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Adult Health > Test4 > Flashcards

Test4 Flashcards

1
Q

Cardiac Output

A

CO = SV x HR

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2
Q

Preload

A

Coming into left ventricle = how much stretching is going on

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3
Q

Afterload

A

What the Left Ventricle is pumping out against.

-if aortic valve is stiff-increased afterload, also PVR (peripheral vascular resistance) affects afterload

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4
Q

BNP

A
  • Brain Naturetic Peptide
  • How much the heart is stretching
  • Should be <100
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5
Q

Troponin I

A
  • specific to cardiac tissue damage
  • released when there’s necrotic tissue
  • any elevation is + for MI
  • Gold Standard
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6
Q

Chemical Stress Test

A
  • adenosine (stops heart in large doses)-makes pt feel like they are having a heart attack-pain, pressure, SOB, can’t take a deep breath. or dobutamine
  • nuclear injection dye
  • Nuclear imaging
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7
Q

Post-Cath/Post PCI care

A
  • PCI=percutaneous cardiac interventions
  • assess for iodine/shellfish allergy
  • bleeding at sight-pressure dressing, hold pressure 10-15 minutes
  • infection
  • peripheral pulses
  • stay flat 6-8 hours (risk for aspiration, DVT)
  • Should NOT have chest pain post cath/PCI–stent didn’t take? closed off again?
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8
Q

Nitro

A
  • sublingual
  • 1 pill q5min
  • check BP-before and after 4.5 minutes (make sure it’s not too low)
  • pain-should be 0
  • Also: nitro drip, patch, paste (1-2 inches on arms), long-acting
  • interact with drugs for erectile dysfunction and pulmonary HTN
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9
Q

LDL and HDL

A

LDL < 100

HDL > 50

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10
Q

Cholesterol-lowering drug therapy

A
  • Statins (Zocor, Lipitor)-don’t work for everyone
  • Niacin (OTC in small amts) prescription-causes flushing
  • Bile acid sequestrants (Welchol)
  • Zetia (flatulence)
  • Omega-3 fatty acids (OTC)
  • Decrease saturated fats
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11
Q

Coronary Artery Disease

A

Chronic Stable Angina → Acute Coronary Syndrome

                                                                     l

                               - Unstable angina         ST elevation MI
                                  - Non-ST MI

ACS-MI-no blood flow-affects the way the ventricle pumps out blood.

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12
Q

Meds for Chronic Stable Angina

A

short acting nitrates

long acting nitrates (isrodil)

Beta Blockers

CCBs

ACE inhibitors

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13
Q

Digoxin

(Lanoxin)

A
  • antidysrhythmic-decreases conduction throught the AV node, reduce automaticity of SA node; prolongs PR interval, AV block
  • improves myocardial contractility and output
  • reduced ventricular rate
  • can cause dysrhythmias and toxicity
  • need apical pulse for 1 full minute (must be 60 bpm minimum)
  • Toxicity: n/v/d, blurred or yellow visual disturbance (2ng/ml is toxic)
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14
Q

CK-MB

A
  • elevation is specific for myocardial tissue injury
  • levels begin to rise about 6 hrs after symptoms
  • levels peak in about 18 hrs
  • return to baseline within 24-36 hrs
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15
Q

Hypertension Defined

A
  • systolic >140, diastolic >90
  • current use of antihypertensives
  • normal: <120/<80
  • pre-hypertension: 120-139 / 80-89
  • stage 1: 140-159 / 90-99
  • stage 2: >160 / >100
  • Risk factors for primary HTN (essential/ideopathic): age, ETOH, smoking, DM, hyperlipidemia, XS dietary Na, gender, family hx, obesity, ethnicity, sedentary lifestyle, socioeconomic status, stress
  • Super high (240/120) pt complains of blurry vision, H/A
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16
Q

Secondary Hypertension

A
  • known cause (5-10% of adult cases)
  • coarctation of aorta
  • renal disease
  • endocrine disorders
  • neurological disorders
  • cirrhosis
  • sleep apnea
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17
Q

