Test 2 Flashcards
What is pericarditis?
inflammation of the pericardial sac that causes a rubbing noise
What is the purpose of valves?
to prevent backflow
What creates heart sounds?
S1 is the closure of the AV valve
S2 is the closure of the semilunar valve
What causes a heart murmur?
a disruption in the flow of blood
What is stroke volume?
the amount of blood ejected per ventricle per beat
What is the cardiac output?
the amount of blood pumped by the ventricles into the pulmonary and systemic circulations in one minute
What is ejection fraction?
the percent of blood ejected from ventricles
What is the normal ejection fraction?
50-70%
What is the normal cardiac output?
4-8 L/min
What is preload?
the ability of ventricles to stretch and go back to normal
What is afterload?
the force needed to eject blood
What is contractility?
the ability of the heart muscle to shorten
What is another name for the Sinoatrial (SA) node?
the pacemaker of the heart
What is a blood pressure?
a reflection of cardiac output.
measure of pressure of blood flow through the arteries
What is the systolic pressure?
pressure that results from contraction of ventricles
What is the diastolic pressure?
pressure of the ventricle at rest
What is pulse pressure?
the difference between diastolic and systolic pressures
What is a normal pulse pressure?
50-100 mmHg
What are determinants of blood pressure?
pumping action of the heart
peripheral vascular resistance
blood volume
blood viscosity
What are non-modifiable risk factors for cardiovascular illnesses?
age, gender, family hx, race, and personal health hx
What are modifiable risk factors for cardiovascular illnesses?
smoking, sedentary lifestyle, hyperlipidemia, obesity, DM, HTN
What is mean arterial pressure (MAP)?
constant blood pressure you have
How do you calculate an MAP?
SBP + 2(DBP) / 3
What is an ideal mean arterial pressure?
> 65mmHg
What three factors determine peripheral vascular resistance?
blood viscosity
length of vessel
diameter of vessel
What is primary hypertension?
increase in blood volume and peripheral vascular resistance
What is secondary hypertension?
hypertension caused by something else.
What are some causes of secondary hypertension?
kidney disease, coarctation of aorta, endocrine disorders, neurological disorders, drug use, pregnancy, hypothyroidism, or obstructive sleep apnea
What is prehypertension?
systolic of 121-139 or diastolic of 81-89
where you can intervene with diet, exercise, stress control, and stop progression to stage 1
What is stage 1 hypertension?
systolic 140-159
diastolic 90-99
What is stage 2 hypertension?
systolic >160
diastolic >100
needs to be on medication
What are nonmodifiable risk factors for hypertension?
age, family hx, genetics, race
What are modifiable risk factors for hypertension?
Diet, obesity, insulin resistance, stress, ETOH
What are early signs of hypertension?
no symptoms other than elevated BP
What are advanced signs of hypertension?
retinal changes - tiny vessels are first to be damaged
hypertensive encephalopathy - swelling because of high pressure, altered LOC, seizures
hypertensive urgency
hypertensive crisis
What is hypertensive urgency?
DBP >120 with no target organ damage
What is hypertensive crisis?
DBP >120 with signs of TOD to include stroke, papilledema, heart failure of aortic dissection
What is the goal of treatment for hypertension?
cannot be cured, but can be controlled
reduce BP <140/90
reduce cardiovascular and renal morbidity and morality.
What are the complications of HTN?
CAD - coronary artery disease
CHF - congestive heart failure
CRF - chronic renal failure
CVA - cardiovascular accident (stroke)
What is the nursing care plan for HTN?
"I TIRED" Intake and output Take blood pressure Ischemia attack, transient (watch for TIAs) Respirations, B/P. Pulse (VS) Electrolytes Daily weight
What antihypertensive drugs are used in the treatment of HTN?
