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Nursing 2005: Clinical Pathophysiology > Nursing 2005: Cardiovascular Disorder (Part 3) Manifestations of the Heart Idease and Shock > Flashcards

Nursing 2005: Cardiovascular Disorder (Part 3) Manifestations of the Heart Idease and Shock Flashcards

1
Q

SA (sinoatrial) node

  • def
  • loc
  • rate
A

pacemaker

  • loc: upper right atrium
  • atrial myocardium causing contraction of atrium
  • rate: 60-80 beats per min
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2
Q

AV (atrialcentricular) node

  • def
  • loc
  • rate
A

Loc: upper right atrium

  • slows impulse before it reaches ventricles so that it can push blood to ventricles
  • if SA if fails, AV takes over
  • rate: 40-60 beats per min
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3
Q

Bundle of HIS = purjunkie fibers (ventricles)

  • def
  • rate
A
  • ventricles can take over as pacemaker but slower

Rate : 15-40 beats/min

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4
Q

EKG

  • P
  • QRS
  • T
A
  • electrical activity of the heart
  • P = atrial depolarization
    • atria contracts
  • QRS = ventricular depolarization
    • ventricles contract
  • T= ventricular depolarization
    • ventricles recocer
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5
Q

Dysrhthmias

A
  • abnormal heart rate and rhythm

– disturbance in conduction system

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6
Q

What is the etiology of dysrhythmias?

A
  1. abnormal rhythmicity of SA node
    - SA is still acting as peacemaking but wrong rhythm
  2. shift of pacemaker function
  3. block of conduction system
  4. abnormal conduction pathway
  5. spontaneous impulses
    - SA works normal but other part of heart takes over = ectopic pacemaker and starts an impulse = disturbs rhythm
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7
Q

What is the cause of dysrhythmias?

A
  • MI
  • Electrolyte imbalance = potassium
  • abnormal Ph
  • meds
  • stress
  • alcohol
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8
Q

Types of dysrhythmias: SA node

  1. Sinus Bradycardia
A

brady =slow

  • rhythm normal
  • EKG normal, but rate slow
  • SA node heart rate <60
  • normal for athletes and when sleeping
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9
Q

What is the etiology of sinus bradycardia?

A
  • hypothermia
  • inc vagal stimulation
  • meds
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10
Q

What are the problems with sinus bradycardia?

A
  • Greater chance for ectopic sites to fire

- dec cardiac output

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11
Q

What are the S/S of sinus bradycardia?

A
  • related to dec in CO

- weakness, dizziness

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12
Q

What are types of treatment for sinus bradycardia?

A
  • med to inc HR

- pacemaker

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13
Q
  1. Sinus Tachycardia
A

tachy = fast

  • rhythm normal
  • EKG normal, but rate fast
  • SA node fires at >100
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14
Q

What is the etiology of sinus tachycardia?

A
  • physiological stress
  • exercise, pain, fever
  • anxiety, anemia, low blood sugar, drugs
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15
Q

What is the significance/problems with sinus tachycardia?

A
  • inc work of heart and demand of O2 -> inc risk of angina, MI
    • ok for a short period but constantly it leads to angina or mi
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16
Q

What are types of treatment for sinus tachycardia?

A
  • meds to dec HR and dec O2 demand
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17
Q

Types of Dysrhythmias: Atria

  1. Premature Atrial Contraction (PAC)
  • def
  • EKG reading
A
  • contraction originating from ectopic focus in atria,
  • not SA node
  • transmit to vent., early beat.
  • EKG = P with QRS but not spaced regularly
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18
Q

What is the etiology of PAC?

A
  • can occur in healthy people

- stress, caffeine, alcohol, valvular disease

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19
Q

What type of meds are given for PAC?

A

digoxin

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20
Q
  1. Atrial flutter
  • def
  • rate
  • EKG reading
  • filing time
A
  • rate 160-350
  • delay through AV node
  • EKG – many P waves but QRS once in a while but regular
  • respond to every 2nd, 3rd, 4th but regular

Causes dec filling time:

  • dec CO -> lead to CHF
    • not enough filling of ven
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21
Q

What is the etiology of atrial flutter?

A
  • CAD
  • HTN
  • mitral valve disorder
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22
Q

What type of treatment is used for atrial flutter?

A
  • meds to slow ventricular responnse
  • Cardioversion
    • voltage shock to the R wave
    • jolts heart back to normal rhythm
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23
Q
  1. Atrial Fibrillation
  • def
  • rate
  • EKG reading
A
  • rate 350-600.
  • Atrial quivers, no contraction
  • EKG – can’t see P waves, QRS irregular
  • atria quivers
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24
Q

What is the etiology of atrial fibrillation?

A
  • happens with people who have underlying heart disease

HTN, RHD, CAD, CHF

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25
Q

Wbat are the problems/dangers with atrial fibrillation?

A
  • dec CO precipitate CHF
    • from no contraction of atria
  • pooling of blood = emboli
    • causes blood clots
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26
Q

What type of treatment is used to treat atrial fibrillation?