Medications for HTN

A
  • Stage 1; thiazide diuretics (hydrochlorthiazide) for most, maybe ACE inhib, ARB, BB, CCB, or combo
  • Stage 2: two-drug combo for most; usually thiazide diuretic + ACE inhibitor (or ARB, BB, CCB)
  • With complications (post-MI, HF, DM, CKD, stroke prevention): loop diurectics (Lasix, torsemide), K-sparing (Amiloride, Spironolactone), ACE inhibitors, ARB, BB, CCB as needed.
  • Lower BP=lower stroke incidence, lower MI, lower HF
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18
Q

Hypertensive Crisis

A
  • lost vision, kidney function, HD, HF, stroke
  • give O2, tele, assess neuro (grip equal bilaterally, move legs)
  • acute target organ damage
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19
Q

ACS-MI

(acute coronary syndrome)

A
  • no blood flow-affects the way the ventricle pumps out blood.
  • PCI
  • Fibrinolytic therapy (if no cath lab)
  • Drug therapy: MONA
  • get pt on a monitor (3 or 5 lead) to see QRS’s, for tachy give BB
  • Coronary surgical revascularization: CABG
  • ICD (implantable cardiac defibrilator
  • ALWAYS check BP bf nitro (if too low give morphine)
  • can delegate 12 lead
  • cannot delegate O2
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20
Q

Heart Failure

A
  • Characterized by ventricular dysfunction
  • Associated with long-term HTN and coronary artery disease, DM
  • Most common reason for hospitalizations in adults >65
  • Systolic failure is most common
  • Usually decrease in left ventricular EF caused by: ** impaired contractile function** (MI), increased afterload (HTN), cardiomyopathy, mechanical abnormalities (valve disease)
  • Normal EF is 65-70%
  • Compensatory mechanisms: Hypertrophy/Ventricular Dilation
  • ashy skin, edema, auscultate fluid in lungs=diminshed breath sounds, peripheral pulses-weak, may hear S3, S4,electrolyte imbalances, ascites
  • BNP should be <200 can be 400-500
  • BUN/creatinine elevated bc kindeys working OT
  • ECHO to monitor EF
  • daily weights, Na restriction, conserve energy
  • Classified functionalyl (I-IV-based on ADLs, daily Sx), and structurally (A-D)-EF
  • complications: XS fluid-decompensation
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21
Q

Types of HF

A
  • Left-sided-most common-MI, HTN, CAD, cardiomyopathy–back-up into LA and pulmonary veins–pulmonary congestion, edema: SOB, anxiety….leads to RHF
  • Right-sided-JVD, hepatomegaly, slenomegaly, ascites, peripheral edema
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22
Q

Meds for HF

A

Coreg (BB) can increase EF a few % points

ACE inhibitors (captopril)–first dose orthostatic hypotension

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23
Q

Management of HF

A
  • fluid management (I&O), daily weights
  • oxygen for SOB
  • physical/emotional rest
  • drug therapy
  • heart transplant-for refractory, end stage HF, inoperable CAD and cardiomyopathy
  • LVAD
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24
Q

ADHF

(acute decompensated HF)

A
  • # 1 complication of HF=lungs fill up with fluid; no gas exchange possible (pulmonary edema)
  • pt is SOB
  • Listen to lungs-monitor for changes-know baseline
  • crackles, wheezes, diminished
  • Management: decrease intravascular volume, decrease venous return (preload), decrase afterload, improve gas exchange and oxygenation, reduce anxiety
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25
Q

EKG Strips

A
  • Each box is 0.04 seconds, dark box is 0.2 seconds
  • PR interval should be < 0.2
  • ST segment should be isoelectric line (problem if it’s not at the baseline)
  • normal sinus rhythm-50 to 90 bpm, follows normal conduction pattern (sinus brady, sinus tachy)
26
Q

Sinus Brady

A
  • sinus node fires <50 bpm
  • concerned if symptomatic: decreased LOC, fatigued, SOB
  • try to wake them
  • atropine
  • pacemaker may be required (internal/external)-on crash cart, can cause burns (AEDs can’t do this)
27
Q

Sinus Tachycardia

A
  • discharge from sinus node is >90 (result of vagal inhibition)
  • causes: meds, fever, decrease in BP, psych stressors, pain
  • symptoms: dizzy, low BP (hypotension) due to decreased CO, angina (due to increased myocardial oxygen consumption)
  • Treat underlying problem (pain?)
  • BB’s and adenosine to lower HR
28
Q

