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NUR 114 > Perfusion A > Flashcards

Perfusion A Flashcards

1
Q

Preload

A

volume of blood entering the ventricles at the end of diastolic

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2
Q

Afterload

A

resistance left ventricles must overcome to circulate blood (systolic) and eject the contents

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3
Q

Cardiac output

A

Heart Rate*Stroke Volume

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4
Q

Normal cardiac output

A

4-8 L/min

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5
Q

Ejection Fraction

A

if low, heart is failing
amount of blood pumped out of the ventricle/total amount of blood in the ventricle=EF
Normal 55-70%

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6
Q

MAP

Mean Arterial Pressure

A

SBP+2(DBP)/
3
Normal 60-70

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7
Q

Angina

A

“heart attack”

pain caused by insufficient coronary blood flow resulting in lack of oxygen

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8
Q

Chronic stable angina

A

pt needs rest; deep breaths

-deep chest pain 
pain radiates to neck jaw shoulders back and arms 
-pain radiates L side normally 
-n/v; indigestion
-dyspnea, diaphoresis, lightheadness
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9
Q

Atypical Angina

A

Women

indigestion, aching jaw, fatigue, sleep disturbances, shob

may not have “chest pain”

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10
Q

Atypical Angina

A

Elderly

no chest pain
shob, disorientation/confusion

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11
Q

Unstable Angina

A

Acute Coronary Syndrome

Pre-infarction
pain, WILL FEEL LIKE AN EMERGENCY
-Usually lasts longer than 15 minutes
-Causes severe activity limitations
-Is not relieved by rest and nitroglycerin

people have this before a heart attack

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12
Q

Variant (Prinzmetal’s) angina

A

Due to coronary artery spasms
Similar to stable angina
Lasts for a longer period of time

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13
Q

Labs for Angina

A

Lipid profile
(triglyceride 35-160,
<200 cholesterol)

Na 135-145
K 3.5-5.3
Ca 8.5-10.5
Mg 1.5-2.5
BUN 6-20
CRT 0.7-1.7
Glucose 65-99
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14
Q

C-Reactive Protein

A
  • shows inflammation in the body; not specific to the heart

- can have a role in the development and progression of atherosclerosis

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15
Q

Coagulation studies

want this to be high for blood to be thinner

A

PT 11-`13.5 seconds
PTT 20-35 seconds (Heparin)
INR 0.9-1.9 (Coumadin)

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16
Q

Troponins T and 1

A

found only in patients with myocardial muscle ischemia or necrosis, so any rise in value indicates possible MI (levels rise within 3-6 hours)

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17
Q

Creatinine Kinase MB(CK-MB)

A

most specific for MI (rises 2-3 hours after cardiac cells are injured and remains elevated for 12 hours)

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18
Q

Myoglobin

A

is a small oxygen-binding protein found in heart and skeletal muscled which is released when heart or skeletal muscles are injured

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19
Q

ECG

A

The electrocardiogram provides a graphic record of the heart’s electrical activity.

  • dysrhythmias
  • electrolyte imbalances
  • conduction abnormalities
  • enlarged heart
  • effects of drugs
20
Q

Exercise ECG (Stress Test)

A
  • Non-invasive
  • Patient should rest, avoid smoking and use of alcohol
  • No food 2 hours before test
21
Q

Pharmacological ECG (Stress Test)

A
  • Invasive (used when patient cannot tolerate exercise)
  • Must have IV access
  • -Dobutamine- strengthen heart muscles
  • -Dipyridamole- anticoagulant
22
Q

Contraindications for CST

A
  • Severe HTN
  • HF
  • Unstable angina
  • Acute myocarditis
23
Q

Goals for Cardiac Stress Test (CST)

A
  • Target heart rate: 80-90% of maximum predicted heart rate

- Discontinue stress test if significant changes noted in the ECG especially changes in ST segment

24
Q

Trans-Esophageal Echocardiography (TEE)

A
  • Examines cardiac structure and function
  • May be done with pharmacologic stress test
  • NPO 4 to 6 hours before and 4 hours after procedure (avoid aspiration)
  • IV access, moderate sedation
  • Monitor for:
  • –Bleeding
  • –Sore throat
  • –Aspiration
  • –Vocal cord paralysis
  • –Pain (could indicate perforation)
  • monitor airway and swallow test
25
Q

What questions to ask before a CT?

