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Medsurg > Midterms p.2 > Flashcards

Midterms p.2 Flashcards

1
Q

pathophysiology of pericarditis

A

INFLAMATION OF PERICARDIUM
1. Inflamed parietal and visceral layer - Friction rub - Chest pain
2. thickened - constrict - innefective contraction - decrease CO - decrease perfusion
3. accumulation of serum - pleural effusion - pressure to the heart below - cardiac tamponade

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2
Q

what are the risk factors of pericarditis?

A
  1. Idiopathic autoimmune infection
  2. neoplastic disorders / disorders Radio theraphy
  3. Chest trauma / metabollic anemia
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3
Q

clinical symptoms of Pericarditis

A

Asymptomatic
Chest pain
Heart rate increase
ESR Increase
Symptoms of anemia
Temperature increase
Friction rub (plueral)
Increase WBC count
R-eactive C protein
Exertion symptoms ( Conpensation)

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4
Q

Diagnostic of Pericarditis

A

Echocardiogram
Pericardiocentesis
TEE
CT scan
MRI
RL ECG

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5
Q

what is the difference between CT scan and MRI?

A

CT scan - Size / Shape / Location
MRI - Detect Inflam / Adhesion

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6
Q

what dx to determine ST segment elevation

A

RL ECG

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7
Q

RL ECG means

A

ST segment elevation

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8
Q

what are the medication of Pericarditis?

A

NSAIDS
Cortecosteriods
Colchicine
Antibiotics

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9
Q

nx intervention of pericarditis

A

Decrease pain - positioning / high fowlers / sitting up right leaning forwards

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10
Q

removal of fluid by what? in pericarditis?

A

Pericardiocentesis by culture

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11
Q

what are the disorder of the layer?

A

pericarditis , myocarditis , edocarditis

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12
Q

reisk factor of myocarditis

A

microorganism / inflam reaction

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13
Q

clinical symptoms of myocarditis

A

Fatigue
Increase Heart Rate
New onset of dyspnea
Dyspnea
Chest pain
High WBC
Elevated C-reactive Protein
Systolic murmur
Temporary Syncope
Syncope
Palpitations
Increase ESR
New murmur

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14
Q

why do we need to avoid nsaid when having myocarditis?

A

because it increase cardiac injury

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15
Q

nx intervention when having myocarditis

A

antibiotics
Bed rest
Avoid Nsaid
Anti Embolic stocking
Passive and Active Excercise

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16
Q

difference of adult and child affect in endocarditis

A

adult: stapyloccocus
child: stretococcus

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17
Q

small pailful node

A

oslens node

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18
Q

irregular red/purple painless flat macules

A

janeway lesion

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19
Q

hemorrhages with pale center in the retina

A

roth spot

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20
Q

hemorrhages fingers and toe nails (reddish - brown lines / streaks)

A

splinter

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21
Q

clinical symptoms of endocarditis

A

fever
heart murmur
oslens node
jane way lesions
roth spot
splinter

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22
Q

diagnostics of endocarditis

A

culture and sensitivity

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23
Q

what need to prevent in endocarditis

A

antibiotic - eradicate good oral hygiene

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24
Q

surgery of endocarditis

A

valve replacement and debridement of vegetation

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25
Q

valves cannot fully open

valves cannot fully close

protrusion of the valves

A

Stenosis
Regurgitation
Prolapse

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26
Q

what happen to tricuspid stenosis?

A

Fatigue
Cyanosis
Diastolic Murmur
R ventricular Failure: Ascite / hepatomegaly , Peripheral edema / jugular vein distention , Decerease CO

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27
Q

r ight ventricular failure indicate?

A

ascites/ hepatomegaly
peripheral edema
jugular vein distention
decrease CO

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28
Q

tricuspid regugitation

A

Asymptomatic
RV failure
Pleural Effussion
Systolic murmur - 4th ICS

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29
Q

mitral stenosis?

A

Dyspnea on excertion
Fatigue - decrease CO
Dry cough - Hemoptysis / wheezing
Orthopnea
Low pitch murmur

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30
Q

Mitral regurgitation

A

asymptomatic
systolic murmur

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31
Q

Dx of mitral stenosis

A

exhocardiogram

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32
Q

mngt of mitral stenosis

A

anti biotics, anti coagulats , rest

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33
Q

mngt of mitral regurgitation?