First Degree Heart Block

A
  • PR interval is > 0.2 sec
  • AV conduction is prolonged
  • Risk factors: BB’s, previous Hx
  • usually asymptomatic
  • may be a precursor to higher degrees of AV block (start dropping QRS’s)
  • Tx-check meds, continue to monitor
29
Q

Atrial Fibrillation

A
  • disorganization of atrial electrical activity-multiple ectoopic foci, resulting in loss of effective atrial contraction
  • most common dysrhythmia
  • prevalence increases with age
  • no consistent P wave
  • QRS is present, but irregular
  • can decrease CO due to loss of atrial kick
  • can cause RVR (rapid ventricular response)-ventricles try to keep up
  • thrombi may form in the atria
  • embolus may develop–stroke
  • Coumadin--INR 2-3
  • Goals-decrease ventricular response, prevent stroke
  • digoxin, BBs, CCBs
  • conversion to sinus rhythm: amiodarone
  • radiofrequency catheter ablation
  • cardioversion
30
Q

A-Flutter

A
  • atrial dysrhythmia
  • recurring, regular, saw-tooth-shaped flutter waves
  • usually occurs in a disease state
  • QRS can be regular or irregular
  • decreased CO
  • precipitates HF, angina
  • Risk for stroke (give coumadin)
  • Tx-same as afib: meds, cardioversion, ablation
31
Q

Abnormal Beats

A

Premature Atrial Contraction (PAC)

Premature Ventricular Contractions (PVC)

32
Q

Premature Atrial Contraction

A
  • contraction originates from ectopic focus
  • may be stopped, delayed or conducted normally at the AV node
  • atria fires before it’s supposed to
  • causes: stress, caffeine, tobacco, alcohol,, hypoxia, electrolyte imbalances (K+), COPD, valvular disease
  • give O2
  • look for 2 QRS complexes closer together, followed by a gap
  • “sinus rhythm with PACs”
  • can occur in normal, healthy heart
33
Q

Premature Ventricular Contractions

A
  • Wide and distorted QRS complex
  • contraction originating in ectopic focus of the ventricles
  • premature occurence of a wide and distorted QRS complex
  • multi-focal (each looks different) or unifocal (look the same)
  • bigeminy (every other), trigeminy, couplet (2 in a row), triplets
  • Do NOT count PVCs as part of HR (only getting 50% of CO)
  • “sinus rhythm with unifocal PVCs”
  • associated with stimulants (caffeine, epinephrine, isoproterenol, aminophylline)
  • also associated with digoxin, electrolyte imbalances, hypoxia, fever, disase states-MI, mitral valve prolapse, HF, CAD
  • more diseased heart, more likely PVCs
  • >3 PVCs = V-tach
  • in a normal heart-usually benign
  • in heart disease, PVCs may decrease CO and precipitate angina and HF
  • Tx-O2, electrolyte replacement, BBs, amiodarone
34
Q

Ventricular Tachycardia

A
  • Run of 4+ PVCs-sustained or unsustained
  • considered life-threatening bc of decreased CO and possibility of deterioration into v-fib
  • no P-wave, QRS is weird
  • risk factors: diseased heart, electrolyte problems (K+)
  • can be stable (pt has pulse)-give antidysrhythmics (BBs)
  • or unstable (no pulse)-crash cart, AED-CODE!!! organs not perfused
  • sustained Vtach-decreased CO–hypotension, pulmonary edema, decreased central blood flow, cardiopulmonary arrest
  • 150-250 bpm
35
Q

Ventricular Fibrillation

A
  • severe derangement of the heart rhythm-irregular, varying contour and amplitude
  • NO effective contraction or CO occurs
  • can be “fine” or “course”
  • pt will be unresponsive, pulseless, apneic
  • CODE!!!!!/BLS
  • defibrillate!
36
Q

Asystole

A
  • TOTAL absence of ventricular electrical activity
  • No ventricular contractions or CO because depolarization does not occur
  • MI’s, electrocution
  • unresponsive, pulseless, apneic
  • poor prognosis
  • BLS (can’t shock them–AED will say, “continue CPR”)
  • Meds: atropine, epi
37
Q

PEA

(pulseless electrical activity)

A
  • electrical activity is observed on EKG, but no mechanical activity of the ventricles
  • patient has no pulse
  • start CPR-no CO!
  • associated with: hypovolemia, hypoxia, metabolic acidosis, hyperkalemia, hypothermia, drug OD, cardiac tamponade, MI, tension pneumothorax, PE
  • CPR, epi, atropine (if ventricular rate is slow)
38
Q

