Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

S4- Acute Care > Week 3- Cardiac Conditions > Flashcards

Week 3- Cardiac Conditions Flashcards

1
Q

PART 1: CARDIAC CONDITIONS

A

PART 1: CARDIAC CONDITIONS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the central compartment of the thoracic cavity that sits between the lungs. It contains the heart and its vessels, the esophagus, the trachea, the phrenic and cardiac nerves, the thoracic duct, the thymus, and lymph nodes of the central chest.

A

Mediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What membrane encloses the heart and protects it from infection and trauma.

A

Pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the outermost layer of the heart, also protects against infection and trauma.

A

Epicardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cardiac muscular tissue that provides major pumping force of the ventricles.

A

Myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What lines the inner surface of the heart, valves, chordae tendinaea, and papillary muscles (muscles in the ventricles).

A

Endocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • The ________ valve is located between the right atrium and ventricle.
  • The _________ valve is located between the left atrium and ventricle.
A
  • tricuspid

- mitral (bicuspid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

All dysfunctions of the heart affect what (5) factors in some way? Describe each.

A
  • Automaticity: the heart has the ability to initiate its own electrical impulse
  • Excitability: this refers to the heart’s ability to respond to electrical stimulus
  • Conductivity: this allows the heart to transmit electrical impulse from cell to cell of the myocardium
  • Contractility: the heart needs to function as one unit, so contractility allows the heart to stretch as a single unit, then passively recoil while actively contracting
  • Rhythmicity: the heart needs to repeat is cycle in synchrony and with regularity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cardiac Cycle Basics:

  • _____ side of heart: low pressure system
  • _____ side of heart: high pressure system
  • Atrial systole: period of atrial ________, includes atrial kick
  • Atrial diastole: period of atrial _______
  • Ventricular _______: period of ventricular contraction (1st reading of BP)
  • Ventricular ________: period of ventricular filling (2nd reading of BP)
  • Ejection fraction: normally __%
A
  • right
  • left
  • emptying
  • filling
  • systole
  • diastole
  • 60%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the (3) parts of the perfusion triangle?

A
  • Heart (Pump Function)
  • Blood Vessels (Container Function)
  • Blood (Content Function)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pump (Heart) dysfunction is commonly known as _____ because it means there has been damage to heart. With this damage, it cannot move blood adequately to support perfusion.

A

CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

With container dysfunction (Blood Vessels) _____ will cause vasoconstriction and ischemia. _________ and _______ shock will cause vasodilation, leading to lethal hypotension.

A
  • HTN

- anaphylaxis and septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

With content dysfunction any kind of sustained bleeding or hemorrhaging will cause a loss of blood content. Gastric bleeding or a slow cerebral hemorrhage can cause “______” loss of blood content.

A

“silent”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

__________ is a measure of tissue perfusion and should be >75mmHg.

A

Mean Arterial Pressure (MAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CO = __*__

A

HR*SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some factors affecting CO?

A
  • Preload
  • Frank-Sterling Law
  • Afterload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  • What is preload?
  • What is Frank-Sterling Law?
  • What is afterload?
A
  • Preload: Amount of tension on ventricular wall before contraction.
  • Frank-Sterling Law: The greater the stretch(blood volume) of the cardiac muscle cell, the greater the force of the contractions (tension).
  • Afterload: The force against which the cardiac muscle must contract such as vascular compliance and resistance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cardiac Conduction System:

  • The _________ is the pacemaker of the heart. If a patient’s is no longer functioning they may need an external pacemaker.
  • The ______ and the ______ also affect conduction of the heart.
A
  • SA node

- SNS (sympathetic), PNS (parasympathetic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Coronary Perfusion:

  • During ventricular _______ blood is pumped to large superficial coronary arteries.
  • During ventricular _________ myocardial tissue is perfused.
A
  • systole

- diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Coronary Reflexes:

  • _________ are a type of mechanoreceptors located in the internal carotid arteries that help relay information derived from BP. Stimulation results in vasodilation, decreased HR, and decreased contractility.
  • _________ are located in in carotid and aortic bodies and can increase rate and depth of ventilation in response to CO2 levels and can also have cardiac effects. Changes in Co2 can result in sinus arrhythmia.
  • __________ regulate hemodynamics by activating mechanosensitive afferents that can inhibit sustained vagal effects on the heart caused by an increased heart rate during physical loading.
A
  • baroreceptors
  • chemoreceptors
  • ergoreceptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some good things to know in regards to patients with cardiac dysfunction?

A
  • Presence of chest pain
  • Location, quality, characteristics of pain
  • Angina
  • Previous MI
  • Medications
  • History of cardiac conditions
  • Syncope, dizziness
  • Cardiac risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

_________ is a key component in the cardiac evaluation and includes things such as skin color/tone, diaphoresis, edema, respiratory rate, signs of trauma, jugular distention.

