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N232 - Intro to Pharma > Module Four: Cardio Assessment, Hypertension, Fluid Balance > Flashcards

Module Four: Cardio Assessment, Hypertension, Fluid Balance Flashcards

1
Q

What is the Cardiovascular System?

A

Responsible for transporting oxygen, wastes, hormones, and nurtients with-in the body. It contains the heart (pump), vessels (pipes), and blood (fluid).

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2
Q

What is Cardiac Output?

A

Cardiac Output (CO) is the volume of blood pumped by the heart per minute (mL blood/min). Cardiac output is a funtion of heart rate and stroke volume. CO = SV x HR

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3
Q

What is Stoke Volume?

A

Stroke Volume (SV) is the volume of blood, in millilitres (mL), pumped out of the heart with each beat.

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4
Q

What is Heart Rate?

A

Heart Rate (HR) is simply the number of heart beats per minute.

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5
Q

What is Ischemia?

A

Ischemia is an inadequate blood supply to an organ or part of the body, expecially the heart muscles. Ischemia occurs when the oxygen supply is less than the oxygen demand. Lack of perfusion leads to ischemia, which leads to hypoxia.

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6
Q

What are the two main arteries in the heart muscle itselft?

A

The Left Main Coronary Artery and the Right Coronary Artery.

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7
Q

What is Mean Arterial Pressure? How do you calculate MAP?

A

Mean Arterial Pressure is a term used to describe the average blood pressure in an individual. MAP = (2 x Diastolic BP) + Systolic BP / 3

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8
Q

What is the normal range of MAP? What is indicated if an individual has low or high MAP?

A

Normal MAP: 70 - 105 mmHg. Ideal MAP: 90-100 mmHg. 105 mmHG = Increased Intervascular Pressure. The heart is working harder than it should, causing stress.

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9
Q

What is Pulse Presssure?

A

Pulse pressure is the difference between systolic BP and Diastolic BP. A normal PP is 30-40 mmHg.

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10
Q

What is a high and low pulse pressure? What do abnormal PP findings mean?

A

40 mmHg: Increased stroke volume. Systemic vascular resistance. Decreased distensibitily of the arteries.

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11
Q

When conducting a visual inspection during a cardiac assessment, what are we looking for?

A

General presentation. Skin. Jugular Venous Destention.

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12
Q

What do we assess during the palpation stage of a cardia assessment?

A

Skin (CWMS). Capillary Refill, Edema, Pulses

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13
Q

Point the the following pulses! Temporal, Carotid, Apical, Brachial, Radial, Femoral, Popliteal, Posterior Tibial, Dorsalis Pedis

A
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14
Q

What is CPK-MB? Why is this important during a cardiac assessment?

A

Also known as CK-MB or Creatine Kinase - MB. It is a cardiac marker to diagnose if there has been an acute myocardial infarction. The test is most likely ordered if a person has chest pain, or if a person’s diagnosis is unclear. Once a primary test for heart attacks, but has been largely replaced by Troponin tests.

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15
Q

What is Myoglobin? Why is it important to a cardiac assessment?

A

Myoglobin is a protein containing heme that carries and stores oxygen in muscle cells. In cardiac assessment it is ordered as a cardiac biomarker to help rule out infarction. Levels of myoglobin start to rise 2-3 hours within a heart attach and peak around 8-12 hours. They return to normal levels within one day. It is detectable sooner than troponin. An increase in blood myoglobin means there has been recent injury to the heart of skeletal muscle tissue.

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16
Q

What is Troponin I and T?

A

Troponin I and T are specific cardiac markers present when damage to the heart has occurred. They can be detected 3 -4 hours after a myocadial infarction, and peak in 4-24 hrs. Unlike myoglobin, they remain elevated for 1 - 3 weeks post heart damage. There is also a High Sensitivity Troponin test which can yield results earlier.

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17
Q

What are the advantages of a High Sensitivity Troponin test? Greater than what value is indicative of an abnormally high level?

