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Med-surg nursing II > Objective 3: cardiovascular alterations > Flashcards

Objective 3: cardiovascular alterations Flashcards

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1
Q
  • To provide oxygenated blood and nutrients to vital
    organs/tissues.
  • Without adequate pressure to force perfusion, tissue and
    organ injury can result
A

cardiovascular/peripheral vascular system

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2
Q

what are the measurements for adequate pressure and perfusion?

A

SBP > 90mm Hg
MAP > 60 mmHg

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3
Q

CK and CK-MB; Troponin T and I; myoglobin - levels rise from heart damage

A

cardiac biomarkers

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4
Q

cholesterol, triglycerides, lipoproteins (12 hr fast)

A

lipid profile

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5
Q

helps regulate BP &
fluid volume; increased with heart failure

A

brain natriuretic peptide

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6
Q

produced in the liver; levels will rise in
response to inflammation

A

C-ractive protein

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7
Q

amino acid in your blood. You get it mostly
from eating meat. High levels of it are linked to early
development of heart disease

A

homocysteine

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8
Q

shows electrical currents; detects abnormal rhythms, and
can sometimes detect heart muscle damage

A

ECG

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9
Q

uses an X-ray machine and a computer to create
3-dimensional pictures of the heart. Sometimes a dye is injected
into a vein so that your heart arteries can be seen as well

A

cardiac CT scan

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10
Q

client wears a small, portable, battery-powered
ECG machine to record heartbeats over a period of 24 to 48 hours
during normal activities. At the end of the time period, the
information is read and evaluated.

A

holter monitor

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11
Q

evaluates CV response to stress;
complications can be life threatening. Often done with ECG

A

cardiac stress testing

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12
Q

treadmill exercise/bicycle to increase HR

A

exercise stress testing

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13
Q

vasodilating agents are used to
mimic effects of exercise on CV system; used with physically
disabled or deconditioned persons

A

pharmacologic stress testing

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14
Q

u/s to measure ejection fraction and examine size,
shape & motion of cardiac structures, also its pumping function. Ejection
fraction 60-65% is normal

A

echocardiogram

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15
Q

uses a small transducer through
mouth into esophagus nearer to the heart. It allows a closer look at the
heart’s structure and function. It also shows any abnormal tissue around
your heart valves, if blood is leaking backward through a valve, and if
blood clots are present in your heart chambers

A

transesophageal echocardiogram

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16
Q

used to distinguish atrial from ventricular
tachycardias when other methods are inconclusive; serious dysrhythmias

A

electrophysiologic testing

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17
Q

a small
catheter guided through the large artery in your upper leg, or sometimes
your wrist or arm, into your heart. Dye is given through the catheter and
moving X-ray pictures are made as the dye travels through your heart.
This comprehensive test shows; narrowing in the arteries, heart chamber
size, how well your heart pumps, and how well the valves open and
close, as well as a measurement of the pressures within the heart
chambers and arteries.

A

cardiac catherization

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18
Q

is the force produced by the volume of
blood in arterial walls

A

Blood pressure

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19
Q

what is BP an indicator of?

A
  • The ability of arteries to stretch and fill with blood
  • The efficiency of the heart as a pump
  • The volume of circulating blood
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20
Q

what is BP affected by?

A
  • Age, body size, diet, activity, gender, time of day, emotions,
    pain, position and disease.
  • Fluctuations occur so it is important to obtain several
    measurements for comparison
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21
Q

is a chronic condition in which the blood pressure in the
arteries is elevated above normal.
* is a risk factor for coronary heart disease, stroke, peripheral artery disease,
and renal failure.
* Systolic blood pressure equal to or greater than 140 mm Hg and a diastolic
pressure equal to or greater than 90 mm Hg over a sustained period.
* Based on the average of two or more blood pressure measurements taken in
two or more visits with the health care provider after an initial screening

A

hypertension

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22
Q

Elevated BP that develops during evaluation by medical
personnel –who traditionally have worn white coat. Likely result of anxiety. Clients are
advised to do regular BP check either at home or with assistance and bring record to
physician

A

white-coat hypertension

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23
Q

what are the 2 types of HTN?