A

Observation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

________ is another key part of the cardiac evaluation and involves pulse for circulation, HR, rhythm, and pitting edema.

A

Palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you measure irregular HR?

A
  • Use care with pressure.

- Count for full 60s for rates <60 or >100 bpm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is used to monitor a person’s vital signs remotely?

A

Telemetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Taking Blood Pressure:

  • Patient ________ is important.
  • Use _____ extremity for serial recordings.
  • Be aware if patient has restrictions on UE for taking BP.
  • Measure for OH as indicated. (drop of ___mmHg with position change)
  • Record ____exertion, _____exertion, ____exertion BP for ID BP response to activity.
  • Be aware of _________ that affect BP.
A
  • positioning
  • same
  • 20mmHg
  • preexertion, paraexertion, postexertion
  • medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Auscultation:

  • With ___________ we are evaluating for valvular function, rate, rhythm, valvular compliance, and ventricular compliance.
  • Tap diaphragm before using on patient to ensure it is properly functioning.
  • Avoid auscultating over ________ (muffles intensity).
A
  • auscultation

- clothing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What allows for continuous monitoring of HR and rhythm along with respiratory rate. It has five color-coded leads placed on the chest and allows for central monitoring at nurse’s station.

A

Telemetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q 
Telemetry:
-Green = \_\_\_\_\_\_\_
-Red = \_\_\_\_\_\_\_
-Purple = \_\_\_\_\_\_\_\_
-Yellow = \_\_\_\_\_\_\_
-Blue = \_\_\_\_\_\_\_\_
=White = \_\_\_\_\_\_\_
A

-Green = HR
-Red = BP (and MAP)
-Purple = BP from cuff (last 5 readings)
-Yellow = PAP (pulmonary artery pressure)
-Blue = O2 sat
=White = RR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Saying to remember placement with 5 Lead Telemetry Electrode placement?

A
  • White on Right
  • White clouds over green grass
  • Black smoke over red fire (left)
  • Chocolate in the middle close to the heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

ECG Reading:

  • _______ = atria depoarization
  • _________ = elapsed time between atrial depolarization and ventricuar depolarization
  • _________ = ventricular depolarization and atrial repolarization
  • _________ = elapsed time between end of ventricular depolarization and beginning of repolarization
  • __________ = elapsed time between beginning of ventricular repolarization and end of repolarization
  • ________ = ventricular repolarization
A
  • P wave
  • PR interval
  • QRS complex
  • ST segment
  • QT interval
  • T wave
32
Q

What lab values are monitored with cardiac patients?

A
  • CBC (WBC, RBC (Hct, Hb, platelet))
  • Coagulation profiles (PT, PTT, aPTT, INR)
  • Biochemical markers (CK-MB, Troponin)
  • C-Reactive proteins (hs-CRP)
  • Natriuretic peptides (ANP, BNP)
33
Q

_____ levels of hs-CRP in the blood is associated with increased risk of heart attacks.

A

High

34
Q

Oximetry:

  • ______: saturation of peripheral oxygen
  • ______: partial pressure of O2, measurement of oxygen in arterial blood
  • In general: Keep SaO2 ___% and higher, STOP activity ___% and lower
A
  • SaO2
  • PaO2
  • 92%, 88%
35
Q

The ___________ ________ ______ (OHDC) indicates the relationship between the oxygen saturation of hemoglobin (Sao2) and the partial pressure of arterial oxygen (Pao2).

A

Oxyhemogobin Dissociation Curve

36
Q

What are some cardiac medications patients may be on?

A
  • Antiarrhythmic agents
  • Anticoagulants
  • Antihypertensives
  • Combination drugs for hypertension
  • Antiplatelet agents
  • Lipid-lowering agents
  • Positive inotropes (pressors)
  • Thrombolytics (also known as fibrinolytics)
37
Q

PART 2: COMMON CARDIAC CONDITIONS AND MANAGEMENT

A

PART 2: COMMON CARDIAC CONDITIONS AND MANAGEMENT

38
Q

Ischemia:

  • _________ is a risk factor for many other cardiac conditions, it may go undetected for decades.
  • ______ ________ ________ includes a constellation of disorders that result in myocardia ischemia.
  • List some disorders that fall under acute coronary synrome.
A
  • HTN
  • Acute Coronary Syndrome
  • Coronary atherosclerotic disease (CAD), Angina (stable vs unstable), Myocardial Infarction (MI)
39
Q

Rhythm and Conduction Disturbance:

