Quiz Units 2 & 3 Flashcards
Name the 3 pacemaker sites within the heart and give a rate range for each.
SA node 60-100 bpm. AV node 40-60 bpm. Perkinje fibers 20-40 bpm.
Name each structure of the heart in order that blood flows through them, including the vessels.
Vena Cava, right atrium, tricuspid valve (and chordae tendinae), right ventricle, pulmonic valve, pulmonary arteries, pulmonary veins, left atrium, bicuspid (mitral) valve, left ventricle, aortic valve, aorta
What is defined as, “The degree of myocardial stretch at the end of diastole, just before contraction of the ventricles?”
Preload
How would you define heart contractility?
The force of contraction independent of preload
What is afterload?
Pressure (leftover from the last cycle) that the ventricle must overcome to open the semilunar valves.
When referring to the heart, what is impedance?
This is afterload, plus the systemic resistance of the vessels, the viscosity of the blood, vessel constriction, and all other factors that make it harder for the aortic valve to open.
Name 3 risk factors for cardiovascular disease in women.
Abdominal obesity, postmenopausal, DM
The _____ nervous system slows the heart rate, while _____ stimulation increases it.
Parasympathetic. Sympathetic
What class of drugs increases heart rate and contractility?
CAtecholamine’s such as epinephrine and norepinephrine.
T/F. A healthy heart can adapt to stress, infection, and hemorrhage.
True
What is pulse pressure?
The difference between diastolic and systolic
What primarily determines diastolic blood pressure?
Peripheral vasoconstriction
Diastolic BP must be at least _____ mm Hg to maintain flow through the coronary arteries.
60
What is pallor indicative of?
Anemia
How would you find the ankle-brachial index?
Apply a BP cuff to the lower extremity and use Doppler to assess the systolic pressure at the dorsalis pedis and posterior tibial pulses
How would you find arterial insufficiency in a lower extremity?
Palpate peripheral arteries in a head to toe fashion, comparing pulses side to side
What abnormal heart sound is common in older adults?
S4
What is S4 indicative of?
Ventricular hypertrophy
When auscultating heart sounds, you find that the point of maximum impact (PMI) has moved more than 1 intercostal space. What is this indicative of?
Left ventricular hypertrophy
What are some s/s of angina?
Sudden onset, substernal, may spread across chest/back/arms, usually lasts less then 15 min
What are s/s of a MI?
Sudden onset/often early AM, substernal, may spread across chest/back/arms, intense stabbing vice-like pain
What are some s/s of pericarditis?
Sudden onset, intermittent/relieved by sitting upright, substernal, may spread across chest/back/arms, sharp stabbing/moderate to severe
What are some s/s of anxiety?
Dull ache to sharp stabbing pain. May be in response to stress
What are some s/s of pleuropulmonary chest pain?
Moderate ache/worse on inspiration, continuous
How does esophageal/gastric chest pain differ from heart related chest pain?
Can be substernal, but spreads to abdomen and shoulders. It is a squeezing feeling and is variable in severity
What s/s of CHF would you teach a client to look for?
Weight gain of 1-2 lbs in 1-2 days, notify physician if rings/shoes feel tight, it is possible to gain 10-15 lbs before edema develops
Name 3 movements that can cause syncope in an aging client.
Turning the head, doing Valsalva maneuvers, and shrugging the shoulders
How is the severity of orthopnea measured?
By the number of pillows it takes to relieve it
What common nursing measures can decrease myocardial contractility, further decreasing cardiac output in a CVD client?
Endotracheal suctioning that causes hypoxemia
What is intermittent claudication? What is done for it?
Muscle pain, usually in the legs, that occurs during exercise, caused by lack of blood flow to the affected area. It is tx by resting with the legs in a dependent position
What is considered a normal triglyceride level?
Less than 150 mg/dl
What is considered a normal total cholesterol level for older adults?
144-280 mg/dl (122-200 mg/dl is normal for younger pts)
What should the HDL-LDL ratio be?