A

Detects the same protein that the standard Troponin T test does, just at much lower levels. Greater than 14ng/L is high. Detects heart injury and acute coronary syndrome earlier than the standard test. Can help confirm a MI earlier. May also be positive in people with stable angina and even in people with no symptoms. Indicative of an increased risk of future heart events.

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18
Q

What are some diagnostic which are conducted during a Cardiac Assessment?

A

ECG, Cardiac Stress Test, Echocardiogram, Angiogram, Ejection Fraction.

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19
Q

What is Ejection Fraction?

A

The percentage of blood that pumped out of a filled ventricle with each heartbeat. Usually only measured in the left ventricle. Can be measured using: Echo, CT Scan, MRI, Angiogram, Nuclear medicine.

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20
Q

What is Hypertension?

A

Abnormally high blood pressure.

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21
Q

What is Blood Pressure?

A

Blood Pressure = Cardiac Output x Peripheral Vascular Resistance

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22
Q

How is Hypertension diagnosed?

A

Two blood pressure readings taken 5 minutes apart. No caffeinated drinks, No smoking, No Alcohol

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23
Q

What are the main concerns for the patient with Hypertension?

A

Target Organ Damage Incresed stress on the heart resulting in Left ventricular hypertrophy Increased stress on blood vessels resulting in atherosclerosis, CVA. Renal Disease (Hypertensive nephropathy). Damage to kidneys. Retina - Visual impairment and damage to the retina.

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24
Q

What are the non-modifiable risk factors of HTN?

A

Age (older than 60). Family History (female relative younger than 65, or male relative younger than 55). Sex (Men and post-menopausal women). Ethnicity (First Nations, Africans, South Asians at increased risk). Insulin Resistance Syndrome/Metabolic Syndrome

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25
Q

What are some modifiable risk factors of HTN?

A

Stress, Fight/Flight (We want to be calm). Obesity: BMI >25. Nutrition: High Na+ diet, High fat content. Substance Abuse: Smoking, Alcohol, Cocaine, Caffeine. Oral contraceptives. Sedentary lifestyle.

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26
Q

What is Orthostatic Hypotension?

A

A change in BP from lying to standing. You must wait 2 full minutes between taking blood pressure readings after moving from one position to the next. Decreased SBP >/= 20mmHg Decreased DBP >/= 10mmHg

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27
Q

What are the causative factors of Orthostatic Hypotension?

A

Prolonged bed rest (= dec. fluid volume, dec. venous tone). Aging Tall/Thin people, Adolescents, Those with low BPs. Medications (Diuretics) Hypovolemia

28
Q

What are some important teaching points for Ortho Hypotension?

A

Instruct Pt. to sit, then stand slowly, then start walking slowly if the have. Use a walker or cane as necessary for balance Teach expected symptoms: dizzy, light-headed, syncope.

29
Q

What are some different diagnostic we can perform on a patient that has HTN.

A

Urinalysis, Electrolytes & Fasting Blood Glucose, BUN and Creatinine, Lipid Profile, CRP, 12-lead ECG, Echocardiogram.The goal is to determine the reason why the patient has high blood pressure. The assessment data can help us to deliver the correct treatment regime for the patient.

30
Q

What is the treatment approach for HTN?

A

HTN treatment is a Three Step Approach: 1. Lifestyle Modifications. 2. Pharmacological Response (One medication). 3. Combination Pharmacology (Multiple medications).

31
Q

What lifestyle modifications would be made during the first step of HTN treatment?

A

Smoking Cessation, Decreased Alcohol Use, Diet/Weigh Loss, Exercise, Blood Glucose control for people with Diabetes.

32
Q

What drugs would be administered for the second stage of HTN treatment?

A

Thiazide/Loop Diuretics, Beta Blockers, ACE Inhibitors, Calcium Channel Blockers, Vasodilators. The most common second step pharmalogical treatment is to start with a Diuretic.

33
Q

What is the third step in HTN treatment?

A

Addition of a second anti-hypertensive medication until the desired results are achieved.

34
Q

When would you consider with-holding Beta Blockers?

A

When the heart rate is <60 bpm.

35
Q

What classification of drugs would be prescribed for HTN?