A
  • same as a-flutter plus anticoagulants
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27
Q

Types of Dysrhythmias: Ventricles

  1. Premature Ventricular Contractions
  • def
  • EKG reading
A
  • contraction originating in ectopic focus in ventricle.
    • premature ventricle contraction
  • EKG: premature QRS, wide and distorted
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28
Q

What is the etiology for Premature Ventricular Contractions?

A

-associated with stimulants = caffeine, low potassium, stress, acid-bace imbalance, lack of sleep, meds

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29
Q

What are the problems of Premature Ventricular Contractions?

A
  • dec co = heart failure
  • angina
  • defib
  • life threatening if 3 PVCs in a row = ventricular tachycardia
    • ventricles take over as pacemaker
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30
Q

What types of treatment are used for Premature Ventricular Contractions?

A
  • Lidocaine

- correct the underlying cause

31
Q
  1. Ventricular Tachycardia
  • rate
  • EGK reading
A
  • 3 or more PVC in row
  • Rate 110-250
  • ventricles take over
  • no p waves, distorted QRS waves
32
Q

What is the etiology of Ventricular tachycardia?

A
  • MI
  • CAD coronary artery disease
  • electrolyte imbalance
  • mitral valve problems
33
Q

What are the life threatening problems that ventricular tachycardia can cause?

A

– CO dec, very little

  • loss of consciousness
  • possible progression to V-fib
  • dec coronary perfusion
34
Q

What type of treatment is used for ventricular tachycardia?

A
  • Lidocaine to slow ventricular response
  • cardioversion
    • voltage shock on R wave
  • Precodial thump
    • hit pt on chest
35
Q
  1. Ventricular Fibrillation
  • def
  • EKG reading
A
  • vent quivers, no contraction
  • Multiple ectopic sites
  • EKG – HR not measurable
36
Q

What is the etiology of ventricular fibrillation?

A
  • MI
  • cardiomyopathy
  • electrical shock
  • inc potassium
  • hypoxia
37
Q

What are the dangers/problems from ventricular fibrillation?

A
  • no CO

- no pulse

38
Q

What type of treatment is used for ventricular fibrillation

A
  • CPR

- defibrillation

39
Q

Heart Failure

A
  • heart unable to pump enough blood to meet metabolic needs

- Caused by any interference with normal mechanisms regulating CO.

40
Q
  1. systolic failure patho
A

Common cause of heart failure : MI and HTN

  • caused by impaired contractile function
    • inc afterload
  • valve problems
    • Unable to generate adequate CO
      impaired emptying.

Leads to:
a. dec L ventricular ejection fraction

b. inc L ventricular end-diastolic volume

  • more blood = bigger heart chambers = dialate
    c. inc L ventricular end-diastolic pressure

d. inc pulmonary pressure

41
Q
  1. Diastolic failure
A
  • problems with relaxation and filling
  • Diastolic failure=High filling pressures and venous congestion
  • Pulmonary congestion present with normal CO.
42
Q

Compensatory Mechanism

  • overtime = heart failure d/t dec CO
    1. Sympathetic stimulation
A
  • inc HR, contractility to inc CO
  • inc epinephrine = inc HR
  • over time over worked heart
43
Q
  1. Dilation
A
  • muscle fibers stretch = inc CO
  • d/t blood pooling
  • overtime over stretching
44
Q
  1. Renal Response
A

renin released= BP inc

45
Q
  1. Hypertrophy
A
  • inc mass = inc CO
  • muscles become thicker for CO
  • overtime thickness in muscles = inc O2
46
Q

Types of Heart Failure

  1. Left- sided Heart Failure (congestive heart failure)
A
  • systolic/diastolic failure
  • most common and happens first
  • one side may be effect but over time both sides will fail because its compensating
  • causes blood to back up into pulm circulation.
    • leaks in LV line
  • Inc pulm pressure causes fluid to leak from pulmonary capillary beds to alveoli –> pulmonary congestion.
47
Q

What are the main problems of LHF?

A

Poor CO

Backed up blood = pulm congestion

48
Q

What are the clinical manifestations of Left HF?

A
  1. weakness, fatigue
  2. pale cool skin
    - vasoconstriction
  3. chest pain
    - inc workload of heart
  4. pulmonary edema
    - backed up blood and leaks to LV = in lungs = sob, diff breathing
  5. confusion
    - no o2 in brain
  6. metabolic acidosis
    - lack of o2
    - Rely on anaerobic
  7. nocturia
    - inc urine output at night
49
Q
  1. Right Sided Heart Failure
A
  • caused by left sided heart failure, MI, lung disease = pneumonia, tumor
  • causes backflow of blood in venous system = venous congestion
  • dec cardiac output
50
Q

What are the clinical maneifestations of Right HF

A
  1. venous congestion
  2. liver engorgement
  3. ascites = edema in abdomen
    - anasarca = mass body edema
  4. jugular vein distention
  5. fatigue
  6. Peripheral edema
51
Q

What types of treatment are used for Right HF?

