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Pathophysiology 238 > Module 2 Cardiac > Flashcards

Module 2 Cardiac Flashcards

1
Q

What is systole?

A

Systole is the period in which the ventricles contract.

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2
Q

What is diastole?

A

Diastole is the period in which the ventricles relax and fill with blood.

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3
Q

What is preload?

A

Preload is the volume of blood in the ventricle at the end of diastole. So, this is the volume of blood the heart pumps out.

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4
Q

What is afterload?

A

Afterload is the resistance the left ventricle must overcome to circulate blood. So remember the left ventricle is pumping blood out to the entire body so afterload is the pressure that must be generated to pump that blood out of the left ventricle to the body systemic circulation.

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5
Q

How does blood flow through the heart?

A

Blood flows through the heart in the following pathway:

  • Superior/ inferior vena cava
  • right atrium
  • Tricuspid valve
  • right ventricle
  • pulmonary semilunar valve
  • pulmonary artery
  • lungs for oxygenation
  • pulmonary vein
  • left atrium
  • mitral valve (aka bicuspid valve)
  • left ventricle
  • aortic valve
  • aorta
  • systemic circulation
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6
Q

What are arteries?

A

High pressure system with thick vessel walls that carries oxygen rich blood to the body tissues.

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7
Q

What are veins?

A

Veins are a low pressure system with thin, collapsible, distensible vessel walls that contain valves to prevent backflow of blood. Veins are a reservoir for blood and can return blood to circulation during periods of trauma to the body.

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8
Q

What are capillaries?

A

Capillaries are thin microscopic vessels which contain capillary pores and are the site of nutrient, fluid, waste, and gas exchange for the body.

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9
Q

Describe the purpose of collateral circulation.

A

Collateral circulation is essentially bypass vessels that will restore circulation to tissues that have a severe reduction in blood supply. These vessels will allow for the continued exchange of oxygen, nutrients, and waste so that damage from the lack of blood supply is lessened. This explains why some people who experience a stroke or heart attack may have less severe symptoms. They have more collateral circulation to supply the tissues affected by the blocked vessel.

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10
Q

What are baroreceptors responsible for?

A

These are receptors that are sensitive to changes in pressure and therefore function to maintain systemic blood pressure at a relatively constant level. They do this by regulating the tone of the vessels (constriction or dilation) to control blood flow.

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11
Q

Describe hyperlipidemia.

A

Hyperlipidemia is an abnormally high concentration of fats or lipids in the blood. Elevations in triglycerides or cholesterol will be seen. LDL is considered bad cholesterol and HDL is considered good cholesterol.

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12
Q

What are the complications or risks associated with a patient having high cholesterol?

A

High cholesterol increases the risk for MI (heart attack), CVA (stroke), CAD (coronary artery disease), and peripheral artery disease.

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13
Q

What is the normal heart rate?

A

Normal HR is 60 - 100 beats a minute.

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14
Q

What is Raynaud’s Disease?

A

Raynaud’s disease is a functional disorder caused by vasospasm of arteries and arterioles in the fingers and/or toes.

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15
Q

What symptoms would you anticipate a client with Raynaud’s disease would complain of and what symptoms would you visually see in the patient?

A

Client would describe coldness, numbness, and pain in the fingers and toes triggered by exposure to cold, stress, or smoking. The nurse would expect to see the fingers/toes turn white due to lack of blood flow from the vasospasm occurring, blue due to the resulting lack of oxygen to the tissues, and then red due to the return of circulation.

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16
Q

What should the nurse teach a client with Raynaud’s disease? What is the goal of the education the nurse is completing?

A

The nurse should teach the client to keep the body warm, wear gloves, smoking cessation, and take medications as prescribed. The goal of teaching is to prevent or lessen occurrences of vasospasms and to prevent complications such as sores and gangrene.

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17
Q

What is peripheral artery disease?

A

PAD is a circulatory condition in which narrowed blood vessels decrease blood flow. This is typically the result of plaque buildup.

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18
Q

What symptoms would you as the nurse anticipate in peripheral arterial disease?

A

The patient will complain of intermittent claudication and have symptoms in the affected extremities of pale bluish discoloration of the skin, decreased hair growth, shinny skin, weak or decreased pulses, and sores that will not heal.