A

Anti-hypertensives

36
Q

Name the different types of Antihypertensives you made see HTN patients taking?

A

Diuretics, Beta Blockers, ACE Inhibitors, Angiotensin Receptor Blockers, Calcium Channel Blockers, Vasodilators

37
Q

What are Diuretics? How do they affect HTN? Are there side-effects? What are several examples of diuretics?

A

Diuretics work by reducting the blood volume through excretion of sodium and water. Reduction in blood volume results in a decreased BP. Side-effects: Dehydration, Electrolyte Imbalances, Hypotenson. Lasix, Furosemide are loop-diuretics. Spironalactone is a K+ sparring diuretic.

38
Q

What are Beta Blockers? How do they affect HTN? Side Effects? What are the names of some common Beta Blockers?

A

Beta Blockers block the effects of the sympathetic nervous system on the heart. This reduces the workload of the so that it requires less blood and oxygen. As a result the heart doesn’t have to work as hard and lowers blood pressure. Beat Blockers are also used to control heart rate and in the treatment of abnormal heart rythems. Beta Blockers typically have the suffix -olol. Examples include Metroprolol, Propranolol, Atenolol. Also Doxazosin and Terazosin. Side Effect: Inadequate CO, CHF, Bradycardia, Pulmonary Edema.

39
Q

What are ACE Inhibitors? Side Effects?

A

ACE Inhibitors prevent the conversion of angiotensin I to angiotensin II. This inhibits the RAAS cycle, resulting in a decrease in volume, and a decrease in BP Side Effects: Inadequate CO, Cough (angioedema).

40
Q

How do Angiotensin II Repector Blockers (ARB) work? Side Effects?

A

ARB block the action of angiotension II at the receptor site. Side Effects: Hypotension, Increased K+, Inadequate CO, Dizziness, Diarrhea, Rash. Examples: Atacand, Cozaar, Micardis

41
Q

What are Calcium Channel Blockers? Side Effects? What should be avioded with Calcium Channel Blockers?

A

Calcium channel blockers block calcium ion channels, which result in relaxation of vessel walls. They are very useful to treat angina and dysrrythymias. Side Effects: Bradycardia (Heartblock), Inadequate CO. Avoid: Grapefruit juice. Examples: Diltiazem, Verapamil, Norvasc, Renidil.

42
Q

Who is at risk of developing a fluid imbalance?

A

Anyone. Those at particular risk are individuals on diuretics, adrenal insufficiencies, diarrhea, renal disease, any serious infection of the liver.

43
Q

What is fluid balance important?

A

To maintain homeostasis.

44
Q

What organs have a part in regulation of body fluids?

A
  1. Kidney: regulation of fluid/electrolytes, selective retention/excretion. 2. Heart: pumping action, cycles blood thru kidney. 3. Lungs: exhalation. 4. Pituitary Gland: Antidiretic hormone (ADH), overproduction results in hypervolemia. 5. Adrenal Gland:
45
Q

What and Where are body fluids?

A

Body fluids are made up for water and electrolytes. They are located in the Intracellular, and Extracellular spaces of the body. Intracellular: 30 liters. Extracellular: 12 liters.

46
Q

What three elements make up the bodies extracellular space?

A
  1. Interstitial Space (9 liters). 2. Intravascular Space (3 liters). 3. Transcellular Space (negligible).
47
Q

How do fluids shift and move with-in the body?

A

The shift from one compatment to another. This is known as compartmental shifts. The carry out these shifts through a variety of different ways. 1. Diffusion. 2. Osmosis. 3. Omostic Pressure. 4. Colloid Osmotic Pressure. 5. Hydrostatic Pressure.

48
Q

What is Hypervolemia?

A

Hypervolemia is an overall fluid volume excess. Expansion of extra cellulare fluid caused by retention of fluid and sodium together. (IV fluids, isotonic - too much fluid, resulting in swelling).

49
Q

What is Hypovolemia?

A

Hypovolemia is an overall fluid volume deficit. Loss of extracellular fluid in excess of intake. H2O and electrolytes are lost in the same proportion as they exist in the body.