A

ACE/ ASB
Vasodilators
Beta blockers

to decrease Afterload

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34
Q

surgery of mitral regurgutation

A

valvuloplasty and valve replacement

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35
Q

prolapse mitral indicate

A

Fatigue
Asymptomatic
Lightheadedness
Loss of consciouness
SOB
Chestpain
Palpitations

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36
Q

pulmonic stenosis

A

Asymptomatic / Dyspnea / Fatigue / Syncope/ RV failure (ascites /edema/hepatomegaly

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37
Q

Aortic stenosis

A

Dyspnea on excertion / syncope / angina / orthopnea / fatigue / systolic mumur

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38
Q

aortic regurgitation

A

diastolic murmur

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39
Q

reduction of blood flow to the cardiac muscle due to build up of atherosclerotic plaque in the arteries of the heart

A

coronary artery disease

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40
Q

what are the risk factor of coronary artery disease?

A

Increase LDL , age Gender, smoking , DM, Increase
SBP, decrease HDL, inactivity

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41
Q

pathophysiology of Coronary artery disease

A

endodelium - injury - inflamatory process - macrophage ingest lipids - transport it to the arterial wall - fatty streaks - activation of macrophage - release of biochemical subs - damage to endothelium - oxidation of LDL - toxic endothelial wall - atherosclerotic formation - rupture- attract more platelets -thrombus formation - obstruction - MI

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42
Q

s/sx of coronary artery

A

chest pain
decrease Tissue perfusion
decrease anabolic respi - decrease co2 - lactic acidosis leads to irritant to muscle

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43
Q

how to prevent coronary artery disease

A
  1. control cholesterol
  2. physical activty
  3. medications: c-statin , fibrates, cholesterol inhibito
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44
Q

how many min in phyiscal activity to prevent CAD? or to reduce cholesterol

A

75-100 min/week

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45
Q

how to determine if there is a presence of clot formation or blockage?

A

Percutaneus Transluminal Coronary Angiography

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46
Q

pain/pressue on the anterior chest

A

angina pectoris

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47
Q

risk factors of angina pectoris

A

Exerciton / exposure to cold / Elevated BP / Eating heavy meal / emotion provoking situation

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48
Q

what type of angina pectoris is : predictable / consistent / occurs on excertion relieved by rest and NTG

A

Stable

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49
Q

stable angina pectoris can be relieved by?

A

NTG and rest

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50
Q

what type of angina pectoris may not be relieved by rest or NTG

A

unstable

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51
Q

what type of angina pectoris is severe / incapacitating chest pain / cannot relieved

A

intractable

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52
Q

what type of angina pectoris prinzmetal / pain @ rest

A

Variant

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53
Q

what is silent angina pectoris

A

no report of pain but ecg changes

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54
Q

what is the s/sx of angina pectoris?

A

chest pain radiate to neck and shoulder left arm

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55
Q

what are the dx of angina pectoris ?

A

12- lead ecg
stress test
cardiac cath
coronary artery angioplasty
Echo

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56
Q

T wave inversion ABN Q wave

A

12 lead ECG

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57
Q

mngt of angina pectoris

A

OBJ: Decrease O2 demand

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58
Q

decrease SA node automaticity

A

Ca channel blocker

59
Q

AV node conduction

A

CA channel blocker

60
Q

pharmacologi of angina pectoris

A

NTG
Beta-blocker
Ca channel blocker
Antiplatelet / coagulant / aspirin (oral) / heparin (IV)
02

61
Q

decrease myocardial consumption what drug

A

beta-blocker

62
Q

AKA acute coronary syndome

A

Myocardial Infarction

63
Q

s/sx of Myocardial infarction

A

CAN I Stop Chestpain
Chest pain
Anxiety
Nausea
Indigention
Shortness of breath
Cool pale moist skin

64
Q

if the ecg found T wave invertion it indicate?

A

Ischemia

65
Q

ecg found ST segment indicate?

A

injury

66
Q

ecg found Abn in Q wave indicate?

A

Infarction

67
Q

in echo what will youu see having MI?