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19
Q

What should the nurse teach a client about peripheral arterial disease?

A

The nurse should teach the client to reduce modifiable risk factors. Stop smoking, change to low cholesterol heart healthy diet, weight reduction, and exercise. Treat and regulate diabetes and high blood pressure (HTN). Check feet/legs frequently for sores. Seek treatment immediately for any sore that will not heal or appears infected.

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20
Q

What is atherosclerosis?

A

Atherosclerosis is the hardening of the arteries with fatty lesions present (plaque).

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21
Q

What symptoms would you anticipate in a patient with atherosclerosis?

A

A patient with atherosclerosis is typically asymptomatic until an occlusion or thrombosis occurs.

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22
Q

What should the nurse anticipate teaching a client diagnosed with atherosclerosis?

A

Reduce modifiable risk factors. Stop smoking, change to low cholesterol heart healthy diet, weight reduction, and exercise. Treat and regulate diabetes and high blood pressure (HTN).

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23
Q

What is the formula for cardiac output?

A

CO = SV (Stroke volume) x HR (Heart rate)

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24
Q

What is an acute arterial occlusion?

A

An acute arterial occlusion is a sudden event that causes obstruction of blood flow to the affected tissue or organ.

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25
Q

What symptoms would the nurse anticipate in a client with an acute arterial occlusion?

A

The nurse should anticipate that the client will complain of a sudden onset of extreme pain (pistol shot) and paresthesia. The nurse should expect the extremity to feel cold, be pulseless, have paralysis, and be pale. Often the skin changes will have a obvious line where they begin. So the nurse may see a very obvious line were the paleness, coldness, and paralysis begin compared to the unaffected (normal) tissues.

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26
Q

Is an acute arterial occlusion a medical emergency? Why or why not?

A

Yes! An acute arterial occlusion is an occlusion of a artery which is a major vessel supplying oxygen rich blood to the body tissues. Lack of oxygen and nutrients will result in tissue death if not corrected quickly.

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27
Q

What is an aneurysm?

A

An aneurysm is an abnormal localized dilation of a blood vessel. This will result in the vessel wall becoming weaker. Think of a balloon. Just like a balloon your blood vessel can only dilate and become so thin and weak before rupture will occur.

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28
Q

What is a berry aneurysm and where would this aneurysm type be located?

A

A berry aneurysm is small circular dilations of the vessel at a bifurcation (normal splitting or forking of vessels). These have a berry appearance. Typical location is the circle of Willis (where several arteries join at the bottom side of the brain. These arteries supply oxygen to over 80% of the cerebrum).

29
Q

Most aneurysms are asymptomatic until rupture occurs. What symptom could the nurse assess for to identify an abdominal aortic aneurysm in some patients.

A

A pulsating abdominal mass may be seen in certain patients depending on the patient’s abdominal girth and the size of the aneurysm.

30
Q

What symptoms should the nurse anticipate in a dissecting abdominal aortic aneurysm?

A
  • Sudden onset of pain described as a tearing or ripping sensation in abdomen
  • decreasing blood pressure
  • decreasing level of consciousness
31
Q

The most severe complication of an untreated ruptured aneurysm is

A

Death

32
Q

What are some risk factors for aneurysms?

A
  • smoking
  • HTN
  • Advanced age
  • trauma
  • atherosclerosis
  • certain congenital defects
33
Q

What is hypertension?

A

Hypertension is a sustained elevation in blood pressure that will result in end organ damage and vessel changes. Normal systolic blood pressure (top number) should be less than 120 and normal diastolic blood pressure (bottom number) should be less than 80.

34
Q

Most patients with elevated blood pressure are asymptotic what are the risk factors associated with untreated hypertension or a patient who does not want to take blood pressure medication due to side effects?

A
  • RF (Renal failure)
  • CAD (Coronary artery disease)
  • CVA (Stroke)
  • Vision loss
  • HF (Heart failure)
35
Q

What are some modifiable risk factors for hypertension and what would the nurse want to teach the patient about these risk factors?

A
  • Diet (change to a low cholesterol, low sodium heart healthy diet)
  • Smoking (advise on smoking cessation)
  • Alcohol (advise on ETOH cessation)
  • Obesity (advise on daily exercise)
36
Q

What is preeclampsia?

