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Test 2 AH Cardiac > Test 2 AH Cardiac > Flashcards

Test 2 AH Cardiac Flashcards

1
Q

How does blood flow through the heart?

A
  • Vena Cava
  • Right Atrium
  • Tricuspid valve
  • Right Ventricle
  • Pulmonic valve
  • Lungs
  • Left Atrium
  • Mitral valve
  • Left Ventricle
  • Aortic valve
  • Systemic Circulation
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2
Q

Diastole

A

relaxation, blood fills ventricles

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3
Q

Systole

A

when the ventricles contract

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4
Q

Normal Cardiac Output

A

4-6 L/Min

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5
Q

Preload

A
  • volume coming into the ventricle (end diastolic pressure)

- increased in hypervolemia

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6
Q

Frank Starling Law

A

as a larger volume of blood flows into the ventricle, the blood will stretch the walls of the heart, causing a greater expansion during diastole, which in turn increases the force of the contraction and thus the quantity of blood that is pumped into the aorta during systole.

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7
Q

Afterload

A
  • resistance the left ventricle must overcome to circulate the blood
  • increased in hypertension
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8
Q

Stroke Volume

A

amount of blood ejected by the left ventricle in one contraction (can be left or right)

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9
Q

Positive Inotropic Agents

A
  • medicines that increase the force of your heart’s contractions
  • digoxin, calcium, dopamine, epinephrine, norepinephrine
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10
Q

Negative Inotropic

A
  • weaken the force of the heartbeat

- Acetylcholine from Vagus nerve

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11
Q

P Wave

A
  • atrial depolarization
  • ## SA Node Initiates this
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12
Q

QRS

A
  • Ventricles contract

- 0.04

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13
Q

QT

A
  • repolarization (recovery)

- 0.42

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14
Q

Cardiac Output

A
  • the amount of blood pumped by each ventricle in 1 minute (normal 4-8 L/min)
  • CO = HR x Stroke Volume
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15
Q

Cardiac Index

A
  • Cardiac Output/Body Surface Area

- Normal is 2.8-4.2 L/min/m2)

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16
Q

Sympathetic Nervous System: Effects on the Heart

A

increases heart rate by the beta adrenergic receptors

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17
Q

Peripheral Nervous System: Effects on the Heart

A

decreases heart rate by the vagus nerve

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18
Q

Sympathetic Nervous System: Effect on Blood Vessels

A

increases vasoconstriction by a1-adrenergic receptors, decreases vasodilation by a1-adrenergic receptors

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19
Q

Baroreceptors

A

sensitive to stretch or pressure with the arterial system (aortic arch and carotid sinus) Fast response in changes in blood pressure

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20
Q

Chemoreceptors

A

capable of causing changes in respiratory rate and BP in response of increased CO2 (aortic/carotid bodies and medulla)

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21
Q

Cardiovascular Disease Risk Factors

A
  • elevated BP
  • diabetes
  • obesity
  • smoking
  • nutrition
  • sedentary lifestyle
  • family history
  • adverse lipid profile
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22
Q

Hypertension

A
  • may need to measure both arms
  • often symptom free
  • typically the primary disease
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23
Q

Hypertension: Patient Evaluation

A
  • two consecutive blood pressure measurements over 2 weeks
  • assess lifestyle and identify other CV risk factors
  • reveal identifiable causes of high BP
  • Assess the presence of absence of target organ damage and CVD
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24
Q

Values: Mild Hypertension

A

140/90

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25
Q

Values: Moderate Hypertension

A

160/100

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26
Q

Values Severe Hypertension

A

180/110

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27
Q

Normal Blood Pressure

A

Systolic -

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28
Q

Prehypertension

A

Systolic - 120-139
Diastolic - 80-89
Need for lifestyle modification

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29
Q

Stage 1 Hypertension

A

Systolic - 140-159
Diastolic - 90-99
Need for lifestyle modification
Single agent drug therapy

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30
Q

Stage 2 Hypertension

A

Systolic >160
Diastolic > 100
Combo Drug therapy and lifestyle modification

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31
Q

DIURETIC

A 
Daily Weight
I and O
Urine output
Response of BP
Electrolytes
Take Pulses
Ischemic Episodes (TIA)
Complications
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32
Q