3:1
At what level should HDLs be maintained?
Greater than 45 mg/dl
At what level should LDLs be maintained?
Less than 70 mg/dl for high risk CVD pts, <130 mg/dl for the rest
What conditions would prompt regular testing for microalbuminuria?
Hypertension, DM, and metabolic syndrome
What tests are run for Coumadin therapy?
PT and INR
What measures are taken to prepare a client for an echocardiogram?
IV access and NPO for 3-6 hours
Do echocardiograms require informed consent?
No
What is an MPI (MNPI)?
Myocardial nuclear perfusion test. It can detect MI and decreased myocardial blood flow
What instructions are given to a pt before a stress test?
Wear comfy clothes/shoes, avoid alcohol/smoking/caffeine the day of the test, light meal at least 2 hours before the test
What ECG parameter would indicate a need to stop a stress test?
Depressed ST segment
What is a technetium scan used for?
To detect the size and location of an MI
What is a thallium scan used for?
To assess myocardial scarring and perfusion, size and location of an MI, CABG graft patency, and to evaluate anti-anginal therapy, thrombolytic therapy, and balloon angioplasty
Is multigated blood pool scanning invasive or non-invasive?
It is a non-invasive test to look at cardiac blood flow
Where do you put the transducer for a Pulmonary artery wedge pressure (PAWP), also called pulmonary artery occlusive pressure (PAOP)? Where is the catheter placed?
At the phlebostatic axis. In the pulmonary artery
During hemodynamic monitoring via a pulmonary catheter, what would a normal range be, and what does it mean if the reading is high?
1-8 mm Hg. High means right-sided heart failure
What is SVO2 and what is considered a normal reading?
It is venous oxygen saturation. The amount of oxygen that isn’t used by the body and is returned to the heart. Normal is 60-80, meaning that 20-40% of the oxygen was used
Name 3 uses for an angiogram.
To identify arterial narrowing, blockages, and aneurysms
What is assessed after cardiac catheterization?
The site for bleeding/hematoma, bedrest 2-6 hrs, supine (HOB elevated up to 30 deg), peripheral pulse/color/temp of affected extremity, vitals q15/1st hr, q30/2 hrs, q4. Of course this is all per facility policy!
After taking a PAWP reading, what 2 things should the nurse do?
Ask the pt to cough and assist them to change positions.
What are some complications of a pulmonary artery catheterization?
Pulmonary infarction, infection, and ventricular dysrhythmias.
Describe the waveform associated with a 3rd deg heart block. Why is it like this? What causes it?
The P wave is usually regular and 60-80 bpm. The R wave is only 40 bpm. The signal is being delayed or blocked after the P wave is produced. In a complete block, there is no correlation btwn the P & R waves timings It may be caused by an MI or Lyme’s disease
How is a 3rd degree heart block treated?
Pacemaker
What’s the difference btwn cardioversion and shocking someone?
In cardioversion, there is an R wave so you must sync it first. If no R wave, then you just shock them
What is done for bradycardia?
Pacing Always Ends Danger. Pacing comes 1st, while waiting, consider Atropine, Epi, Dopamine
What is the acronym for V-Tach?
SCREAM. Shock (q2min if necessary). CPR (2 min - Do NOT check pulse/rhythm). Rhythm (q2mins). Epi. Anti-Arrythmic Medications (Epi, Lidocaine, Mag Sulfate)
What is the acronym for the treatment of asystole?
PEA. Pacing (CPR). Epi. Atropine
What is of greatest concern with Afib and how is it treated? How do you tx the Afib?
Emboli, so tx with Coumadin, Cardizem, and maybe cardioversion
What is a concern with SVT and what is the tx for it? How is the SVT treated?
Clots/anticoagulants. Adenosine/tx
How is V-tach treated? What drugs?
Sync and cardiovert @ 200/300/360 joules. Amiodarone and lidocaine
What can cause V-tach?
