med surg lecture 4 Flashcards

1
Q

the cardio-vascular system consists of what

A

-heart
-blood
-vessels
-arteries
-veins
-capillaries

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2
Q

vessels consist of

A

-arteries
-veins
-capillaries

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3
Q

where is the heart located

A

central thoracic cavity
Mediastinum

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4
Q

the pericardial sac consists of what

A

-fibrous pericardium
-parietal pericardium
-visceral pericardium

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5
Q

what is the visceral pericardium also known as

A

epicardium

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6
Q

what part of the pericardial sac outlines the heart

A

fibrous pericardium

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7
Q

what part of the pericardial sac is serous membrane and decreases fricton

A

parietal pericardium

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8
Q

what part of the pericardial sac that is the inner most protective layer

A

visceral pericardium (epicardium)

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9
Q

what are the cardiac layers

A

-epicardium
-myocardium
-endocardium

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10
Q

the protective layer of the heart

A

epicardium

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11
Q

the thick layer of muscle of the heart and aides in contraction

A

myocardium

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12
Q

the layer of the heart inside the cardiac chambers lining the inside of the heart chambers and valves

A

endocardium

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13
Q

how the heart is being profused with oxygen is called what

A

coronary circulation

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14
Q

this artery supplies blood to the right atrium, right ventricle, bottom portion of the left ventricle and back of the septum

A

right coronary artery

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15
Q

veins that take oxygen-poor deoxygenated blood that has been “used” by muscles of the heart and return it to the right atrium

A

coronary veins

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16
Q

artery that divides into two branches: the circumflex artery and the left anterior descending artery

A

left coronary artery

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17
Q

artery that supplies blood to the left atrium and the side and back of the left ventricle

A

circumflex artery

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18
Q

artery that supplies blood to the front and bottom of the left ventricle and the front of the septum

A

left anterior descending artery (LAD)

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19
Q

superior chambers of the heart

A

right atrium
left atrium

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20
Q

inferior chambers of the heart

A

right ventricle
left ventricle

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21
Q

which part of the heart has the thickest wall

A

left ventricle

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22
Q

what are the cardiac valves

A

atrioventricular valves (AV)
semilunar valves

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23
Q

what are the atrioventricular valves

A

right av valve - tricuspid
left av valve - bicuspid/mitral

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24
Q

coronary blood flow in order

A

-inferior/superior vena cava
-right atrium
-tricuspid valve
-right ventricle
-pulmonic/pulmonary valve
-pulmonary artery
-lungs (oxygenation occurs)
-pulmonary veins
-left atrium
-mitral/bicuspid valve
-left ventricle
-aortic valve
-aorta
-body tissue/organs

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25
Q

the heart is an _________ driven pump

A

electrically

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26
Q

the pump is comprised of ______

A

muscle

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27
Q

the pump requires both ________ and ________ to function

A

electricity and oxygen

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28
Q

muscle tissue needs _______ to survive

A

oxygen

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29
Q

electricity is derived from ________

A

electrolytes

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30
Q

which electrolytes are important for cardiac electrical system

A

-potassium
-sodium
-calcium
-magnesium

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31
Q

electrical conduction system coordinates both ______ and _______ of the heart chambers

A

-contraction
-relaxation

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32
Q

pathway of electrical impulses that generates a heartbeat

A

conduction pathway

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33
Q

electrical impulses causes the heart to _______ and pump _______ to the rest of the body

A

-contract
-blood

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34
Q

cardiac conduction pathway includes

A

-sinoatrial (SA) node
-interatrial node/pathway bundle
-atrioventricular (AV) node
-bundle of His
-right and left bundle branches
-purkinje fibers

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35
Q

which node is located in the wall of right atrium

A

sinoatrial node (SA)

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36
Q

what is also called bachmann’s bundle

A

interatrial node/pathway/bundle

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37
Q

known as “pacemaker” of the heart

A

sinoatrial node

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38
Q

this node delays conduction briefly

A

atrioventricular node

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39
Q

connecting fibers that rapidly send an impulse from the right atrium to the left atrium