A

Preeclampsia is a blood pressure that is elevated above 140/90 in pregnancy and produces impaired renal function, impaired liver function, pulmonary edema, vision disturbances, and decreased platelet counts.

37
Q

What assessment findings would you anticipate in a patient who has been diagnosed with preeclampsia?

A
  • Reports of vision changes (double vision, stars in vision, floaters)
  • Headache
  • Nausea / vomiting
  • Decreased urine output
  • Bilateral lower extremity edema
  • Protein in the urine
  • Low platelet count
  • High creatinine level (renal function test)
  • High liver function tests (due to liver impairment)
38
Q

What is the is the serious complication that can occur in preeclampsia-eclampsia and result in death in the mother and child if not treated immediately?

A

HELLP syndrome

39
Q

What is the treatment of preeclampsia?

A
  • Delivery of the child.
  • Magnesium can be given to prevent seizures in the mother and for the neuroprotective effects it can have on the unborn child until delivery is safe to perform.
40
Q

What drug class of medication would you expect a client diagnosed with hypercholesterolemia (high cholesterol) to be given?

A

Statins

41
Q

What is a DVT (deep vein thrombosis)?

A

A DVT is the presence of a clot (thrombus) in a vein and the inflammatory response that occurs as a result.

42
Q

What assessment findings would the nurse anticipate in a client diagnosis with a DVT (deep vein thrombosis)?

A

The nurse would expect the client to complain of pain at the site of the DVT. The nurse would anticipate that the client would have tenderness over the area where the DVT is located along with skin redness, and edema. A fever may be present.

43
Q

What is the most severe life-threatening complication of a DVT (deep vein thrombosis)?

A

PE (Pulmonary embolism) which is a clot in the patient’s lungs

44
Q

What are the risk factors for development of a DVT (deep vein thrombosis)?

A
  • Sedentary lifestyle
  • Prolonged rest (Hospitalization or bedrest)
  • Surgery
  • Pregnancy
  • Smoking
  • Estrogen containing birth control pills
45
Q

What medication treatment would the nurse anticipate for a client diagnosed with a DVT (deep vein thrombosis)?

A

Anticoagulants

46
Q

What are some non-pharmacologic methods the nurse can teach the client who is hospitalized to prevent a DVT from occurring?

A

Promotion of early ambulation (walking) and usage of SCD’s

47
Q

What is a cardiac tamponade?

A

A rapid filling of the pericardial sac which compresses the heart

48
Q

What symptoms would the nurse anticipate in a client with a suspected cardiac tamponade?

A

Anxiety, chest pain, difficulty breathing, increased heart rate, JVD, low SBP (systolic blood pressure), and muffled heart sounds.

49
Q

What treatment is preformed for a cardiac tamponade and what would occur if treatment is delayed or not completed?

A

Pericardiocentesis is performed for treatment and if not completed the patient will progress to circulatory shock and impending death

50
Q

What is a pericardial effusion?

A

A pericardial effusion is an accumulation of fluid in the pericardial cavity from inflammation or infection.

51
Q

What is the most serious complication of a pericardial effusion?

A

Cardiac Tamponade from the increased pressure the fluid accumulating in the pericardial sac is placing on the heart

52
Q

What symptoms would the nurse anticipate in a patient diagnosed with a pericardial effusion?

A
  • Chest pain
  • Feeling faint
  • Chest fullness
  • Shortness of breath
  • Difficulty breathing when lying flat
53
Q

What symptoms would the nurse anticipate in a client diagnosed with right sided heart failure?

A
  • Fatigue
  • Pitting edema in lower extremities
  • JVD
  • Anorexia
  • GI complaints
  • Weight gain
  • Ascites
  • Enlarged liver and spleen
54
Q

What symptoms would the nurse anticipate in a client diagnosed with left-sided heart failure?

A
  • Fatigue
  • Confusion
  • Restlessness
  • Cyanosis
  • Orthopnea
  • Exertional shortness of breath
  • Tachycardia
  • Chronic cough
  • Wheezes, crackles, blood tinged sputum
55
Q

What is a normal EF and what is considered abnormal?

A

EF is an ejection fraction which is determined by how much blood in the ventricle is pumped out with each beat.