A

hypokinetic and akinetic wall motion

68
Q

when pci is not available what medication? in MI

A

thrombolitics (IV) and should be given 30 mins of symptoms onset

69
Q

drug of choice for chest pain in MI

A

morphine sulfate

70
Q

nX management of valvular disorder

A

echo: after 3 to 4 wks
Repeated: 1-2 yrs
Avoid dental procedure 6 months
Avoid heavy lifting

71
Q

A ballon tipped catheter is used to open blocked coronary artery and what is the purpose

A

Percutaneus Transluminal Coronary Angiography to miprove blood flow

72
Q

PTCA inserted where?

A

femoral and radial

73
Q

compress the plaque formation

A

angioplasty

74
Q

what will you do when in radial artery is bleeding?

A

put pressure

75
Q

what will you do when femoral artery is bleeding?

A

put sand bag

76
Q

what need to monitor in PTCA?

A

6P’s
1. Pulse
2. Poikilothermia (cold)
3. Paresthesia
4. Pain
5. Pallor
6. Paralysis

77
Q

exapandable metallic device which are introduce into coronary artery that are clogged due to atherosclenosis

A

Coronary stent

78
Q

what are the complication of coronary stent

A

Dissection
Perforation
Abrupt Closure
Vasospasm

79
Q

what are the 2 invasice coronary artery procedures and types

A
  1. Percutaneus coronary iinterventions
    - percutaneus transluminal coronoary angography
    - coronary stent
  2. coronary artery revascularization
    - Coronary brpass graft
80
Q

Indication to alleviation of angina that cannot be controlled with medication or PCI

A

Coronary ARtery Bypass graft

81
Q

commonly used inserted Coronary bypass graph

A

saphenous vein
- L internal thoracic artery

82
Q

what is sinud bradycardia? count

A

SA node impulse is decrease - less than 60 bpm

83
Q

what are the mngt in sinus bradycardia if it’s reponsive and unresponsive

A

responsive: Atropine

unresponsive:
- Dopa / isoprotenerol
- EPI / “E” Transcutaneous Pacing

84
Q

what is sinus tachycardia and count?

A

SA node increase impulse more than 100 bpm

85
Q

what are the cause of sinus tachycardia?

A

stress / medications / Disorders

86
Q

mngt of sinus tachycardia?

A

Carotid massage / Gagging / Bearing down / Coughing / Cold stimuli to the face

87
Q

Medication sinus tachycardia?

A

Adenosine
Sync Cardioversion
IV beta Blockers
CA channel Blockers

88
Q

Originated fro the Foci

A

Atrial arrhythmias

89
Q

what are the 3 Atrial arrhythmias

A
  1. Premature Atrial Complex
  2. Atrial Fibrilation
  3. Atrial flutter
90
Q

premature atrial complex is caused by?

A
  1. Caffeine
  2. Alcohol
  3. Nicotine
  4. Anxiety
  5. Hypokalemia
91
Q

Premature complex is needed a treatment?

A

false

92
Q

Rapid, Disorganized and uncoordinated twitching of the atria

A

Atrial fibrilation

93
Q

Atrial Fibrilation is associated with ?

A

aging

94
Q

Risk factors of Atrial Fibrilation?

A

Hpn/DM/Obese/HeartDisease/MI/Alcohol/Smoking/Excercise/Surgery

95
Q

Atril fibrilation what wave is non present?

A

No P wave Quivering

96
Q

mngt for Atrial Fibrilation

A

anticoagulant
Cardioversion

97
Q

Atrial fibrilation
what is atrial rate?

A

300-600

98
Q

atrial fibrilation what V rate?

A

120-200

99
Q

Conduction detect in atrium

A

Atrial flutter

100
Q

Atrial rate of Atrial flutter

A

250-400

101
Q

ventricular rate of atrial flutter

A

75-150

102
Q

no P wave quivering

A

Atrial fibrilation and atrial flutter

103
Q

saw tooth in reading

A

Atrial flutter

104
Q

mngt for atrial flutter

A

Vagal maneuver
IV adenosine Rapid administration

105
Q

what are the ventricular arrythmias?

A
  1. Premature Ventricular Complex
  2. Ventricular Tachycardia
  3. Ventricular Fibrilation
  4. Ventricualr asystole
106
Q

cause of premature ventricular complex

A

3ID HA
Ischemia / infarction / increase workload / Digitalis toxicity / hypoxia / Acidosis

107
Q

if freqquent and persistent premature ventricular complex what medication?