Pacemakers

A
  • pace the heart when normal conduction pathway is damaged/diseased
  • # 1 reason is symptomatic bradycardia
  • also antitachycardia and overdrive pacing
  • can be atrial paced or ventricle paced “A paced” or “V paced”
  • NO MRI’s
  • carry card at all times with type of pacemaker and settings
39
Q

ICD

(Implantable Cardioverter-Defibrillator)

A
  • Pts at high risk for V-fib and V-tach (massive MI, low EF, HF)
  • sensing system monitors the HR and rhythm and id’s VT and VF
  • equipped with antitachycardia and antibradycardia pacemakers (all ICDs are pacemakers as well)
40
Q

Defibrillation

A
  • most effective method for terminating VF and pulseless VT
  • depolarizes cells to allow the myocardium to allow the SA node to resume role of pacemaker
  • monophasice (more joules) or biphasic (newer technology, better outcomes0
41
Q

Catheter Ablation Therapy

A
  • ablation catheter burns accessory pathways or ectopic sites in the atria, AV node and ventricles
42
Q

EKG changes in ACS

(acute coronary syndrome)

A
  • in response to ischemia, injury or infarction of myocardial cells
  • changes seen in the leads that face the area involved
  • provides info about the coronary artery involved in ACS
  • ST-segment: too high (worse) or too low-heart muscle is dead, signal going around
43
Q

Syncope

A
  • lapse in consciousness accompanied by loss in postural tone (fainting)
  • Cardiovascular causes: Vtach (non-sustained), Bradycardia, MI
  • Non-Cardiovascular: stroke, breathing, hypoglycemia
  • Elderly with syncope-mortality rate 40% over next few years
44
Q

Infective Endocarditis

A
  • inner layer of heart-usually affects valves-valves don’t work well, vegetation breaks free–goes to lungs (R) or body (kidney, limbs, liver, spleen)-stroke (L)
  • vegetation: fibrin, leukocytes, platelets, microbes
  • may cause local damage to valves and infiltrate to supporting structures: sepsis, HF (heart works hard against valves), heart block
  • SOB, fatigue, fever, chest pain, tachy
  • get EKG, blood culture, CBC, electrolytes, ECHO
  • IV drug users at risk
  • splinter hemorrhages, petechiae, murmurs
  • clubbing may be present
45
Q

Acute Pericarditis

A
  • inflammation of pericardial sac
  • heart sounds diminished-muffeled, sand-paper friction rub
  • SOB because heart takes up lung space, confused, chest pain, anxious, restless (LOW CO)
  • High risk-post MI
  • idiopathic-or coxsakie virus, bacterial infection (strep), acute MI, TB, trauma
  • SHARP chest pain, may radiate, worse with inspiration and laying flat-alleviated by tri-pod
  • ECHO
  • complications: cardiac tamponade
  • Tx-diuretics, pull fluid with syringe, O2, tripod
  • Pulsus paradoxus (drop in systolic BP)-indicates cardiac tamponade
46
Q

Rheumatic Fever

A
  • endocardium, myocardium, pericardium
  • strep-related–attaches to valves
  • full course of antibiotics for strep infection
  • IE is likely to recur
  • permanent damage to valves; worried about vegetation breaking free
47
Q

Valvular Heart Disease

A
  • Stenosis (stiff)
  • Regurgitation (valve is too flimsy)
  • seen on ECHO
  • Meds: diuretics, digoxin (+ionotrope), antidysrhythmics for atrial issues
  • Tx: replacement–either open heart or percutaneous
  • mechanical vs. biological valve replacement-must be on coumadin post-op; INR must be 3-4
  • prophylactic antibiotics for any procedures to prevent IE
  • activity intolerance, excess fluid volume, decreased CO
  • if pulmonic valve is faulty-usually taken care of in peds.
48
Q

Mitral Valve Stenosis

A
  • Left side
  • Most common
  • hard to move blood from LA to LV
  • LA backs up…backs up into lungs
  • SOB
  • risk for afib, aflutter, pulmonary congestion, fatigue
49
Q