MI, K+, Mag, stress
What can cause sinus tachycardia?
Bundle branch block
How is sinus tach treated?
Tx underlying cause
What is the acronym for STEMI tx?
MONA. Morphine. O2. Nitrates. Aspirin. (send to cath lab)
What is it called if there is a long delay between the P wave and the QRS complex? How is that tx?
1st deg block (Blocked btwn the SA and AV nodes). Usually not tx
If there is a straight line going up or down on the tracing it is caused by what? If the tracing has 2 of these, it is called an _____ _____ _____.
A pacemaker. An AV sequential, which paces the atria and the ventricles.
What do we look for in the tracing with a pacemaker?
Fire and capture with each pulse
If sinus bradycardia is symptomatic, what is done for it? Non-symptomatic?
Atropine. Ask more questions
What are 2 types of PVCs?
Unifocal and multifocal
What can cause PVCs?
CHF, Anemia, electrolytes
What is the tx for PVCs?
Amiodorone, lidocaine
If you get a 4 beat run of VT, what may be happening?
It may be an MI in the making if it is maintained
What might cause a 4 beat pattern of VT and how would you tx it?
MI, mag, K+. Amiodorone, lidocaine
Why can’t you sync with V-Fib?
The waves are so small they can’t really be defined as true waves
What will the pt look like if he is in V-Fib?
Dead. Blue. Cells are dying causing anaerobic respiration which causes lactic acidosis
What is the tx for V-Fib?
Epi, lidocaine, amiodorone. Shock at 200/300/360 joules
What labs are needed with Coumadin?
PT & INR
What labs are needed with Heparin?
PTT/APTT
What is the antidote to Heparin?
Protamine sulfate
How long is a normal PR interval?
.12-.20 sec
How long is a normal QRS complex?
.04-.10 sec
What are the 4 questions you ask yourself when looking at an EKG tracing?
Is there a P wave? Is every P wave followed by a QRS complex? Is the rate fast/slow? Is the rhythm regular?
What is the antidote to Coumadin?
Vitamin K
How do ACE inhibitors work?
Inhibit conversion of Angiotension1 and Angiotension 2, which lowers arterial resistance and increases vascular capacity. It also increases renin, thereby reducing aldosterone levels, which causes the kidneys to release sodium and water, reducing blood volume
What is the major effect that must be monitored for when administering Beta Blockers, ACE inhibitors, anti-arrhythmics, and calcium channel blockers?
Bradycardia
What dysrhythmia does lidocaine treat?
PVCs, VT and VF
What is atropine used for?
Bradycardia
What is done for SVT?
Adenosine (adenocard) 6/12/12 Slam it in! Lay flat
What is amiodarone used for?
Afib and life threatening ventricular dysrhythmias
What is digoxin used for?
Afib/flutter/PSVT
What is done for sinus tachycardia?
We treat the underlying cause
How do you assess for a pulse deficit?
Take the apical and radial pulses for a full minute and see if there is a difference
Which of these instructions to a UAP would help prevent a vagal response? Don’t raise the pts arms over her head. Don’t use a rectal thermometer. Keep the pt supine.
Instruct them to avoid raising the pts arm over her head
What is ejection fraction and what is its normal range?
EF is the stroke volume divided by the End Diastolic Volume. SV/EDV. 50-75% 36-39 is very bad!
What is the tx for V-Tach?
Amiodorone. Hang a drip. Weight based
How do you identify an MI on a trace and what is the PRIORITY goal?
ST elevation. Tombstone. Cath Lab. Must be done within 90 minutes
What are Urokinase and Tissue Plasminogen Activator?
Clot busters. UPA and TPA
What is Bumex (bumetandine)?
A loop diuretic often used in heart failure
At what point is surgery the option of choice for blocked arteries?
70% blocked, or less in heart failure
What is the difference between stable and unstable angina?