A

primary
secondary

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24
Q

is HTN with no identifiable cause but
implicated factors include:
* 90-95% of population
* Heredity
* Increased sympathetic neural activity
* Age

A

primary HTN

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25
Q

has an identifiable underlying cause and is less
common than primary HTN.
* 5-10% of population

A

secondary HTN

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26
Q
  • The rate of the rise of BP is more important than the absolute value in
    determining the need for emergency treatment.
  • Prompt recognition and management is essential to decrease threat to
    organ function and life!
A

hypertensive crises

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27
Q

occurs when
* BP > 180/120 mmHg
* must be treated and lowered immediately to prevent further
damage to organs

A

hypertensive emergency

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28
Q

is defined as severely elevated
BP with no evidence of target organ damage.
*Develops over days to weeks
*Client requires close monitoring of BP and CV status
*ASSESS FOR POTENTIAL EVIDENCE OF TARGET ORGAN
DAMAGE.
*The blood pressure must be lowered within a few hours

A

hypertensive urgency

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29
Q

occurs when the major
blood vessels that supply the heart become damaged or
diseased.
* Inflammation and plaque formation in the coronary
arteries is most common cause (atherosclerosis). As this
plaque builds up, the arteries are narrowed which
decreases blood flow.
* If blood flow is compromised enough, angina pectoris
(chest pain) occurs.
* If a full blockage occurs, a myocardial infarction (MI or
heart attack) will occur.

A

coronary artery disease

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30
Q
  • A loss of elasticity and artery hardening that accompanies
    the aging process.
  • Arteries lose elasticity, are more rigid
  • arterial vessels fail to stretch causing less O2 rich blood to
    be delivered to the organs
A

arteriosclerosis

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31
Q
  • Artery lumens fill with fatty, cholesterol plaque deposits
  • reducing the amount of O2 rich blood reaching organs.
  • This is a more modifiable contributor to vascular disease
    than _______________
A

atherosclerosis

32
Q

chest pain caused by myocardial ischemia

A

angina pectoris

33
Q

This is a sum of your blood’s cholesterol content. Below
5.2 mmol/L desirable, Above 6.2 mmol/L is considered high

A

total cholsterol

34
Q

“good” cholesterol because it
helps carry away LDL cholesterol, keeping arteries open and your blood
flowing more freely. Above 1.5 mmol/L is best; Below 1 mmol/L is poor

A

HDL cholesterol

35
Q

“bad” cholesterol. Too much of
it in your blood causes the buildup of fatty deposits (plaques) in your
arteries (atherosclerosis), which reduces blood flow. These plaques
sometimes rupture and can lead to a heart attack or stroke. 2.6-3.3 mmol/L
for clients without CAD, Below 1.8 mmol/L for client with symptomatic CAD;
Above 4.9 mmol/L is considered very high.

A

LDL cholesterol

36
Q

When you eat, your body converts calories it doesn’t need
into triglycerides, which are stored in fat cells. High triglyceride levels are
associated with several factors, including being overweight, eating too many
sweets or drinking too much alcohol, smoking, being sedentary, or having
diabetes with elevated blood sugar levels. Below 1.7 mmol/L is desirable;
Above 5.6 mmol/L is considered very high

A

triglycerides

37
Q
  • Pain: pressure, fullness, burning or
    tightness in your chest, crushing
    or searing pain that lasts for more
    than a few minutes and increases
    with exertion.
  • May be associate with shortness
    of breath, cold sweats, dizziness
    or weakness, nausea or vomiting.
  • Since this is visceral pain,
    radiation of cardiac pain is
    common to any of the following
    sites: back, neck, jaw, shoulders,
    and one or both arms
A

cardiac pain

38
Q
  • Pain: Typically sharp and
    unilateral
  • Increases with point tenderness
    or coughing- this is somatic pain
    which increases with movement
    of the thorax
  • Sore throat may be present as
    associated with excessive
    coughing
A

pleuritic pain

39
Q
  • A syndrome characterized by episodes of paroxysmal pain
    or pressure in the anterior chest caused by insufficient
    coronary blood flow
  • Physical exertion or emotional stress increases myocardial
    oxygen demand, and the coronary vessels are unable to
    supply sufficient blood flow to meet the oxygen demand
A

angina pectoris

40
Q

what are the types of angina pectoris?

