothes

111
Q

whats the point of PVD treatments

A

keep the vein open

112
Q

whats the point of PAD treatments

A

get blood moving

113
Q

skin care for PAD pt

A

moisturize

114
Q

PVD pt pulse

A

may not be palpable

115
Q

when would stable angina occur

A

exertion

116
Q

when would unstable angina occur

A

at rest and frequently

117
Q

when would prinzmetal/variant angina occur & EKG changes

A

at rest w reversible ST elevation

118
Q

where can angina pain radiate to

A

neck
jaw
shoulders

119
Q

signs of angina

A

-chest pain
-fatigue
-weakness
-SOB
-pallor
-diaphoresis

120
Q

what is the purpose of angina interventions

A

decrease oxygen demand on heart

121
Q

meds for angina

A

nitrates
calcium channel blockers
beta blockers
antiplatelets/anticoagulatns

122
Q

why do u give nitrates for angina

A

lower ischemia
vasodilate (increase blood to heart)

123
Q

why do u give calcium channel blockers for angina

A

relaxes blood vessels
increase oxygen to heart
decreases heart workload

124
Q

why do u give beta blockers for angina

A

decreaees heart oxygen consumption

125
Q

what kind of chest pain will MI pt have

A

sudden crushing radiating

126
Q

will MI chest pain resolve with rest and meds

A

no

127
Q

where will pain radiate to in MI

A

left arm
mid back/shoulder
heartburn

128
Q

s/s of MI

A

-SOB
-N/V
-sweating
-pale/dusty skin

129
Q

MI s/s in women

A

-fatigue
-shoulder blade discomfort
-SOB

130
Q

how to diagnose MI

A

ECG
Troponin
stress test

131
Q

EKG signs of MI

A

ST changes
T wave inversion

132
Q

how to know if MI is caused by no O2 on EKG

A

ST elevation

133
Q

how to know if MI is caused by decreased O2 on EKG

A

ST depression

134
Q
A
135
Q

what is the best indicator of an acute MI

A

troponin

136
Q

anti HTN meds MNEUMONIC

A

ABCDD (ABC DOUBLE D’s)

137
Q

antiHTN meds classes & their suffixes

A

ace inhibitors (-pril)
beta blockers (-olol)
calcium channel blockers (-dipine, -amil)
digoxin
diuretics (-thiazide)

138
Q

how can a BP cuff thats too large affect reading

A

false low reading

139
Q

how can BP cuff thats too small affect reading

A

false high BP

140
Q

can u take arm BP of pt with hx of blood clots

A

no

141
Q

can u take arm BP of pt w mastectomy

A

no

142
Q

when are elevated CK lvls detectable after an MI

A

3-6 hrs

143
Q

how long is CK-MB (creatine kinase-myocardial band) elevated after a MI

A

2-3 days

144
Q

when are troponin T detectable after an MI

A

2-3 hrs

145
Q

how long are troponin T lvls elevated after an MI

A

10-14 days (*T=2 weeks)

146
Q

when is troponin I detectable after an MI

A

2-3 hrs

147
Q

how long is troponin I elevated after an MI

A

7-10 days

148
Q

when is myoglobin detectable after an MI

A

2-3 hrs

149
Q

how long is myoglobin elevated after MI

A

24 hrs

150
Q

troponin T expected range

A

less than 0.1 (*T= ten)

151
Q

troponin I expected range

A

less than 0.03

152
Q

myoglobin expected range

A

less than 90 (my green goblin is from the 90s)

153
Q

what to tell pt before echocardiogram, who asks how long it will take

A

non invasive wont take longer than an hr

154
Q

what position should pt be in during echocadiogram

A

left side

155
Q

A client who has heart failure should be on a fluid restriction of

A

2 L per day

156
Q

how g of sodium can a HF pt have a day

A

3 g

157
Q

why cant HF pt cook w baking soda

A

high in sodium

158
Q

what causes flattened t waves

A

hypokalemia

159
Q

prolonged st and qt intervals are caused by

A

hypocalcemia

160
Q

what ekg dysrhytmias happen with digoxin toxicity

A

av block
v-fib
v-tach

161
Q

Absent P waves can indicate

A

atrial fibrillation and sustained ventricular tachycardia

162
Q

Depressed ST segments can indicate

A

hypokalemia and ventricular hypertrophy

163
Q

varying p-p intervals (distance between p waves) indicates

A

sinus arrythmia (regularly irregular sinus rhythm)

164
Q

Elevated ST segments can indicate

A

hyperkalemia and pericarditis.

165
Q

The appearance of ventricular dysrhythmias following thrombolytic therapy is a sign of

A

reperfusion of the coronary artery

166
Q

Pericarditis is usually seen on an ECG as

A

an ST-T spiking

167
Q

Chest discomfort associated with pericarditis will decrease when the client sits

A

upright or leans forward

concept 4 (12 decks)

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