Complications: 4 C’s

A

Coronary Artery Disease
Chronic Renal Failure
Congestive Heart Failure
Cerebrovascular Accident

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33
Q

Antihypertensive Drugs: Ace Inhibitors

A
  • end in pril
  • captopril
  • enalapril
  • benzapril
  • lisinopril
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34
Q

Antihypertensive Drugs: B-Blockers

A
  • ends in olol
  • propanolol
  • atenolol
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35
Q

Antihypertensive Drugs: Calcium Antagonists

A
  • verpamil
  • diltiazem
  • nifedipine
  • amlodipine
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36
Q

Ace Inhibitors

A

decreases vascular resistance without increasing cardiac output, cardiac rate or cardiac contractility

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37
Q

Side Effects of Ace Inhibitors

A
  • dizziness
  • orthostatic hypotension
  • GI distress
  • non productive cough
  • headache
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38
Q

Angiotensin II Receptor Antagonists (Blockers) = ARBS

A
  • Losartan and Valsartan
  • similar to ACE inhibitors
  • cause vasodilation and decreased peripheral resistance
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39
Q

Beta Blockers

A

blocks beta receptors in the heart causing decreased heart rate, force of contraction and rate of AV conduction

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40
Q

Beta Blocker: Side Effects

A
  • bradycardia
  • lethargy
  • GI Disturbance
  • Congestive Heart Failure
  • decreased BP
  • depression
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41
Q

B1 Blockers

A
  • selective
  • works mainly in the heart
  • metaprolol (lopressor)
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42
Q

B2 Blockers

A
  • non-selective
  • works in heart and lungs
  • inderal/propanolol
  • decreases heart rate and cardiac output
43
Q

Calcium Antagonists

A
  • blocks calcium access to cells

- causes decrease in the contractility and conductivity of the heart which decreases demand for oxygen

44
Q

Calcium Antagonists: Side Effects

A
  • lowers BP
  • Bradycardia
  • May Precipitate AV Block
  • headache
  • abdominal discomfort (constipation, nausea)
  • peripheral edema
45
Q

LDL Cholesterol

A
  • Bad cholesterol which is primarily fatty and carries cholesterol into your arteries.
  • less than 100 is good and anything over 190 needs immediate action
46
Q

HDL Cholesterol

A
  • good cholesterol consists of high density lipoprotein particals which are high in protein and low in fat. Help clear arterial plaque.
  • reading over 60 is optimal and anything under 40 requires immediate action
47
Q

Overall Total Cholesterol

A
  • less than 200mg/dl

- anything over 240 is considered high and needs immediate action

48
Q

Artrovastatin (Lipitor)

A
  • prevents the production of cholesterol in the liver by blocking HMG-CoA which makes cholesterol.
  • taken once a day and can cause muscle fatigue, pain and break down and liver damage
49
Q

Niacin

A
  • can raise the HDL by 15-35%, most effective

- it can decrease your LDL and triglyceride levels which prevents heart disease

50
Q

Coronary Artery Disease

A
  • narrowing of coronary arteries
  • impaired blood flow
  • ischemia
  • pain
    S/S: pain, N/V, diaphoresis and pallor
51
Q

Atherosclerosis

A
  • Injury to artery endothelial cells
  • inflammation
  • fibrous plaque with platelet adhesion
52
Q

Chronic Stable Angina

A

form of chest pain that happens when your heart is working hard and needs more oxygen, such as during exercise

53
Q

Unstable Angina

A

a condition in which your heart doesn’t get enough blood flow and oxygen. It may lead to a heart attack.