A

positive anotropic agents

a. digoxin
- dec hr

b. diuretics
- dec fluid
- dec preload on heart

c. vasodilators
- dilate blood vessels

  1. oxygen
    - not enough gas exchange d/t edema
  2. low sodium diet
    - risk of fluid retention
    - on fluid restrictions 1800 cc fluids/day
52
Q

Shock

A
  • failure of CV system to perfuse tissues adequately

- inadequate blood flow to organs = lack of O2 and nutrients to cells

53
Q
  1. Impairment of O2 use
A

no O2, cells shift to aneorobic metabolism

  • less efficient, less energy -> can’t operate Na-K pump.
  • Na stays in cell -> water in
  • dec circ volume -> activation of clotting cascade
  • release of lysosomal enzymes and inflammatory response.
  • aneorobic metabolism causes inc acid -> impair cell function.
54
Q
  1. Impairment of glucose use
A
  • shift to lipolysis, gluconeogenesis, glycogenolysis

- Protein breakdown -> ammonia, urea -> toxic to cells -> organ failure

55
Q

Types of Shock:

  1. Cardiogenic Shock
A
  • Heart can’t pump blood efficiently
  • dec CO
  • d/t MI = massive heart attack
56
Q

What is the patho of cardiogenic shock?

A
  • occurs after MI. Dec in compliance and contractility d/t infarction
  • > dec CO, dec BP
  • Low arterial pressure -> dec CA perfusion -> inc ischemia
57
Q

What are the clinical manifestations of cardiogenic shock?

A

a. impaired thought process = dec bp

b edema, pulmonary and peripheral

c. hypotension- dec UO
d. dec renal perfusion – dec Urine output

58
Q

What type of treatment is used for cardiogenic shock?

A

a. restore CA blood flow – angioplasty
b. thrombolytics
c. intraaortic balloon pump

d. inotropic meds
- inc contractility of heart (+)

59
Q
  1. Hypovolemic Shock
A
  • loss of intravascular volume
  • failure of CV system because cant profuse tissues
  • lack of blood flow, o2, nutrients to cell
  • hemmorhage, burn victims, extreme dehydration = vomit, diarrhea
60
Q

What is the patho for hypovolemic shock?

A
  • dec vascular volume -> dec venous return, dec CO.
  • Compensatory mechanism
    • HR, SVR inc, interstitial fluid moves into vascular space.
  • Stored RBC and plasma released.
  • Kidneys secrete renin.
  • Compensatory mechanisms fail = dec CO and inadequate perfusion.
61
Q

What are the clinical manifestations of hypovolemic shock?

A

a. drop in BP
b. inc HR, thready pulse
c. poor skin turgor
d. thirst
e. dec UO

f. dec in mental status
- d/t lack of blood flow

62
Q

What types of treatment are used for hypovolemic shock?

A
  • volume replacement

- blood and blood products for hemorrhage

63
Q

Neurogenic Shock

A
  • massive vasodilation

- from parasympathetic NS over stimulation or sympathetic under stimulation.

64
Q

What is the patho for neurogenic shock

A
  • vasodilation = dec SVR
  • pooling f blood
  • dec HR and CO
  • inadequate perfusion
65
Q

What are the clinical manifestations of neurogenic shock?

A
  • low BP
  • dec HR
  • fainting
66
Q

What type of treatment is used for neurogenic shock?

A
  • fluid replacement

- meds to inc BP

67
Q

Anaphylactic Shock

A
  • allergic reaction

- stim immune and inflam respnse

68
Q

What is the patho of anaphylactic shock?

A
  • Immune response causes vasodilation and inc vascular permeability
    • > peripheral pooling of blood and edema -> dec perfusion.
  • respiratory problems possible
69
Q

What are the clinical manifestations of anaphylactic shock?

A

a. dec BP
b. weak pulse
c. dec mental status
d. anxiety
e. difficulty breathing
f. skin rash

70
Q

What types of treatment are used for anaphylactic shock?

A

a. epinephrine
b. antihistamines

c. steroids
- dec inflam

71
Q

Septic Shock

  • bactieremia
  • sepsis
A

infection
– bacteremia = bacteria in blood

– sepsis = infection in blood

– septic shock

SIRS – systemic inflammatory response syndrome.

72
Q

What is the patho of septic shock?

A
  • gram (-) bacteria.
  • Endotoxins trigger inflammatory responses
  • bind to monocytes, macrophages

– stimulate release of mediators.

  • Mediators cause vasodilation, inc capillary permeability
  • dec in myocardial contractility -> organ failure.
73
Q

What are the clinical manifestations of septic shock?

A

a. dec BP
b. fever
c. flushed skin
d. chills
e. confusion
f. edema

74
Q

What type of treatment is used for septic shock?

A

a. antibiotic therapy

b. fluids

Nursing 2005: Clinical Pathophysiology (9 decks)

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