Stable is predictable. Exercise/pain/take nitro/relief. Unstable happens at rest
Besides relieving pain, why is morphine used for MI?
It is also a vasodilator
What disease process blocks coronary arteries? Describe this process.
Atherosclerosis. Plaque builds up under the interior lining of the arteries. (cholesterol/triglycerides/Etc.) When it breaks through that lining (a lesion), the body attacks with an immune response (platelets/t-cells/WBCs), closing off the artery
What is “The Widowmaker”?
Left anterior descending (LAD)
When is balloon angioplasty not an option in the LAD?
When it is a high lesion in the LAD
What is the protocol for home use of nitroglycerin?
3 max, 5 minutes apart, call 911 if the 3rd doesn’t work
What is integrelin?
An antiplatelet drug
What priority nursing measures must be done every shift for a pt with an invasive temporary pacing?
Change the battery q shift, check rate and amplitude of the pacing pulse
What is the tx protocol for PVCs?
Amiodorone/lidocaine if symptomatic, usually for multifocal PVCs
What is “high output failure”?
It is a prolonged condition of high volumetric output due to high diastolic pressure. This causes circulatory overload and pulmonary edema. It can be caused by anemia, sepsis, hyperthyroidism, or anything that increases metabolic states
Name some catecholimines? How do they affect blood vessels?
Epinephrine, nor-epi, dopamine. Vasoconstrictors
What often causes right sided HF?
The left ventricle is unable to relax enough to allow proper filling, often caused by infarct
How does the body’s natural mechanisms cause HF to worsen?
Low output causes the CNS to increase the HR and constrict the vessels to maintain perfusion. At the same time, it causes the renin angiotensin cascade to produce more aldosterone increasing fluid volume. This increases preload and afterload stretching the muscle and causing loss of contractility over time
What are some s/s of right-sided HF?
JVD, edema, ascites, hepatomegaly
What are some s/s of pulmonary edema?
Difficulty breathing, pink/frothy sputum, sweating, anxiety, pale, orthopnea, SOB
What are some s/s of left-sided HF?
Tachypnea, rales/crackles, cyanosis
What is the tx acronym for pulmonary edema?
MAD DOG. Morphine, airway, digitalis, diuretic, O2, Gasses (ABGs)
What are the s/s of dig toxicity?
Hypokalemia, confusion, anorexia, NVD, yellow/green halos, dizziness, agitation/depression
What nursing measures are a priority with pulmonary edema?
VS hourly. ABGs (they will be acidotic). PAO2 will determine if vent is needed
What is BNP? What is it for?
B type natriuretic peptide. It is only produced during heart failure and is used to stage it
What is Natrecor (Nesiritide)?
An artificial BNP (diuretic) used to treat HF and reduce pulmonary edema
What is LVEDP and how is it measured?
Left Ventricular End Diastolic Pressure. It is calculated by measuring wedge pressure in the pulmonary artery. Normal wedge pressure is 12-20
What type of MI do women prefer?
Non-STEMI
What blood test peaks 24 hours after an MI?
CK-MB
Explain systole and diastole.
There is actually atrial systole/diastole and ventricular diastole/systole. Our BP is measured by the max (systolic) & min (diastolic) pressure on the arteries. Within the heart, ventricular or atrial systole was contraction (when the greatest force is observed) & diastole is at max stretch, before the muscle contracts
Explain the stages of HF.
Stage A: Pts at high risk for developing HF but currently have no functional or structural deficits. Stage B: Structural disorder but no s/s. Stage C: Previous or current s/s of HF in the context of an underlying structural heart problem, but managed with medical tx. Stage D: Advanced disease requiring hospital based support or palliative care
Explain the classes of HF.
Class I: No limitations or s/s. Class II: Slight/mild limitations. Pt is comfortable at rest or with mild exertion. Class III: Marked limitations. Pt only comfortable at rest. Class IV: S/S at rest
What are acute coronary syndromes?
Unstable angina and MI (most serious)