A

amiodarone and Betablocker

108
Q

defined as 3 or more PVC in a row

A

Ventricular tachycardia

109
Q

what are the vetricular and atrial rate of ventricular tachycardia?

A

100-200

110
Q

whappen to P wave and QRS wave in ventricular tachy cardia?

A

P wave (+) but difficult to detect
QRS is bizzare and abnormal (-)

111
Q

mngt of ventricular tachycardia

A

phocainamide
amiodarone
sotalol
lidocaine
= anti arrthmic

112
Q

difference of cardioversion and defibrilation in ventricular tachycardia

A

cardiversion : Conscious : (+) pulse
Defibrilation : unconscious : (-) pulse

113
Q

common arrthmias in pt. with cardiac arrest

A

ventricular fibrilation

114
Q

rapid disorganized ventricular rhythm

A

ventricular fibrilation

115
Q

absence of an audible heartbeat / palpable pulse

A

ventricular fibrilation

116
Q

mngt of ventricular fibrilation

A

Early defib / CPR
Amiodarone / EPI

117
Q

Ventricular fibrilation V rate

A

more than 300

118
Q

vetricular asystole aka?

A

flatline

119
Q

ventricular asystole mngt.

A

CPR / Intubation

120
Q

atrial impulse are conducted through AV node into the ventricles at a slower rate

A

First degree block

121
Q

what happend to first degree block?

A

P wave is Normal
Pr interval greater than .20

122
Q

there is a repeating pattern in which all but one of a series of atrial impulses are conducted through AV node into the vetricles

A

Type 1

123
Q

intial treatment of Type 1 Second degree block is?

A

IV bolus atropine

124
Q

Some of the atrial impulse are conducted through the AV node into the ventricels

A

Type 2

125
Q

No atrialimpulse is conducted through the AV node into the ventricles

A

third degree block

126
Q

V/a rate of 3rd degree

A

depends on the shape and rhythm

127
Q

joules of cardioversion

A

50-360

128
Q

monphasic defib joules

A

360 joules

129
Q

biphasic joules

A

150 - 200

130
Q

after initial unsuccessful defib what be given?

A

EPI

131
Q

when women have a large breast what should do?

A

Placed underneath or lateral to the left breast

132
Q

Why do we not used UTZ gel?

A

poor electical activity

133
Q

how many pressure should have for good skin contact?

A

20-25 pounds

134
Q

electronic device that provides electrical stimulation of the heart

A

pacemaker

135
Q

used when Pt. has a permanent temporary slower than normal pulse

A

pace makerc

136
Q

controls tachyarrthmias that do not respond to meds

A

pacemaker

137
Q

during cardioversion monitor whaT?

A

monitor leads: must be attached to pt. set tje defib in sync

138
Q

Pathophysiology of Right sided heart failure

A

Cannot eject Blood efficiently - returns to venous circulation - 1. Increase veous pressure - jular vein distention, hepatomegaly , spleenomegaly 2. increase hydrostatic pressure - intravascular fluid goes to interstitial spaces - edema

139
Q

Pathophysiology of LEFT sided heart failure

A

cannot pump blood out of the ventricle - 1. to aorta - decrease CO - decrease Tissue perfusion 2. Left ventricle - Backflow - L atrium - backflow - pulmonary vein - lungs - pulmo congestion - cough, dyspnea, crackles, sub orthopnea.

140
Q

pharmacologic heart failure and meaning

A
  1. diuretics - remove excess fluid
  2. ACE / ARBS - decrease BP and Afterload
  3. Beta blockers- Dilates blood vessel - decrease afterload
  4. Ivabradine - decrease rate of conduction of the SA node
  5. Hydralazine- Decrease BP / decrease afterload / dilated blood vessels
  6. Digoxin - imrpoves contractility
141
Q

heart is unable to pump and circulate blood to the body’s organs and tissues

A

cardiac arrest

142
Q

cardiac arrest is caused by

A

Vfibrilation and asystole

143
Q

manefestation of cardiac arrestq

A

loss of consciouness / no BP / rr / Pr / cyanosis

Medsurg (5 decks)

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