Test 2 Flashcards
1
Q
What is pericarditis?
A
inflammation of the pericardial sac that causes a rubbing noise
2
Q
What is the purpose of valves?
A
to prevent backflow
3
Q
What creates heart sounds?
A
S1 is the closure of the AV valve
S2 is the closure of the semilunar valve
4
Q
What causes a heart murmur?
A
a disruption in the flow of blood
5
Q
What is stroke volume?
A
the amount of blood ejected per ventricle per beat
6
Q
What is the cardiac output?
A
the amount of blood pumped by the ventricles into the pulmonary and systemic circulations in one minute
7
Q
What is ejection fraction?
A
the percent of blood ejected from ventricles
8
Q
What is the normal ejection fraction?
A
50-70%
9
Q
What is the normal cardiac output?
A
4-8 L/min
10
Q
What is preload?
A
the ability of ventricles to stretch and go back to normal
11
Q
What is afterload?
A
the force needed to eject blood
12
Q
What is contractility?
A
the ability of the heart muscle to shorten
13
Q
What is another name for the Sinoatrial (SA) node?
A
the pacemaker of the heart
14
Q
What is a blood pressure?
A
a reflection of cardiac output.
measure of pressure of blood flow through the arteries
15
Q
What is the systolic pressure?
A
pressure that results from contraction of ventricles
16
Q
What is the diastolic pressure?
A
pressure of the ventricle at rest
17
Q
What is pulse pressure?
A
the difference between diastolic and systolic pressures
18
Q
What is a normal pulse pressure?
A
50-100 mmHg
19
Q
What are determinants of blood pressure?
A
pumping action of the heart
peripheral vascular resistance
blood volume
blood viscosity
20
Q
What are non-modifiable risk factors for cardiovascular illnesses?
A
age, gender, family hx, race, and personal health hx
21
Q
What are modifiable risk factors for cardiovascular illnesses?
A
smoking, sedentary lifestyle, hyperlipidemia, obesity, DM, HTN
22
Q
What is mean arterial pressure (MAP)?
A
constant blood pressure you have
23
Q
How do you calculate an MAP?
A
SBP + 2(DBP) / 3
24
Q
What is an ideal mean arterial pressure?
A
> 65mmHg
25
What three factors determine peripheral vascular resistance?
blood viscosity
length of vessel
diameter of vessel
26
What is primary hypertension?
increase in blood volume and peripheral vascular resistance
27
What is secondary hypertension?
hypertension caused by something else.
28
What are some causes of secondary hypertension?
kidney disease, coarctation of aorta, endocrine disorders, neurological disorders, drug use, pregnancy, hypothyroidism, or obstructive sleep apnea
29
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
30
What is stage 1 hypertension?
systolic 140-159
| diastolic 90-99
31
What is stage 2 hypertension?
systolic >160
diastolic >100
needs to be on medication
32
What are nonmodifiable risk factors for hypertension?
age, family hx, genetics, race
33
What are modifiable risk factors for hypertension?
Diet, obesity, insulin resistance, stress, ETOH
34
What are early signs of hypertension?
no symptoms other than elevated BP
35
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
36
What is hypertensive urgency?
DBP >120 with no target organ damage
37
What is hypertensive crisis?
DBP >120 with signs of TOD to include stroke, papilledema, heart failure of aortic dissection
38
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.
39
What are the complications of HTN?
CAD - coronary artery disease
CHF - congestive heart failure
CRF - chronic renal failure
CVA - cardiovascular accident (stroke)
40
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
```
41
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)
42
What to remember with beta blockers?
can cause tiredness, decrease HR, impotence, not usually used in elderly because its hard to excrete, GI disturbances
43
What to remember with calcium channel blockers?
lowers HR and demand for oxygen, can cause headache, peripheral edema, nausea, constipation
44
What to remember with thiazide diuretics?
watch potassium levels when taking Lasix. decreases peripheral vascular resistance, reduces circulating blood volume
45
What to remember with potassium sparing diuretics?
promotes Na excretion without K loss
46
What to remember with Loop diuretics?
inhibits sodium reabsorptions, its better for renal failure
47
What to remember with Ace inhibitors?
can cause dry, hacking cough, acute angioedema (especially in AA), dizziness, orthostatic hypotension, headache
48
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
49
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
50
What are examples of ACE inhibitors?