Mitral Valve Regurgitation

A
  • blood flows back into LA–lower CO
  • Heart pumps harder, faster to compensate–stresses LV
  • auscultate whooshing
  • can replace the valve
50
Q

Aortic Valve Regurgitation

A
  • flimsy
  • blood falls back into LV
  • stresses LV
  • blood can back up into lungs
51
Q

Aortic Valve Stenosis

A
  • Big deal–usually needs to be replaced
  • stiff
  • blood backs up in LV…LA….Lungs
  • decreased CO
  • LV stressed
  • SOB, dizzy, decreased peripheral pulse
  • listen for fluid in lungs
  • valve–whoosh-murmur
52
Q

Tricuspid Valve Stenosis

A
  • RA stressed-has to push harder
  • RA hypertrophies
  • backs up to body
  • peripheral edema, liver, ascites, JVD
  • murmur, pitting edema that can restrict blood flow in lower extremities, pedal pulses
53
Q

Cardiomyopathy

A

Dx with ECHO

dilated: fatigue, decreased EF

 give:  + ionotropes (dig, BBs), O2, pacemaker, ICD (@     risk for Vfib and Vtach

hypertrophic: decreased CO

ALL: low Na diet, avoid stimulants, balance activity/rest, stress reduction, report wt gain, edema, SOB and fatigue (changes), family learn CPR, notify provider bf procedures

54
Q

PAD

(peripheral artery disease)

A
  • fatty streak build-up
  • Risk factors: damage to endothelial lining=smoking, HTN, DM, obesity
  • Carotid artery disease
  • Renal artery disease
  • superficial femoral artery, popliteal artery, anterior tibial, peroneal, posterior tibial
  • Lower extremeties: intermittent claudication-should go away after 10 mins rest, poor circulation-feels cold, muscle fatigue, slow capillary refill, cyanotic, delayed healing. Dx-angiogram, doppler, US. Tx-stents or bi-pass. NO-smoking, TED hose, don’t put legs up, amputations
55
Q

Disorders of the Aorta

A
  • Aneurysm (pouching)-weak spot in wall; CAT scan,MRI,angiograph, US for AAA; CAT scan, TEE for thoracic aneurysm. Assess for rupture (decreased BP, increased HR and RR, abd distension, abd pulsations, can have pain) Tx-endovascular graft, surgery. * Assess kidneys* post-make sure peeing, I&O’s
  • Aortic Dissection (hole)-blood trickles–painful, CO diminished, MRI/CAT scan, TEE, angiography, CXR (if high), keep BP as low as possible. Tx-graft over dissection, keep calm, telemetry, meds to decrease HR and BP, post-op: peripheral pulses, BP. At risk for future dissections
56
Q

Raynaud’s Phenomenon

A
  • vasoconstriction in hands/feet
  • burns/pain
  • pale, blotchy
  • avoid cold weather, vibrations (lawn mower)
  • luke warm tap water for relief
57
Q

Venous Thrombosis

A
  • superficial or deep
  • Virchow’s Triad: venous stasis, damaged endothelium (smokers, HTN, DM, needle sticks), hypercoagulabiltiy of blood (PG)
  • Deep: heparin drip (PTT-next AM after 2 therapeutics)…coumadin (INR 2-3); pain edema (unilateral), skin-warm, red, +Homans, bed rest, no TED hose, leg feels heavy. Dx-US, d-dimer (shows fibrin breakdown of clot). If DVT breaks free…RA…RV…lungs…PE (SOB–ER!!); prevention=lovenox (=low MW heparin) sub Q, soft tooth brush, electric razor, restrict exercise. Return for any SOB
58
Q

Vericose Veins

A
  • genetic
  • more common-female
  • pedal pulse, venous return to heart, and capillary refill are unaffected
  • cosmetic, but insurance will cover for pain
  • remove-laser, saline
  • post-compression stockings
59
Q

Chronic Venous Insufficiency

A
  • valves in veins fail
  • fluid pools
  • lower extremity edema
  • ulcers
  • leathery, brown, painful, itchy
  • infection, cellulitis,rarely-amputaions
  • TED hose if arterial flow is sufficient
  • elevate legs
60
Q

Heparin

Coumadin

A
  • IV
  • measure PTT
  • protamine sulfate is antidote
  • PO
  • measure INR (3-4 for valve repl, 2-3 for afib)
  • vitamin K is antidote

Adult Health (9 decks)

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