A

interatrial node/pathway/bundle

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40
Q

what starts the heart rate and keeps the heart rate going

A

sinoatrial node

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41
Q

what gives atria time to contract and pump all blood into the ventricles

A

atrioventricular node because it delays conduction briefly

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42
Q

conduction passes from av node and travels through

A

bundle of his

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43
Q

conduction bifurcates into the what and travels through the walls of venticles

A

right and left bundle branches

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44
Q

fibers spread widely across the ventricles to cause all cells of the ventricles to contract quickly and this is when blood is expelled from ventricles

A

purkinjie fibers

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45
Q

as atria and ventricles refill with blood the SA and AV node _______ with electrolytes so that they can repeat the electrical conduction cycle again

A

recharge

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46
Q

cardiac conduction pathway in order

A

-sinoatrial node
-interatrial node/pathway/bundle (bachmanns bundle)
-atrioventricular node
-bundle of his
-right and left bundle branches
-purkinje fibers

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47
Q

a single cycle of cardiac activity can be divided into what two phases

A

systole
diastole

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48
Q

contraction of chambers is called what

A

systole

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49
Q

relaxation of chambers is called what

A

diastole

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50
Q

atrial systole

A

atria contracts, blood flows from the atria into ventricals

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51
Q

ventricular diastole

A

ventricles relax filling with blood sent from atria

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52
Q

amount of blood ejected from the left ventricle in one minute

A

cardiac output

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53
Q

how do you calculate cardiac output

A

stroke volume x heart rate

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54
Q

amount of blood pumped per beat

A

stroke volume

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55
Q

number of heart beats in one minute

A

heart rate

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56
Q

what is cardiac output measured in

A

L/min or mL/min

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57
Q

what is the average cardiac output for a healthy adult is about

A

5L/min

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58
Q

amount of blood the left ventricle pumps out with each contraction

A

ejection fracture

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59
Q

what value shows how well the heart is functioning

A

the ejection fraction value

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60
Q

normal range of ejection fraction

A

55% - 70%

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61
Q

an ejection fraction under 40% may be evidence of _________ or _________

A

heart failure or cardiomyopathy

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62
Q

what is the most common test performed to determine the ejection fraction

A

echocardiogram

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63
Q

force of blood against blood vessel walls

A

blood pressure

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64
Q

what is blood pressure measured in

A

millimeters of mercury

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65
Q

why is blood pressure greatest in the arteries

A

there is more force to get to the body

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66
Q

arteries and arterioles are usually slightly _______ to maintain normal blood pressure

A

constricted

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67
Q

if heart rate and force of contraction increases what happens

A

blood pressure increases

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68
Q

if heart rate is increased but ventricles are not filing prior to contraction, cardiac output will be decreased and cause blood pressure to what

A

decrease

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69
Q

the average pressure within the arteries throughout one cardiac cycle (systole and diastole)

A

mean arterial pressure

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70
Q

what is considered a better indicator of perfusion to vital organs than the blood pressure

A

The MAP

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71
Q

if the MAP is below __ mmHg for prolonged periods of time, vital organs are not receiving adequate blood flow and oxygen

A

65

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72
Q

if the MAP is above ___ mmHg for prolonged periods of time the heart workload is increased which leads to various complications

A

100

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73
Q

what is the MAP equation

A

systolic blood pressure + 2 times the diastolic blood pressure divided by 3

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74
Q

what does MAP stand for

A

mean arterial pressure

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75
Q

when calculating the MAP if results are decimals what do you need to do

A

round to the nearest whole number

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76
Q

hormones made by your adrenal glands

A

catecholamines

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77
Q

neurotransmitters of the sympathetic nervous system

A

epinephrine and norepinephrine

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78
Q

what happens when epinephrine and norepinephrine are released

A

-increased impulse conduction
-increased heart rate
-increase in systolic BP (due to increased cardiac output)

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79
Q

what regulates serum sodium and potassium levels

A

aldosterone

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80
Q

aldosterone is made by the _________

A

adrenal cortex

81
Q

when aldosterone is released kidneys hold onto ______ and releases _______ via urine