54
Q

Vasospastic /Prinzmetal’s/ Variant Angina

A

only happens at certain times and only for a certain amount of time

55
Q

Area of Infarction

A
  • o2 deprived
  • damage irreversible
  • causes Q wave on EKG
56
Q

Area of Injury

A
  • next to infarction
  • tissue is viable as long as circulation remains adequate
  • increasing O2 may save this area from necrosis
  • causes S-T segment elevation on EKG
57
Q

Area of Ischemia

A
  • viability may not be damaged as long as MI doesn’t extend and collateral circulation is able to compensate
  • Causes depressed ST Segment
58
Q

MONA

A

Morphine
Oxygen
Nitroglycerine
Aspirin

59
Q

Nitroglycerin

A

opens blood vessels to improve blood flow. It is used to treat angina symptoms, such as chest pain or pressure, that happens when there is not enough blood flowing to the heart. (vasodilator)

60
Q

Nitroglycerin (Quick Acting)

A
  • sublingual tablets

- translingual spray

61
Q

Nitroglycerin (Slow Acting)

A
  • nitro-bid (patch)
  • nitro ointments
  • sustained release tablets
62
Q

Side Effects of Slow or Quick Release Nitro

A
  • severe hypotension
  • tachycardia
  • dizziness
  • headache
  • syncope
63
Q

Left Sided Heart Failure

A
  • Pulmonary Edema
  • Shortness of Breath
  • Crackles
  • Pink, Frothy Sputum
  • Cyanosis
  • Restlessness
  • Confusion
64
Q

Right Sided Heart Failure

A
  • Liver Engorgement
  • Positive JVD
  • Edema
  • Ascites
65
Q

Goals of Heart Failure

A
  • decrease workload of heart
  • increase force and efficiency of heart
  • eliminate excess fluid
66
Q

Treatment of Heart Failure

A
  • Digoxin
  • Diuretics
  • Electrolyte Replacement
  • Vasodilators
  • Na Restriction
67
Q

Treating Congestive Heart Failure

A 
Upright Position
Nitrates
Lasix
Oxygen
ACE Inhibitors
Digoxin

Fluids (decrease)
Afterload (decrease)
Sodium Restriction
Test

68
Q

Digoxin

A
  • positive inotrope
  • negative chronotrope
  • negative dromotrope
  • monitor drug levels
  • check K levels first
  • heart has to be at 60 bpm
69
Q

Chronotrope

A

increases or decreases heart rate

70
Q

Dromotrope

A

decreases or increases conduction veolocity

71
Q

Safe Digoxin Levels

A

0.5-2 ng/mL

72
Q

Diuretics

A
  • Furosemide, Hydrodiuril

- treatment for CHF, cirrhosis, renal disease and hypertension

73
Q

Side Effects of Diuretics

A
  • decreased BP
  • decreased Na
  • decreased Chloride
  • decreased K
  • Hyperglycemia
  • weight loss
  • decreased I & O
  • Dehydration
74
Q

Peripheral Arterial Diseases

A
  • Thrombus or Embolus which obstructs arterial flow
  • Mottled Extremity, Capillary Refill is prolonged, pain
  • Chronic: Skin thin and shiny
  • heparin, angioplasty, surgery
75
Q

Venous Insufficiency

A

inadequate venous return over a long period of time that causes pathologic changed as a result of ischemia in the vasculature, skin and supporting tissues.

76
Q

Venous Insufficiency Findings

A
  • history of DVT/thrombophlebitis
  • Hypertension
  • Varicose Veins
  • Edema
  • thick, coarse, brownish skin around the ankles/feet
  • stasis ulcers
77
Q

Deep Vein Thrombosis

A
  • thrombus formation
  • swelling tenderness/redness
  • D-Dimer
  • elevate extremity, bedrest, heparin
78
Q

DVT: Risks and Interventions

A
  • Movement of the clot!
  • Anticoag: heparin, coumadin, lovenox, catheter directed thrombolysis
  • Vena Cava Filter
79
Q

A vs V: Color

A

A - Pale

V - Ruddy; cyanotic if dependent

80
Q

A vs V: Edema

A

A - None or Minimal

V - Usually Present

81
Q

A vs V: Nails

A

A - Thick and brittle

V - Normal

82
Q

A vs V: Pain

A

A - worse with elevation and exercise; may be sudden or severe; claudication
V - better with elevation, dullness or heaviness

83
Q

A vs V: Pulses

A

A - decreased, weak or absent

V - Normal

84
Q

A vs V: Temperature

A

A - Cool

V - Warm

85
Q

A vs V: Extremities

A

A - Dry and Necrotic

V - Moist

86
Q

Warfarin Sodium (Coumadin)

A
  • reduces the amount of blood clots by thinning out the blood
  • reduces the liver’s ability to produce vitamin K
  • PT + INR
87
Q

Coumadin Overdose

A

can cause hemorrhage, headache, bruising or back pain

88
Q

Heparin

A
  • inhibits clotting time
  • prevents clots in the arteries, veins and lungs.
  • doesn’t break them up, just delays formation
  • check PTT and APTT labs
89
Q

What does Heparin do?