```
Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril (Zestril, Prinivil)
Quinapril (Accupril)
Ramipril (Altace)
```
51
What are examples of angiotensin II receptor antagonists?
Losartan (Cozaar)
Valsartan (Diovan)
Irbesartan (Avapro)
52
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
53
What are some patient teachings with beta blockers?
do not use in asthmatics
| monitor HR and BP
54
What are examples of beta blockers?
Atenolol (Tenormin)
Metoprolol (Lopressor, Toprol XL)
Propranolol (Inderal)
Carvedilol (Coreg)
55
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
56
What is some patient teaching with calcium channel blockers?
monitor HR and BP
do not use in heart blocks
avoid grapefruit juice
57
What is the mechanism of action for digoxin?
cause the heart to beat more slowly and forcefully improving cardiac output
58
What is the therapeutic level for digoxin?
0.5-2
59
What does diuretics do?
assists with preload reduction.
| increases urinary output and decreases fluid retention
60
What are the types of diuretics?
loop - furosemide/Lasix BEST
thiazide - HCTZ
Potassium sparing - spironolactone/aldactone
61
What is digoxin?
positive inotropic effect
increases strength of contraction
slows conduction through AV node, decreasing HR
increase ventricular fill time
62
What is the S/S of digoxin toxicity?
halo vision, increased HR, irregular heart beat. nausea, vomiting, diarrhea. confusion.
63
What are the types of vasodilators?
arteriolar vasodilators - nifedipine, hydralazine, minoxidil
venodilators - nitroglycerin
mixed arterio and venodilators - sodium nitroprusside, prazocin, ACEIs.
64
What is given as an antidysrhythmic?
amiodarone - stops the heart for 6 seconds. depresses left ventricular function
65
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
66
When is prevention of DVT most important?
imbolized patients
post-op patients
post partum patients
67
What is Virchow triad?
three pathological factors associated with thrombophlebitis
1. stasis of blood
2. vessel damage
3. increased blood coagulability
68
What are risk factors for DVT?
```
specific conditions
orthopedic procedures
atrial fibrillation
acute MI
ischemic stroke
woman in childbearing age
oral contraceptives
pregnancy
smoking
```
69
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
70
What are some complications of DVT?
```
Pulmonary embolism (PE)
chronic venous insufficiency (CVI)
```
71
What are the lab tests for DVT?
D-dimer
prothrombin time (PT)
partial thromboplastin time (PTT)
bleeding time, platelet count
72
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
73
What is heparin used for?
DVT prophylaxis
74
What do you monitor while on heparin?
watch for bleeding
| monitor PTT and platelets
75
What PTT level should you maintain with heparin?
60-80 PTT
76
What is the reversal agent for heparin?
protamine sulfate
77
What is warfarin used for?
given with heparin for DVT prophylaxis. takes up to 5 days for full effect
78
How long should a patient take warfarin?
atleast 3 months
79
What is the therapeutic INR level for warfarin?
2.0 - 3.0
80
What should you monitor while on warfarin?
PT and INR
81
What is the reversal for warfarin?
vitamin K
82
What does the use of fibrinolytics with DVT do?
dissolves clots
83
What are examples of fibrinolytics?
tPa
| streptokinse
84
What kind of surgery is involved with DVT?
venous thrombectomy
| filters to prevent PE
85
What are some therapies for DVT?
```
warm, moist compress.
extremity rest
bed rest
elevate legs
SCDs
activity, walking
avoid prolonged sitting or standing, crossing legs, and tight fitting garments
```
86
What is arteriosclerosis?
general term describing hardening of arterioles. can affect legs and feet first.
usually from calcium or LDL build up
87
What is atherosclerosis?
hardening of an artery specificly due to atheromatous plaque. deposits of fat or fibrin that obstruct vessel causing tissue hypoxia
88
What are sites of arterial occlusion?
```
carotid arteries
coronary arteries
abdominal aorta, iliac, and femoral arteries
renal arteries
peripheral arteries (PVD or PAD)
```
89
What are some problems associated with atherosclerosis?
```
atherosclerosis --> PVD and/or CAD
angina
ischemia
myocardial infarction
heart failure
death
```
90
Who are more likely to experience PVD?
>60-70 y/o
men > women
African Americans & Hispanics
91
What are modifiable risk factors of PVD?
hyperlipidemia, HTN, DM, women: premature menopause. metabolic syndrome. smoking.