  • Normal is 50% to 75%
  • 41% to 49% is borderline and symptoms of HF may occur with activity
  • Heart failure symptoms will be present at rest and activity with a EF of 40% or less. These patients are also at a higher risk for complications
56
Q

Digoxin can be given in a patient with heart failure to improve the patient’s condition. This medication can become toxic if the dosage is not monitored. What does this medication do to improve the patient’s symptoms?

A

This medication will increase the force and contraction of the ventricles.

57
Q

As heart failure progresses and treatment options begin to fail what would the nurse anticipate the patient with end-stage heart failure will require?

A

A heart transplant

58
Q

What medication class can be given in a heart failure patient to reduce excessive fluid volume in the patient

A

Diuretics

59
Q

What symptoms would the nurse anticipate in a client with stable angina?

A

Chest pain occurring at a predictable pattern that is relieved with rest and/or nitroglycerin

60
Q

What would alert the nurse that a client may be experiencing a STEMI?

A
  • ST elevation on EKG
  • Elevated cardiac enzymes (cardiac markers such as troponin)
  • Abrupt onset of symptoms
  • Severe and crushing pain in the chest
  • Pain may radiate to the left jaw or left neck.
  • GI symptoms of nausea and vomiting
  • Fatigue / weakness
  • Tachycardia, anxiety, restlessness, feelings of impending doom
  • Pale, cool, and moist skin
61
Q

The nurse understands that the abnormal condition rhythm known as a-fib (atrial fibrillation) results in what happening in the client’s heart?

A

A-fib results in the atrium quivering rather than contracting appropriately which causes stagnant blood flow. Stagnation of blood flow will produce clots in clients with a-fib.

62
Q

A client diagnosed with a-fib is at a high risk for developing clots. Treatment of a-fib includes prescription of what two drug classes?

A

Beta-blockers (for rate control) and anticoagulants (reduce clotting risk)

63
Q

In a client who is experiencing ventricular fibrillation the nurse understands that what is happening in the client’s heart?

A

The nurse understands that the client’s rhythm is originating in the ventricles rather than the SA node. This results in the ventricles quivering rather than contracting as they should. Since the right ventricle pumps blood to the lungs for oxygenation and the left ventricle pumps blood to systemic circulation this means the client will not have effective blood flow to the body and will die if the rhythm is not corrected.

64
Q

A client has recently experienced a heart attack and when the nurse assesses the cardiac monitor she notes ventricular fibrillation. The nurse understands this is a medical emergency and the patient requires what immediate treatment?

A

Ventricular fibrillation requires immediate defibrillation. Hint: think v-fib = d-fib every time.

65
Q

The electrical impulse for a normal sinus rhythm in the heart originates in what area and produces a normal heart rate of how many beats a minute?

A

The electrical impulse should originate in the SA node which is the pacemaker of the heart. This should produce a heart rate of 60 to 100 beats a minute. If the heart rate is too high this is considered tachycardia and if the heart rate is too low this is bradycardia.

66
Q

In a client diagnosed with shock the nurse would anticipate the following symptoms:

A
  • Altered level of consciousness
  • Pale or bluish discoloration of the skin
  • Cool and moist skin
  • Restlessness or irritability
  • increased thirst
  • Rapid and weak pulse (Tachycardia = HR greater than 100 beats a min)
  • Rapid breathing (Tachypnea = rate greater than 24 breaths a minute)
  • Nausea or vomiting
67
Q

A client is experiencing anaphylactic shock related to a peanut allergy. What treatment should the nurse rapidly administer?

A

Anaphylactic shock should be treated with epi administered as quickly as possible. The nurse should additionally call 911 if he/she is not in the hospital and maintain an open airway in the client.

68
Q

Cardiogenic shock is failure of the heart to pump blood sufficiently to meet the body’s demands. An acute event that result in cardiogenic shock would be?

A

Myocardial infarction (MI), cardiac contusion, and sudden change from sinus rhythm to an arrhythmia such as ventricular fibrillation.

69
Q

The nurse understands that the symptoms of Kawasaki disease include the following:

A
  • Acute onset of fever that is often 104 degrees and is unresponsive to antibiotic treatment
  • Measles like rash
  • Enlarged lymph node
  • Redness of the sclera (white part) of the eye
  • After the fever resolves the skin on the hands and feet will begin to peel off

Pathophysiology 238 (15 decks)

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