A

interferes with the conversion of fibrinogen to fibrin and prothrombin to thrombin, which creates the product for clotting.

90
Q

Heparin Side Effects

A

can cause spontaneous bleeding starting in the mucus membranes. vasospasm, ecchymosis and hypersensitivities

91
Q

Plavix

A
  • platelet aggregation inhibitor

- inhibits platelet aggregation by dilating the vascular bed

92
Q

Instructions on Giving Plavix

A
  • given PO w/ or w/o aspirin
  • give with food
  • use cautioulsy with asthma patients and hypertension, hepatic or renal problems, and a history of bleeding.
93
Q

Plavix Side Effects

A
  • skin disorders
  • URI
  • flu like symptoms
94
Q

Plavix Labs

A

Platelet counts before beginning and every 2 days for a week, then weekly

95
Q

Bleeding Precautions

A 
Razor Electric
Aspirn NO
Needles Small Gauge
Decrease needle sticks
Injury protect from
96
Q

Bleeding Precautions: Observation

A
  • Hematuria or Melena
  • Nosebleeds
  • Gingival Bleeding
  • Bruising
97
Q

When would you implement bleeding precautions?

A
  • using anticoagulants
  • liver disease
  • platelets are less than 150,000
  • hemophilia present
  • using thrombolytic meds
98
Q

Normal sinus rhythm

A

Rhythm interpretation: regular
Rate: 60-100 beats/min
P Waves: Normal in size, shape, direction, positive in lead II, one P wave precedes each QRS complex
PR interval: Normal (0.12 - 0.20 second)
QRS Complex: Normal (0.10 second or less)

99
Q

Sinus bradycardia

A

Rhythm interpretation: regular
Rate: 40-60 beats/min
P Waves: Normal in size, shape, direction, positive in lead II, one P wave precedes each QRS complex
PR interval: Normal (0.12 - 0.20 second)
QRS Complex: Normal (0.10 second or less)
Intervention: atropine sulfate

100
Q

Sinus tachycardia

A

Rhythm interpretation: regular
Rate: 100-180 beats/min
P Waves: Normal in size, shape, direction, positive in lead II, one P wave precedes each QRS complex
PR interval: Normal (0.12 - 0.20 second)
QRS Complex: Normal (0.10 second or less)
Intervention: PRN order to decrease heart rate- pain/anti-anxiety medication

101
Q

Atrial fibrilation with uncrontrolled/controlled ventricular rate

A

Rhythm interpretation: Grossly irregular (unless ventricular rate is very rapid, in which case the rhythm becomes more regular)
Rate:
-Atrial: 400 beats/min or more; not measurable on surface ECG
-Ventrical: varies with number of impulses conducted through atrioventricular node to ventricles; ventricular rate is controlled if rate is less than 100 beats/min, uncontrolled if it is greater than 100 beats/min
P Waves: Wave deflections that affect entire baseline
PR interval: Not measurable
QRS Complex: Normal (0.10 second or less)
Intervention: Ablation

102
Q

Ventricular tachycardia

A 
Rhythm interpretation: regular
Rate: 140-250 beats/min
P Waves: None associated
PR interval: Not measurable
QRS Complex: Normal (0.10 second or greater)	
Intervention: Medications
103
Q

Ventricular fibrillation

A

Rhythm interpretation: Chaotic, irregular deflections
Rate: 0 (P waves and QRS complexes absent)
P Waves: Absent; wavy, irregular deflections are present that vary in size, height, and shape
PR interval: Not measurable
QRS Complex: Absent
Intervention: CPR Defibrillation

104
Q

Asystole

A

Flatline

Intervention: Compressions

Test 2 AH Cardiac (2 decks)

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