A

sodium
potassium

82
Q

aldosterone will be released by the body if it needs to ________ blood pressure

A

raise

83
Q

increases excretion of sodium by inhibiting secretion of aldosterone

A

atrial natriuretic peptide

84
Q

atrial natriuretic peptide inhibits release of _________ when blood pressure is too high

A

aldosterone

85
Q

atrial natriuretic peptide is released when we need blood pressure to be _______

A

lowered

86
Q

arteries and arterioles carry blood ______ the heart ____ capillaries

A

from
to

87
Q

arteries and arterioles are thicker than veins because

A

it needs more protection

88
Q

what are the inner layers of arteries and arterioles made up of

A

simple squamous

89
Q

capillaries carry blood _____ arterioles ____ venules

A

from
to

90
Q

continuation of the lining of arteries and veins

A

capillaries

91
Q

capillaries are ____ cell thick to permit exchange of _____, ______, and _______

A

one
gases
nutrients
waste products

92
Q

capillaries are ____ and _______

A

thin
fragile

93
Q

veins and venules carry blood _____ capillaries ____ heart

A

from
to

94
Q

veins dont have as much ______ as arteries

A

pressure

95
Q

what happens to the heart as a person ages

A

-increased atherosclerosis
-resting blood pressure increases
-vein valves more incompetent
-decreased HR
-kyphosis

96
Q

atherosclerosis

A

-build up of fats, cholesterol and other substances on artery walls
-reduced/restricted blood flow
-atherosclerosis increases risk for developing cardiovascular disease, increases with age

97
Q

why does resting blood pressure increase

A

left ventricle workload increases, increased risk for left sided heart failure

98
Q

vein valves more incompetent causes

A

-backflow of blood, varicosities
-dependent edema

99
Q

dependent edema is caused by

A

blood not being able to get back up and it starts pooling

100
Q

what causes decreased heart rate in older adults

A

-conduction cells less effective
-dysrhythmias common

101
Q

kyphosis causes what

A

-changes the shape of chest walls
-hear sounds distant

102
Q

start cardiovascular assessment with ________ data

A

subjective

103
Q

subjective data of a cardiovascular assessment

A

-health history
-follow up with appropriate questions and assessments based on patients complaints

104
Q

if there are cardiac related issues upon questioning like dizziness, fatigue, chest tightness/pain, sob or dyspnea do

A

vital signs
thorough pain assessment by scale
ask more questions about sob and dyspnea

105
Q

appropriate oxygenation and blood flow to area of skin color

A

pink

106
Q

decreased arterial blood flow or decreased oxygen to tissues skin color, possible anemia

A

pallor

107
Q

color of skin with gas exchange and/or perfusion issue, tissues are oxygen deficient

A

cyanosis

108
Q

decreased arterial blood flow causes what

A

blood not able to get to the extremeties

109
Q

what will skin look like with decreased arterial blood flow

A

-dependent rubor (red)
-shiny, taut, dry skin and decreased hair distribution

110
Q

venous blood flow problems causes what

A

blood cant get back to the heart and it is pooling in the extremities

111
Q

what will skin look like with venous blood flow problems

A

brown discoloration
purple/blue skin in dependent position

112
Q

veins in neck are distended/visible when sitting 45-90 degrees and this is caused by increase in venous volume; fluid overload

A

jugular venous distention

113
Q

S1 heart sound is heard when

A

the beginning of ventricular systole

114
Q

S2 hear sound is heard when

A

the start of ventricular diastole

115
Q

this is caused by narrowed valve opening or a valve that doesnt close tightly and prolonged swishing sound due to regurgitation of blood