92
What are nonmodifiable risk factors of PVD?
age, gender, heredity
93
What are clinical manifestations of PVD?
intermittent claudication, rest pain, paresthesia, diminished or absent peripheral pulses, pallor vs rubor, thin, shiny, hairless skin. areas of discoloration or skin breakdown. toenails are thickened. stroke. blurred vision. sudden headache. sudden weakness, loss of coordination, may have edema and ulcerations
94
What is intermittent claudication?
cramping in legs, calves, buttocks w/activity. stops with rest
95
What is rest pain?
burning sensation that increases with elevation, decreases with limbs dependent.
96
What are some complications of PVD?
extremities amputation. rupture of triple As. gangrene. infection. sepsis.
97
What is chronic venous insufficiency?
disorder of inadequate venous return over a prolonged period.
98
What are clinical manifestations of chronic venous insufficiency?
brown pigmented skin. non-healing venous ulcers. lower leg edema. itching. pain w/sitting. cyanosis. recurrent stasis ulcers at ankle.
99
What are s/s of arterial ulcers?
```
toes, feet, shin
skin is normal
absent or mild edema
pain severe, claudication, rest pain
gangrene
ulcer deep, pale
pulses decreased or absent
```
100
What are s/s venous ulcers?
```
medial or anterior ankle
skin brown discoloration
edema significant
mild aching, throbbing
no gangrene
appear pink and superficial
pulses normal, possibly difficult to palpate
```
101
What are treatments for ulcers?
debridement. topical therapy. wound dressings. non-coherent intense pulsed light source. boots. surgery.
102
How do you manage PVD?
```
slow the process and maintain tissue perfusion.
avoid prolonged sitting or standing.
do not cross legs.
elevate legs and feet.
control risk factors.
surgical intervention.
lower lipid levels.
```
103
What are mediations given for PVD?
aspirin - inhibits platelet aggregation
clopidogrel (Plavix) - inhibits platelet aggregation
cilostazol (pletal) - platelet inhibitor w/vasodilation
pentoxifylline (trental) - thins blood, increase blood flow
104
What is heart failure?
a condition in which the heart is unable to pump enough blood into circulation to meet the body's needs.
105
What are risk factors for heart failure?
coronary artery disease. HTN. family hx. cardiotoxic drugs. smoking. obesity. alcohol abuse. DM. children with congenital heart defects.
106
What are signs of left-sided heart failure?
fatigue, activity intolerance. dizziness, syncope, dyspnea. orthopnea, cyanosis. crackles. wheezes. S3 gallop. productive cough w/ pink tinged sputum
107
What are signs of right sided heart failure?
edema in feet, legs, sacrum. anorexia, nausea. JVD. depended edema. liver and spleen engorgement. ascites. fatigue.
108
What are complications of heart failure?
hepatomegaly. splenomegaly. liver dysfunction. dysthymias. pleural effusion. cardiogenic shock. acute pulmonary edema.
109
What causes CHF exacerbation?
```
"FAILURE"
Forgot medication
Arrhythmia/Anemia
Ischemia/Infarction/Infection
Lifestyle
Upregulation of cardiac output
Renal failure
Embolism
```
110
What are diagnostic tests for heart failure?
atrial natriuretic peptide. serum electrolytes. urinalysis. BUN. serum creatinine. liver function tests. thyroid function tests. ABGs. CXR. ECG. echocardiogram. stress test.
111
What is hemodynamics?
study of forces involved in blood circulation
112
What is hemodynamic monitoring?
used to assess cardiovascular function
113
How do sympathomimetic agents act on the heart?
stimulates the heart and improves force of contractions. mild vasodilatory effects.
114
What are examples of sympathomimetic agents?
dobutamine
| dopamine
115
How do inotropes act on the heart?
positive effects by increasing strength of myocardial contractions.
116
What is an example of an inotrope?
digoxin
117
How do you treat CHF?
```
"UNLOAD FAST"
Upright, sit
Nitro
Lasix
Oxygen
Aminophylline
Digoxin
Fluids - decrease
Afterload - decrease
Sodium - decrease
Tests - dig level, ABD, K+
```
118
What is a stroke?
aka brain attack
| neurological deficits result from a sudden decrease in blood flow to a localized area of the brain.