A

chronic stable
unstable
intractable
variant
nocturnal
silent ischemia

41
Q

Predictable and consistent pain initiated by exertion and
responds to rest or nitroglycerine. Same pattern of onset, duration & intensity of
symptoms

A

chronic stable angina

42
Q

Persistent and unpredictable, even during rest. Doesn’t respond
to nitroglycerine. Requires medical intervention

A

unstable angina

43
Q

severe and incapacitating chest pain; unrelenting
pain

A

intractable angina

44
Q

pain at rest, often with reversible electrocardiogram
(shows the heart’s electrical activity) changes. Seen in clients with a history of
migraine headaches and Raynaud’s phenomenon

A

variant angina

45
Q

Occurs only at night but not necessarily during sleep. May occur
in the absence of significant coronary atherosclerosis or coronary spasm. More
common in women

A

nocturnal angina

46
Q

Objective evidence (EKG changes) but patient does not report
symptoms; no pain

A

silent ischemia

47
Q
  • Spectrum of conditions which describes the reduction of blood flow to
    the heart muscle (myocardium) .
  • When ischemia is prolonged and is not immediately reversible, acute
    coronary syndrome (ACS) develops.
A

acute coronary syndrome

48
Q

a change in the pattern of angina symptoms, without signs of an MI

A

unstable angina

49
Q

an MI identified by BW, without the typical ECG changes

A

non-ST-elevation MI

50
Q

an MI identified by BW and produces typical ECG changes. SERIOUS

A

ST-elevation MI

51
Q
  • Infarct, or tissue death, occurs when:
    An area of heart tissue dies (necrosis) from reduced oxygen supply.
  • Result of prolonged occlusion (blockage) of the coronary arterial
    blood flow (RCA, LAD & LCx).
  • Larger necrotic area = more serious damage
  • classified based on the area affected and the depth of the
    damage to the heart muscle
A

Myocardial infarction

52
Q
  • CK-MM (skeletal muscle), CK-MB (heart muscle), CK-BB (brain tissue).
  • CK-MB is found mainly in cardiac cells and increases with damage.
  • Increases in a few hours and peaks within 24 hours.
  • Sensitivity and specificity are not as high as for troponin levels.
  • Currently replaced by troponin levels
A

creatine kinase

53
Q

s found in cardiac and skeletal muscle.
* It is released rapidly, within 1-3 hours after an MI.
* has high sensitivity in that it occurs quickly, but poor
specificity to the heart alone. It may be useful for the early
detection of myocardial infarction.
* If it is not present – MI may be ruled out

A

myoglobin

54
Q
  • bleeding (from puncture and from getting heparin during procedure),
  • damage to coronary artery (occurs mainly in the procedure room),
  • infection (invasive procedure),
  • clot formation in stent after procedure (called restenosis, client must
    ensure to take required medication post procedure to the period of
    time prescribed (usually ASA and Plavix),
  • abnormal heart rhythms (Post procedure vitals and site checks are
    required as ordered)
A

post cardiac catheterization/stenting procedure risks

55
Q
  • bleeding (from puncture and from getting heparin during procedure),
  • damage to coronary artery (occurs mainly in the procedure room),
  • infection (invasive procedure),
  • clot formation in stent after procedure (called restenosis, client must
    ensure to take required medication post procedure to the period of
    time prescribed (usually ASA and Plavix),
  • abnormal heart rhythms (Post procedure vitals and site checks are
    required as ordered)
A

heart failure

56
Q

characterized by a weakened heart muscle,
and the EF is severely reduced (55-70%).
* Inability of heart to pump blood related to impaired contraction, increased
afterload, mechanical abnormality (valve disease)
* most common type
* Caused by left ventricular hypertrophy from chronic systemic HTN, aortic
stenosis, hypertrophic cardiomyopathy

A

systolic HF

57
Q

characterized by a stiffened non-compliant
heart muscle. EF is normal.
* Insufficient blood volume pumped related to reduced filling during diastole
(preserved systolic function- normal EF)
* Characterized by high filling pressures and venous engorgement
* caused by Left ventricular hypertrophy from chronic hypertension, Aortic
stenosis, Hypertrophic cardiomyopathy

A

diastolic heart failure

58
Q

Imaging of tissues, organs and BV; estimation of
velocity. Can use doppler

A

ultrasonography

59
Q

Images of arteries/occlusions in lower limbs as blood flows;
contrast agent. Can be done with CT or MRI