A

murmur

116
Q

what causes heart sounds

A

valve closure

117
Q

which valves makes s1 “lubb” sounds

A

tricuspid and mitral

118
Q

which valves makes s2 “dubb” sound

A

aortic and pulmonary

119
Q

palpation of cardiac assessment

A

-capillary refill
-edema
-pulses
-temperature

120
Q

capillary refill of <3 seconds indicates what
and >3 seconds indicates what

A

-appropriate arterial blood flow
-decrease in arterial blood flow

121
Q

swelling in dependent extremities is due to

A

fluid build up/fluid overload

122
Q

pulses assess what and what do we need to determine with the pulse

A

arterial blood flow to area and determine rate, volume and strength

123
Q

if pulse is 0 what is it

A

absent

124
Q

if pulse is 1+ what is it

A

weak/thready

125
Q

what condition might a person have if their pulse is 1+

A

hypotension

126
Q

what does it mean if a person has a 2+ pulse

A

strong

127
Q

what does it mean if a person has a 3+ pulse

A

bounding

128
Q

what conditions can a person have if pulse is 3+

A

htn
fluid overload

129
Q

athletic individuals may have a heart rate between

A

40-50 bpm

130
Q

what are the 6 P’s of a neurovascular assessment

A

-pain
-paresthesia
-pulselessness
-pallor
-poikilothermia
-paralysis

131
Q

diagnostic studies not heart specific

A

-chest xray
-ct scan
-cta scan
-mri
-ultrasound of extremities

132
Q

chest xray of heart shows what

A

size, position and structures of heart

133
Q

ct scan of heart shows

A

calcified plaque in the coronary arteries

134
Q

cta scan of heart shows

A

blood flow within coronary arteries

135
Q

mri of heart can identify

A

ischemia and heart damage

136
Q

ultrasounds of extremities

A

-arterial ultrasound
-venous ultrasound

137
Q

which ultrasound of the extremities will look for dvts

A

venous ultrasound

138
Q

heart specific diagnostic testing

A

-echocardiogram
-electrocardiogram
-cardiac monitoring

139
Q

ultrasound test specific for the heart

A

echocardiogram

140
Q

what does the machine record when doing an echocardiogram

A

-the motion of heart structures (valves and chambers)
-heart size, shape, position
-visualize blood flow through heart
-determine ejection fraction of left ventricle

141
Q

what test shows cardiac electrical activity in a moment of time like a snapshot

A

electrocardiogram

142
Q

the ekg or electrocardiogram will reflect abnormalities related to:

A

-conduction
-heart rate and rhythm
-heart chamber enlargement
-myocardial ischemia and/or infarction
-electrolyte imbalances

143
Q

cardiac monitoring is also known as

A

telemetry

144
Q

how many leads with electrodes are connected to a central cardiac monitor

A

5 leads

145
Q

cardiac monitoring may be worn if patient has:

A

-cardiac complaints
-receiving medications that can change cardiac activity
-during acute illness
-electrolyte imbalances
-iv electrolyte replacement

146
Q

which lead is colored white

A

RA

147
Q

which lead is colored green

A

RL

148
Q

which lead is colored black

A

LA

149
Q

which lead is colored red

A

LL

150
Q

which lead is colored brown

A

V

151
Q

labs specific to the cardiovascular system

A

-troponin
-ck-mb
-bnp
-electrolytes
-lipid panel
-d-dimer

152
Q

what electrolytes labs are ran for cardiovascular system

A

-potassium
-calcium
-magnesium
-sodium

153
Q

this lab is drawn in serial increments every few hours to see if acute cardiac damage is persistent/continuing

A

troponin

154
Q

the more cardiac damage present the _______ the troponin value

A

higher

155
Q

this lab supports the diagnosis of myocardial injury and will be ordered in conjunction with what other lab

A

-CK-MB
-will be ordered with troponin

156
Q

this lab is ordered to diagnose and monitor progression of chronic heart failure

A

brain naturetic peptide (BNP)

157
Q

what is the gold standard for heart attack labs

A

troponin

158
Q

all therapeutic measures for cardiovascular issues

A

-improve diet
-promote exercise
-weight loss if needed
-smoking cessation
-ted hose/stocking
-sequential compression devices
-leg elevation
-supplemental oxygen
-medications

159
Q

what ways would you tell a patient to change their diet if they have cardiovascular disease