Ace inhibitors/ angiotensin II antagonists
Beta blockers
Calcium channel blockers
Diuretics (thiazides, potassium sparing, loop)
What to remember with beta blockers?
can cause tiredness, decrease HR, impotence, not usually used in elderly because its hard to excrete, GI disturbances
What to remember with calcium channel blockers?
lowers HR and demand for oxygen, can cause headache, peripheral edema, nausea, constipation
What to remember with thiazide diuretics?
watch potassium levels when taking Lasix. decreases peripheral vascular resistance, reduces circulating blood volume
What to remember with potassium sparing diuretics?
promotes Na excretion without K loss
What to remember with Loop diuretics?
inhibits sodium reabsorptions, its better for renal failure
What to remember with Ace inhibitors?
can cause dry, hacking cough, acute angioedema (especially in AA), dizziness, orthostatic hypotension, headache
What is the mechanism of action in ACE inhibitors or angiotensin II receptor antagonists?
prevents formation of angiotensin II (which causes vasocontraction) causing them to relax which lowers blood pressure
What are some patient teaching with ACE inhibitors or angiotensin II receptor antagonists?
monitor potassium levels
avoid salt substitutes
may cause hypotension
take a bed time
What are examples of ACE inhibitors?
Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Zestril, Prinivil) Quinapril (Accupril) Ramipril (Altace)
What are examples of angiotensin II receptor antagonists?
Losartan (Cozaar)
Valsartan (Diovan)
Irbesartan (Avapro)
What is the mechanism of action with beta blockers?
blood the effect of epinephrine - slows HR, decreases workload of the heart, improves blood flow, and reduces BP
What are some patient teachings with beta blockers?
do not use in asthmatics
monitor HR and BP
What are examples of beta blockers?
Atenolol (Tenormin)
Metoprolol (Lopressor, Toprol XL)
Propranolol (Inderal)
Carvedilol (Coreg)
What is the mechanism of action of calcium channel blockers?
prevent calcium rom entering heart muscle cells and blood vessels which promote relaxation and lower BP
What is some patient teaching with calcium channel blockers?
monitor HR and BP
do not use in heart blocks
avoid grapefruit juice
What is the mechanism of action for digoxin?
cause the heart to beat more slowly and forcefully improving cardiac output
What is the therapeutic level for digoxin?
0.5-2
What does diuretics do?
assists with preload reduction.
increases urinary output and decreases fluid retention
What are the types of diuretics?
loop - furosemide/Lasix BEST
thiazide - HCTZ
Potassium sparing - spironolactone/aldactone
What is digoxin?
positive inotropic effect
increases strength of contraction
slows conduction through AV node, decreasing HR
increase ventricular fill time
What is the S/S of digoxin toxicity?
halo vision, increased HR, irregular heart beat. nausea, vomiting, diarrhea. confusion.
What are the types of vasodilators?
arteriolar vasodilators - nifedipine, hydralazine, minoxidil
venodilators - nitroglycerin
mixed arterio and venodilators - sodium nitroprusside, prazocin, ACEIs.
What is given as an antidysrhythmic?
amiodarone - stops the heart for 6 seconds. depresses left ventricular function
What is Deep Vein Thrombosis (DVT)?
a thrombosis (a blood clot) forms on the wall of a vein causing inflammation and some degree of obstruction. located in a deep vein in the body
When is prevention of DVT most important?
imbolized patients
post-op patients
post partum patients
What is Virchow triad?
three pathological factors associated with thrombophlebitis
- stasis of blood
- vessel damage
- increased blood coagulability
What are risk factors for DVT?
specific conditions orthopedic procedures atrial fibrillation acute MI ischemic stroke woman in childbearing age oral contraceptives pregnancy smoking
What are clinical manifestations of DVT?
ususally asymptomatic.
dull, aching pain in affect extremity, especially with walking
possible tenderness, warmth, erythema
possible cyanosis of affected extremity
What are some complications of DVT?
Pulmonary embolism (PE) chronic venous insufficiency (CVI)
What are the lab tests for DVT?
D-dimer
prothrombin time (PT)
partial thromboplastin time (PTT)
bleeding time, platelet count
What is used in preventing DVT?
heparin - enoxaparin, lovenox
oral anticoagulation - warfarin (coumadin) or aspirin
elevating food of bed, knees slightly flexed
early mobilization
leg exercises - foot pump
SCDs,TED hose, or elastic stockings
What is heparin used for?
DVT prophylaxis
What do you monitor while on heparin?
watch for bleeding
monitor PTT and platelets
What PTT level should you maintain with heparin?
60-80 PTT