119
What are the two main types of strokes?
ischemic or hemorrhagic.
120
What is the most common artery to experience a stroke?
an occluded middle cerebral artery
121
What are ischemic strokes?
either thrombotic or embolic
| blockage or stenosis of the cerebral artery
122
What is transient ischemic attack (TIA)?
a mini stroke. stroke like symptoms, usually resolves itself in approx. 15 minutes. a warning. 1/3 will have a stroke in 3-5 years.
123
What is a thrombotic stroke?
an occlusion of large vessel in the brain by a thrombus
124
What is an embolic stroke?
sudden onset, travelling clot. caused by afib.
125
What is a hemorrhage stroke?
an intracranial or subarachnoid hemorrhage. a ruptured cerebral blood vessel - often an aneurysm first
126
What is an aneurysm?
a bulging weak area in the wall of an artery
127
What is the leading cause of a hemorrhagic stroke?
hypertension
128
What is an intracerebral hemorrhagic stroke?
a bleed within the brain
129
What is a subarachnoid hemorrhagic stroke?
a bleed in the space around the brain. most severe form, often from trauma
130
What are risk factors for strokes?
HTN, heart disease, DM, sleep apnea, blood cholesterol levels, smoking, SCD, substance abuse, living in the stroke belt, family hx. obesity. sedentary lifestyle. recent infections. hx of TIA. oral contraceptives. pregnancy. childbirth. menopause. migraines with aura. autoimmune disorders. clotting disorders. previous strokes.
131
What are clinical manifestations of a stroke?
depend on the artery involved and the area of the brain affected. sudden, focal, often one sided. weakness in face, arm, leg. numbness on one side. loss of vision. speech difficulties. sudden severe headache. difficulty balancing. facial droop.
132
What are some complications of a stroke?
hemianopia, neglect syndrome. agnosia. apraxia. pain. emotional lability. intellectual changes. aphasia. dysarthria. hemiplegia. hemiparesis. flaccidity. spasticity. loss of sensations for elimination.
133
What is hemianopia?
half of visual field in one or both eyes
134
What is neglect syndrome?
pattern of disorder in head, neglect of what they cant see (affected side)
135
What is agnosia?
decreased recognition
136
What is apraxia?
cant voluntarily do tasks
137
What is aphaisa?
nonverbal
138
What is dysarthria?
disturbance in muscle control of face
139
What is hemiplegia?
paralysis on one side
140
What is hemiparesis?
weakness on one side
141
What is spasticity?
increase of muscle tone, jerking
142
What is flaccidity?
decrease in muscle tone
143
What are the diagnostic tests for strokes?
stroke scale. CT scan. cerebral arteriography. transcranial doppler ultrasound. MRI. PLAC blood test. Lumbar puncture.
144
What are pharmacologic therapy for prevention of stroke?
statins - reduce cholesterol in blood
| antiplatelet agents - thins blood (aspirin, Plavix, ticlid)
145
What are pharmacologic therapy for acute ischemic stroke?
anticoagulant therapy - heparin, lovenox, coumadin . things blood to prevent new clots from forming
146
What are pharmacologic therapy for acute thrombotic stroke?
fibrinolytic therapy. tPa - breaks up clot but NOT used with hemorrhagic stroke
147
What is a seizure?
periods of abnormal electoral discharges in the brain, causing involuntary movement or behavior or sensory alterations
148
What is epilepsy?
a chronic disorder characterized by recurrent unprovoked seizures
149
What is a focal seizure?
caused by abnormal electrical activity in one hemisphere or in a specific area of the cerebral cortex
150
What is a generalized seizures?
diffuse electrical activity that often begins in both hemispheres then spreads throughout cortex
151
What are febrile seizures?
generalized seizure resulting from rapid temperature rise about 39C seen in infants and children
152
What are some causes of seizures?
can be idiopathic - no source, unknown cause
traumatic brain injury, falls, illicit drugs, concussions, brain surgery, congenital defects, brain tumors, brain pathology stroke.
153
What is the frontal lobe of the brain responsible for?
executive functions, thinking, planning, organizing, and problem solving. emotions, behavioral control, and personality.
154
What is the motor cortex of the brain responsible for?
movement
155
What is the sensory cortex of the brain responsible for?
sensations
156
What is the parietal lobe of the brain responsible for?
perception, making sense of the world, arithmetic, spelling.