A

-increase fruits and veggies
-decreased saturated fats

160
Q

how can exercise improve cardiovascular issues

A

-promotes and improves blood flow
-assists in optimum cardiac function

161
Q

smoking causes _________ which reduces blood flow

A

vasoconstriction

162
Q

ted hose/stockings improve _______ blood flow and _____ blood return

A

arterial
venous

163
Q

ted hose/stockings prevent what two things

A

-clots
-edema

164
Q

what type of patients are ted hose/stockings used for

A

-peripheral vascular disease
-bedrest
-after surgery/trauma

165
Q

what is the most important thing to remember when using a sequential compression devices

A

make sure it is turned on

166
Q

leg elevation should be done when there is _______ insufficiency

A

venous

167
Q

if a patient has ______ blood flow problems you should not elevate legs

A

arterial

168
Q

what type of position would you want your patient in if they are having arterial blood flow problems

A

dependent

169
Q

the formation of plaque buildup in the walls of the arteries throughout the body

A

atherosclerosis

170
Q

build up of fatty deposits

A

plaque

171
Q

plaque causes what

A

irregular and jagged edges which causes blood cells and other material to stick

172
Q

atherosclerosis may lead to

A

ischemia of the organ/tissue

173
Q

with atherosclerosis arteries ______ and lead to decreased blood flow and oxygen delivery to organs and tissues

A

narrow

174
Q

modifiable risk factors for atherosclerosis

A

-diabetes
-hypertension
-elevated cholesterol
-elevated ldl
-excessive alcohol use
-obesity
-sedentary lifestyle
-tobacco use

175
Q

non-modifiable risk factors for atherosclerosis

A

-older age
-african american
-male
-genetics

176
Q

atherosclerosis lifestyle treatment

A

-smoking and alcohol cessation
-low fat and low cholesterol diet
-exercise

177
Q

atherosclerosis medication treatments

A

-antiplatelet aggregators
-lipid lowering medication

178
Q

increased activity can raise what lab levels and improve blood flow/circulation

A

HDL levels

179
Q

what are the two antiplatelet aggregators

A

aspirin and clopidogrel

180
Q

what are the first line drugs to reduce ldl levels in the body by reducing cholesterol synthesis

A

statins

181
Q

what are the two things aspirin does

A

-antiplatelet aggregator
-nsaid

182
Q

antiplatelet aggregators do what to the platelets

A

makes them less sticky

183
Q

what labs will you monitor when taking aspirin

A

platelets
hemoglobin
hematocrit

184
Q

what will you need to educate patient on when they are taking aspirin

A

that they may bleed or bruise easily

185
Q

if platelets are below _____ you will hold patients antiplatelet aggregator

A

100

186
Q

common medications for cholesterol

A

simvastatin (zocor)
atorvastatin (lipitor)
pravastatin (pravachol)

187
Q

what do statins do

A

reduces ldls and total cholesterol levels
may increase hdls

188
Q

what time of day should statins be taken

A

in the evening

189
Q

what should you watch for when a patient is taking statins

A

muscle pain can cause rhabdomyolysis

190
Q

narrowing of coronary arteries due to plaque buildup

A

coronary artery disease

191
Q

chest pain due to ischemia

A

angina pectoris

192
Q

coronary artery disease decreases blood flow which causes what

A

decreased oxygen delivery to cardiac tissue

193
Q

stable chest pain qualities

A

-pain is predictable
-occurs with moderate exertion in familiar pattern
-usually stops with rest or nitroglycerin

194
Q

unstable chest pain qualities

A

-pain is unpredictable
-occurs with less exertion, at rest, during sleep
-unrelieved with rest or nitroglycerin
-can lead to myocardial infarction

195
Q

what does angina feel like

A

-chest pain
-chest pressure
-squeezing sensation in chest
-indigestion
-pain that spreads to your neck, jaw, arms, back or belly

196
Q

what is the key drug to fight heart ischemia

A

nitroglycerin

197
Q

what does nitroglycerin do in the body

A

-dilates coronary arteries to increase oxygen
-dilates peripheral vessels to decrease work for the heart

198
Q

nursing considerations for patients taking nitroglycerin

A

-monitor bp, hr, and pain level before and after administration
-sublingual
-carry at all times and in original container
-sit down or lay down while taking due to blood pressure changes

199
Q

what is a common side effect of nitroglycerin

A

headache