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Med Surg 3 (theory class) > NURS 444 week 4 heart > Flashcards

NURS 444 week 4 heart Flashcards

1
Q

Cardiac output

A

Heart rate (HR) x stroke volume (SV)

normal is 4-8 L/min

  • preload
  • afterload
  • contractility

Arterial blood pressure:
BP- cardiac output (CO) x systemic vascular resistance (SVR)
**normal: SBP < 120 mm Hg, DBP < 80

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2
Q

Preload

A

volume in the ventricles at the end of diastole (end diastole pressure). Amount of blood in the ventricles right before contraction

increased in:
Hypervolemia
Regurgitation of cardiac valves

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3
Q

Afterload

A

Resistance left. Ventricle must overcome to circulate blood

Increased in:
htn
vasoconstriction

increased afterload
increased cardiac workload

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4
Q

Cardiomyopathy (CMP)

A

Primary- idiopathic and only heart involved

Secondary-
Major types: dilated, hypertrophic, restrictive

Leads to cardiomegaly and HF
leading cause of heart transplantation

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5
Q

Types of secondary CMP

A

> dilated- due to too much fluid backing up into the ventricle. think of balloon stretching; alcoholic, CAD, htn, valve disease, pregnancy
MOST COMMON mixed heart failure

> hypertrophic (enlarged vent.)- aortic stenosis, htn
more common in men. dyspnea most common symptom

> restricitve- post-radiation therapy, ventricular thrombus, scarring (not as common)
least common
classic symptoms are fatigue, exercise intolerance, and dyspnea

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6
Q

Management for Dilated

A
  • control HF
  • doesn’t respond well to therapy- hospitalized numerous times
  • vent. assist device***
  • heart resynchronization therapy
  • heart tranplantation
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7
Q

Hypertrophic management

A
  • beta or calcium channel blockers
  • ICD
  • surgical treatment
    (ventriculomyotomy and myectomy)
  • percutaneous transluminal septal myocardial ablation
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8
Q

Restrictive management

A
  • no specific tx exists
  • conventional therapy for HF and dysrhythmias
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9
Q

Ejection Fraction

A

normal: 55- 65%

< 45% = HF

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10
Q

Heart Failure compensatory mechanism

A

sympathetic nervous system
- Catecholamines: epinephrine and norepinephrine
- detrimental over time. increases O2 demand, increases workload of hert

neurohormonal response
- decreases renal perfusion causes kidney to increase renin
RAAS. results in water retention
may be on ACE inhibitor or ARB

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11
Q

Frank Sterling Law

A

dilation of heart chambers, muscle fibers stretch in response to volume

hypertrophy follows dilation

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12
Q

Patients who have had an MI

A

will go on a beta blocker to prevent remodeling of the heart
also on a low dose ACE inhibitor

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13
Q

Monitoring HF patients

A

weigh: call if more than 1lb/ day

BMP stretching: check labs

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14
Q

Left Sided Heart Failure

A

Pulmonary congestion:
- cough
- crackles
- wheezes
- blood-tinged sputum
- tachypnea

restlessness
confusion
orthopnea
tachycardia
exertional dyspnea
fatigue
cyanosis

** correct fluid before med. therapy
also systolic HF

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15
Q

Right sided HF

A

“Cor Pulmonale”
- faitgue
- increased peripheral venous pressure
- Ascites
- enlarged liver/ spleen
- may be secondary to chronic pulmonary problems
- DJV
- anorexia and GI distress
- swelling in hands and fingers
- dependent edema

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16
Q

HF complications

A

! pleural effusions
! dysrhythmias
! left ventricular thrombus
! hepatomegaly
! renal failure

17
Q

HF management

A

Drug therapy:
» diuretics
» ACE inhibitors/ ARBs
» Vasodilators: nitrates, B-adrenergic blockers, positive inotropes (help with contractility)

Nutritional therapy:
» diet education: sodium and occasional fluid restriction
» weight management

!! nitrates used to shunt fluid away from lungs
!! probably 2g or less of sodium diet

18
Q

UNLOAD FAST

A

Upright position
Nitrates
Lasix
Oxygen
ACE inhibitors
Digoxin

Fluids (decrease)
Afterload (decrease)
Sodium restriction
Test (dig levels, ABGs, potassium level)

19
Q

2 different valve diseases

A

Stenosis

Regurgitation

**commmon valve disorders in older adults

20
Q

Mitral valve regurgitation

A
  • caused by; MI, rheumatic heart disease, mitral valve prolapse, ischemic papillary dysfunction
  • chronic leads to; LA enlargement, LV hypertrophy/ dilation and decrease in cardiac output
21
Q

manifestations of mitral valve regurgitation

A

chronic
- weakness, fatigue, palpitations, dyspnea with progressive worsening, peripheral edema
- S3
- holosystolic and pansystolic murmur

22
Q

Valvular heart disease

A

Aortic stenosis
- rheumatic fever or age calcification (like CAD)
- causes obstruction of flow from LV to Aorta
- results in LV hypertrophy
*** nitroglycerin used cautiously to treat angina

manifestations
- angina, syncope, and dyspnea on exertion
- prominent S4
- systolic murmur

extra oxygen and pressure is used to open valves
*** think of how meds. affect pressure

23
Q

PAD

A

intermittent claudication
- ischemic muscle ache or pain caused by exercise, such as walking
- resolves with rest

parasthesia
- from nerve tissue ischemia

neuropathy

24
Q

PAD manifestations

A

skin: shiny, thin, taut, hair loss
popliteal and femoral pulses present
others are diminished

** don’t elevate legs over the heart
** keep warm but don’t apply heat, don’t wear restrictive clothing, don’t cross legs

25
Q

Care for PAD

A
  • SMOKING CESSATION NECESSARY***
  • Antiplatelet therapy is critically important
  • trental and pletal treat intermittent claudication
  • exercise therapy: walking
  • nutritional therapy: low sodium, low cholesterol, low saturated fat. High in fruits, veggies, whole grains
  • complementary and alternative therapies
  • protect from trauma, infection
  • decrease pain

***peripheral artery bypass is most common

26
Q

Chronic Venous Insufficiency; venous leg ulcers

A

valves in veins are damaged, which allow retrograde blood flow, pooling of blood in legs

Hydrostatic pressure in vein increases
- fluid and RBCs leak into tissue
- enzymes breakdown RBC causing brownish skin discoloration
- skin and subcutaneous tissue are replaces with fibrous tissue

**ulcers are common

27
Q

Care for venous insufficiency

A

compression therapy
- make sure PAD or clots not present

patient/caregiver teaching
- avoid trauma
- proper skin care
- avoid standing or sitting for long periods of time
- moist environment- keep dry

nutritional therapy for ulcers
- protein, calories, and micronutrients

meds. for ulcers
- antibiotics may be necessary

skin grafts for ulcers

Med Surg 3 (theory class) (13 decks)

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