A
  • assess for die allergy (iodine and seafood)

- assess for Metformen (for DM) do not take 48H before

26
Q

MONA for pt with heart attack

A
  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin
27
Q

Nitroglycerin

A
  • Short acting sublingual
  • given to reduce cardiac muscle oxygen demand through vasodilation which decreases ischemia, relaxes blood vessels and relieves pain
  • Prevents pain in patients with angina when climbing stairs, having sexual relations, or going outside in cold weather
  • Decreases afterload, creating a more favorable balance between oxygen supply and demand
28
Q

PT education with Nitro

A
  • Keep nitroglycerin in original dark capped bottle and renew supply every 3-5 months
  • Do not eat, drink or smoke while nitroglycerine is dissolving
  • Lie down when taking sublingual nitroglycerin to prevent falls resulting from sudden hypotension
29
Q

Long Acting Nitrates

  • Isosorbide dinitrate
  • Isosorbide mononitrate
  • Nitroglycerin patch or paste
A
  • Used to reduce the incidence of angina attacks
  • Apply to clean, dry, hairless area
  • Remove after 12-14hours
  • Rotate application sites
30
Q

Beta-Blockers (LOL)

A

Metoprolol
Carvedilol

  • block cardiac stimulating hormones
  • reduces HR, BP, O2
  • wheezing, crackles, cough, edema, weight gain (HF)
31
Q

Calcium Channel Blockers (PINES)

A

Amlodipine
Verapamil (no grapefruit juice)

  • Action of drugs:
    • -Decreases afterload (resistance in vascular)
    • -Decreases HR
    • -Decreases peripheral vascular resistance
    • -Promotes vasodilation, thus lowering BP
    • -Improves myocardial perfusion
  • Check BP and pulse prior to administration
32
Q

Anti-Platelet Agents(GREL)

A

Prevent platelet aggregation

Aspirin (bleeding)

  • 81-325mg
  • no herbal remedies
  • ringing in the ears; ototoxicity

Clopidrogrel

  • Take with food
  • Report s/s bleeding
  • avoid grapefruit juice

Prasugrel

  • Do not give to patients with history of stroke
  • Watch for s/s bleeding
33
Q

Clopidrogrel

A
  • Take with food
  • Report s/s bleeding
  • Anti-Platelet Agents
34
Q

Prasugrel

A
  • Do not give to patients with history of stroke
  • Watch for s/s bleeding
  • Anti-Platelet Agents
35
Q

Peripheral Vascular Diseases (PVD)

A
  • lower and upper extremities
  • Arteries and arterioles transport oxygenated blood from the heart to the body tissues
  • Veins and venules return unoxygenated blood back to the heart
36
Q

S/S of Peripheral Artery Disease (PAD)

A
  • intermittent claudication (too little blood flow to legs and arms)
  • rest pain
  • paresthesias (numbness)
  • diminished peripheral pulses
  • pallor w/ extremity elevation
  • rubor w/ extremities
37
Q

Peripheral Artery Disease (PAD)

A

result of systemic atherosclerosis

-can cause gangrene, extremity amputation, rupture of aneurysms, infection/sepsis

38
Q

Stage I: Asymptomatic PAD

A
  • No claudication is present
  • Bruit or aneurysm may be present
  • Pedal pulses diminished
39
Q

***Stage II: Claudication PAD

A
  • Muscle pain, cramping or burning with exercise relieved by rest
  • Symptoms return with exercise
40
Q

Stage III: Rest pain PAD

A
  • Pain while resting(often awakens patient at night)
  • Numbness, burning or toothache like
  • Pain relieved by placing the extremity in dependent position
41
Q

StageIV:Necrosis/ Gangrene PAD

A
  • Ulcers and blackened tissue occur on the toes

- Gangrenous odor

42
Q

best way to manage PAD?

A

EXCERCISE

43
Q

Stains

A

-lower cholesterol
-monitor liver enzymes
AST 10-40
ALT 7-57
-avoid grapefruit juice
-take with food (GI disturbances)

44
Q

Arterial thrombosis/embolism

A 
6Ps
-pain
-pallor
-paresthia (numbness/tingling) 
-pulselessness
-paralysis
poikilothermia (coldness)
45
Q

Chronic Venous Insufficiency

A

Chronic Venous insufficiency is inadequate venous return for a period of time, resulting in stagnation most commonly in the lower leg

46
Q

Virchow’s triad:

A

Blood stasis (pooling)
Vessel wall injury
Hyper coagulation

47
Q

Diagnosis of DVT

A

-D-dimer test (fibrin coagulation activation)
Helps determine risk

-Compression ultrasonography
Allows rapid and clear visualization of thrombi

-DVT risk classification (page 742 Iggy)

NUR 114 (4 decks)

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