50
Q

What is a third space shift?

A

A third space shift occurs when too much fluid moves from the intravascular space into the interstitial or “third” space. This is the nonfunctional area between cells. This can potentially cause serious problems such as edema, reduced cariac output, and hypotension.

51
Q

Fluid trapped in transcellular space is known as?

A

Third Spacing. In the: Peritoneal cavity = ascites. Pleural cavity = pleural effusion. Pericardial sac. Joint spaces (knee).

52
Q

What labs would be used to assess and monitor fluid balance?

A

Serum Electrolytes: Na+, Cl-, K+. Blood Urea Nitrogen (BUN) and Creatinine. Serum Albumin. Hematocrit. Urine Specific Gravity.

53
Q

What is the significance of Albumin in fluid balance?

A

Albumin in the most prolific protein in the blood. It is produced in the liver. Albumin is essential for vascular osmotic pressure.

54
Q

What is the effect of water loss or excess fluid on hematocrit?

A

During fluid loss, hematocrit is high. During times of excess fluid, hematocrit is low.

55
Q

Why would an individual have an increase or decrease of Na+ in fluid imbalance?

A

An increase in Na+ is due to loss of H20. This is because the concentration of Na+ will increase in the blood when we are dehydrated. A decrease in Na+ occurs when there is excessive H20 intake or retention due to the decreased concentration of Na+ in the blood.

56
Q

What is the relationship between Cl- and Na+?

A

Cl- follows Na+. (up or down together).

57
Q

What are some causes of Hypervolemia or Fluid Volume Excess?

A

Increased injection (Iatrogenic). Increased retention (cardiac disease). Decreased excretion (liver failure, renal failure).

58
Q

What are some signs and symptoms of Hypervolemia?

A

Acute weight gain (ascites). CVS symptoms (Increased BP, HR JVP, and peripheral edema). Respriratory Symptoms (pulmonary edema). Laborartory findings (low Hct, pulmonary edema).

59
Q

What is the treatment for Hypervolemia?

A
  1. Identify and treat the cause. 2. Restrict Na+ and fluid in patients diet. 3. Diuretic (block sodium reabsorption in distal tubule, loop diuretic to increase loss of water and sodium). 4. Hemodialysis (patients in renal failure and restrict fluid diet).
60
Q

What are the important nursing interventions when dealing with fluid balance (or imbalance)?

A

Detecting is primary importance! Acurate measurment and accurate recording (In/Outs). Assess for edema. Rest. Monitor and teach sodium restrictions. Administer diuretic as ordered and monitor. Chest Assessment. Vitals Q4-6H. Position for optimal comfort, circulation and respiration. May require IV Albumin.

61
Q

What are some causes of Hypovolemia? What are some signs and symptoms of Hypovolemia?

A

Causes: Reduced intake. Increased losses. Signs and symptoms: Acute weight loss. CVS symptoms (low BP, increased HR). Thirst. Dehydrations. Lab findings (Increased Hct, serum and urine osmolarity).

62
Q

What is the treatment for Hypovolemia?

A

Indentify and treat the underlying cause. Consider usual maintenance requirements. Fluid replacement: Isotonic IV solutions. Ecourage oral fluid intake. Must be done quickly to prevent renal damage.

63
Q

Nuring interventions for Hypovolemia?

A

Monitor Ins/Outs. Daily weights. Bowel care PM. Skin Care. Vital Signs. Parenteral Administration (monitor for fluid overload when replacing fluids). Provide excellent mouth care. Monitor LOC.

64
Q

What are the causes, signs and symptoms of Hypernatremia?

A

Causes: Increased water loss, Reduced water intake, Sodium Gain. Signs and Symptoms: Lab findings (Na>145mmol/L), CNS symptoms, Thrist, Dehydration.

65
Q

What are the causes, signs and symptoms of Hyponatremia?

A

Causes: Increased water intake, reduced water loss, sodium loss. Signs and Symptoms: Lab findings (Na

N232 - Intro to Pharma (8 decks)

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