A

angiography

60
Q

compares the BP in the client’s ankle with the
BP in the arm. The ratio represents the reduction in blood flow between
the 2 sites. ABI range of 0.90 to 1.40 is considered normal. Mild to
moderate if the ABI is between 0.41 and 0.90, and severe if an ABI is less
than 0.40

A

ankle-brachial index

61
Q

a more invasive procedure that involves
guiding a catheter through an artery in your groin to the affected area and
injecting the dye that way. Although invasive, this type of angiography
allows for simultaneous diagnosis and treatment. After finding the
narrowed area of a blood vessel, your doctor can then widen it by inserting
and expanding a tiny balloon or by administering medication that improves
blood flow.

A

catheter angiography

62
Q

A sample of your blood can be used to measure cholesterol
and triglycerides and to check for diabetes.

A

blood tests

63
Q

refers to diseases of the blood
vessels outside the heart and brain.
* It’s often a narrowing of the vessels that carry blood to the legs, arms,
stomach or kidneys.
* Can affect arteries or veins
* reduced blood flow through the
peripheral blood vessels.
* This causes decreased perfusion and oxygenation of the peripheral
tissues.
* This decrease may lead to ischemia, malnourished tissues and tissue
death.

A

peripheral vascular disease

64
Q
  • Atherosclerosis is the leading cause
  • So patients are likely to have CAD
  • The gradual thickening of the layers of the arterial wall cause
    narrowing of the lumen, or stenosis, thrombosis blockage, aneurysm,
    ulceration and rupture.
  • These changes starve organs and tissues of necessary blood flow and
    the components it carries.
  • Commonly affects arteries of neck, abdomen, and extremities
A

peripheral arterial disease

65
Q
  • Reduction in arterial circulation
    caused by brief spasms of the
    arteries and arterioles in fingers
    (most common), toes, nose, ears,
    or chin
  • Spasms last about 15 minutes
  • Cause: no explainable reason, or
    secondary to connective tissue
    disease; impaired release of
    prostaglandins
  • Post spasm, vessels dilate widely
A

non-atherosclerotic PAD

66
Q

aggregates of platelets attached to vein that have a
tail-like appendage containing fibrin, WBC, RBC

A

venous thrombi

67
Q

is a condition where the flow of blood through
the veins is inadequate, causing blood to pool in the legs.
* May be consequence of varicose veins or valve damage from previous
thrombosis.
* Blood cannot return to heart, due to valve damage.
* Volume accumulates.
* Fluid leaves veins and enters the interstitial spaces due to increased
pressure in vessels.
* Results in localized edema, fluid-filled space becomes shiny and
hard. Skin is leathery in appearance

A

venous insufficiency

68
Q

tissue swelling related to obstruction of lymphatic flow
(unable to drain unabsorbed plasma from the interstitial
spaces).

A

lymphedema

69
Q

congenital ® hypoplasia of the lymphatic system
if the lower extremities (females age 15-25)

A

primary lymphedema

70
Q

acquired obstruction ® axillary node
dissection for breast cancer or chronic inflammation of
the lymph vessels

A

secondary lymphedema

71
Q

occur when part of an artery wall weakens, allowing it to
widen abnormally or balloon out, and may rupture causing
hemorrhage and death.
* Commonly involves aorta (aortic arch, thoracic, abdominal)

A

aneurysms

72
Q

what are the types of aneurysms

A

saccular
fusiform
dissecting

73
Q

projects only from one side of the vessel.
Pouch-like

A

saccular aneurysms

74
Q

he entire arterial segment becomes dilated.
Circumferential and uniform in shape

A

fusiform aneurysms

75
Q

the inner layer of the vessel tears and a
hematoma forms and may rupture. Can be in ascending or
descending aorta; acute or chronic

A

dissecting aneurysm

76
Q

A weakening in the wall of a cerebral blood vessel
Usually occur in the circle of Willis (ring of arteries
that supply the brain)
Defect is congenital or secondary to hypertension
and atherosclerosis
Can cause cranial nerve deficits
Many have no warning prior to its rupture

A

cerebral aneurysms

Med-surg nursing II (6 decks)

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