157
What is the temporal lobe of the brain responsible for?
memory, understanding, language.
158
What is the occipital lobe of the brain responsible for?
vision
159
What are outcomes of altered level of consciousness with seizures?
persistent vegetative state. locked-in syndrome. brain death.
160
What are risk factors for seizures?
infant small for age. brain tumors. stroke. autistic disorder. neurological conditions. infections of brain. cerebral palsy. drug abuse. metabolic disorders. antidepressants.
161
How can you reduce the frequencies of seizures?
identify general triggers, such as fatigue, hypoglycemia, fever, alcohol, hyperventilation, menstruation, strobe light. sleep deprivation.
162
What are the two types of partial seizures?
simple partial seizures and complex partial seizures.
163
What is a simple partial seizure?
part of brain effected. no change in consciousness
164
What is a complex partial seizure?
one part of brain effected. causes repetitive movements
165
What are the two types of generalized seizures?
absence seizures (petit mal) and tonic-clonic seizures (grand mal)
166
What is an absence seizure?
effects the whole brain. often in kids. sudden, brief stop of activity. staring. lasts 5-10 seconds.
167
What is a tonic-clonic seizure?
effects the whole brain. jerking movements. never try to stop a convulsion. protect head, but do not hold patient.
168
What is status epilepticus?
abnormally prolonged seizure, or continuous seizures. considered a medical emergency. airway is the main priority
169
What is the stages of seizures?
aura - early warning sign
ictus or ictal - the actual seizure
post ictal - after the seizure
170
What is the tonic phase of a tonic-clonic seizure?
unconsciousness, continuous muscular contraction. BMR rises. increase demand for oxygen. posture loss. clenched jaw. becomes rigid.
171
What is the clonic phase of a tonic-clonic seizure?
alternating muscle contractions and relaxation
172
What occurs during the postictal phase of a seizure?
LOC is decreased. client is sleepy but arousable.
173
What are diagnostic tests for seizures?
CBC, urine culture. lumbar puncture. serum drug levels. EEG. CT scan. MRI. angiography. lead level. lead poisoning. Glascow coma scale.
174
What is a glascow coma scale?
a scale that determines level of consciousness. best score is 15, lowest score is 3.
175
What are the antiepileptic drugs for seizures?
```
Dilantin (phenytoin)
luminal (phenobarbital)
egretol (carbamazepine)
depakene (calproic acid)
Neurontin (gabapentin)
lamictal (lamotrigine)
klonopin (clonazepam)
Keppra (levitricetam)
apitom (eslicarbazepine acetate)
oxtellar XR (oxcarbazepine)
exogabine (fycompa)
vigabatrin (sabil)
```
176
What should you remember about antiepileptic drugs?
want to control seizures with the lowest dose possible
177
What should you remember with giving Dilantin (phenytoin)?
never mix with NS - can cause necrosis.
| give in D5. monitor for bleeding. monitor Ca levels.
178
What is the therapeutic level for Dilantin (phenytoin)?
10-20 mcg
179
What should you remember when giving luminal (phenobarbital)?
it decreases digoxin levels and decreases the effect of coumadin
180
What should you remember when giving tegretol (carbamazepine)?
it decreases the effect of oral contraceptives. watch for visual problems.
181
What should you remember when giving Depakene (valproic acid)?
monitor for liver toxicity and GI upset.
182
What kind of diet is needed for seizure patients?
ketogenic diet, decrease of carbs, increase of fats
183
What is important to remember with treatment of status epilepticus?
continuous seizure lasts more than 30 minutes. immediate intervention. airway priority. IV 50% dextrose. diazepam, lorazepam IV, repeated in 10 minutes. Phenytoin IV for longer-term control. phenobarbital.
184
What is important to remember when giving lamictal (lamotrigine)?
watch for rash
| stevens-johnson
185
What are alternate therapies for seizures?
surgery - craniotomy
responsive neurostimulator system
vagal stimulation therapy
186
What is the first aid of seizures?
```
cushion head, remove gloves.
loosen tight fitting clothes.
turn on side.
time the seizure with a watch
don't put anything in mouth
look for medical I.D.
don't hold down.
as seizure ends.. offer help
```
187
What is the brain stem responsible for?
breathing, Heart rate, temperature
188
What is the cerebellum part of the brain responsible for?
balance and coordination