  • _______ rhythm: irregular, < 20bpm, near death
  • _______ ________: most common arrhythmia. Can lead to syncope due to no atrial kick. Found with CHF, CAD, HTN and other cardiac conditions
  • _________ ________: rate >100bpm, usually regular rhythm, most common after acute MI
  • ________ __________: chaotic rate and rhythm, will lead to death if untreated
  • __________ VT (torsades de pointes): irregular rhythm and rate >150bpm
  • ___ ________: rhythm disturbance where electrical conduction from atria to ventricles is partially or completely blocked
A
  • Agonal Rhythm
  • A.fib
  • Ventricular Tachycardia
  • Ventricular Fibrillation
  • Multifocal VT
  • AV Blocks
40
Q

Atrioventricular Blocks:

  • Divided into _____ degrees.
  • Which ones can we work with, and which ones can we not work with due to hemodynamic instability?
A
  • Three degrees (w/ exception of Type I and Type II second degree)
  • Can work with first degree and second degree (Type I). Cannot work with second degree (Type II) or third degree due to hemodynamic instability.
41
Q
  • ________ Heart Disease affects one or more of the 4 valves in the heart.
  • What are the 3 types and explain them.
A

-Valvular

  • Mitral stenosis: The leaflets are fused, are too thick, or there is some other structural defect in the valve leaflets. As a result, the valve is too narrow, and the heart has to work harder to pump blood through the valve.
  • Mitral regurgitation: The valve doesn’t close completely and allows blood to leak back (regurgitate) into the atrium from the ventricle.
  • Mitral valve prolapse: When the valve is closed, the leaflets bulge abnormally up, into the atrium. Sometimes mitral valve prolapse causes mitral valve regurgitation. If the prolapse is severe, the valve leaflets can become disconnected from tendons that stretch between the leaflets and the heart muscle. This can cause the valve to malfunction.
42
Q
  • __________ Heart Disease affects heart muscle tissue and is referred to as cardiomyopathy.
  • What are the 3 classifications? Explain them.
A

-Myocardial

  • Dilated Cardiomyopathy: The heart muscle becomes thin, the left ventricle becomes enlarged (dilated) and the heart is unable to squeeze efficiently, reducing the amount of blood that is pumped to the body.
  • Hypertrophic Cardiomyopathy: The muscle is thickened (hypertrophic). When the muscle becomes thickened, it may make it difficult for an efficient amount of blood to flow into and out of the heart, especially during exercise.
  • Restrictive Cardiomyopathy: The heart muscle becomes rigid and unable to relax and fill with blood. The function or squeeze of the heart may be normal, but the relaxation is abnormal. When the lower left chamber of the heart, called the left ventricle, is unable to stretch and fill with blood, pressure builds up causing abnormal heart rhythms and symptoms of heart failure.
43
Q
  • __________ Heart Disease affects the pericardium and may be referred to as pericarditis.
  • What is a cardiac tamponade?
A
  • Pericardial

- Fluid collects between pericardial sac and myocardium, life threatening.

44
Q

Heart Failure:

  • Pump failure that reduces ______.
  • Most common etiology is __________.
A
  • CO

- cardiomyopathy

45
Q

PART 3: CARDIAC MANAGEMENT

A

PART 3: CARDIAC MANAGEMENT

46
Q

Thrombolytic Therapy:

  • Acute management strategy for patients experiencing ____.
  • Known as “____ _______”
  • Indications are _____ ____ suggesting MI, ________ ST segment, and bundle branch block.
  • What is the timing of administration?
  • Contraindicated in patients at risk for excessive __________.
  • Typically used in conjunction with other meds.
A
  • MI
  • “clot busters”
  • chest pain suggesting MI, elevated ST segment
  • within 3 hours of onset
  • bleeding
47
Q

Percutaneous Revascularization:
-_____ involves a balloon-tipped catheter threaded into occluded artery. It is then inflated to make artery patent once again.

A

PTCA (percutaneous transluminal coronary angioplasty)

48
Q

Coronary Artery Bypass Graft:

  • What is it?
  • What is the standard approach?
A
  • Vascular graft is used to revascularize the myocardium when a coronary artery is occluded.
  • Median sternotomy
49
Q

Sternal Precautions:

  • Purpose is to reduce risk for sternal __________.
  • Duration is usually about ___ weeks but depends on surgeon.
  • What are the restrictions?
  • What are the risk factors for dehiscence?
  • Can they use ADs?
A
  • dehiscence
  • 8 weeks
  • No UE pushing, pulling, overhead reaching (>90 degrees), no lifting objects (>10lbs), no resistive exercise of UE. Driving usually restricted.
  • obesity, COPD, diabetes, smoking, PVD, repeat thoracotomy, female, penduous breasts
  • Walker may be used, but cannot place weight onto arms.
50
Q

Ablation Procedures:

  • What is the purpose?
  • _____ procedure is used to ablate atrial fibrillation.
  • Leg used for procedure must remain straight and immobile for __-__ hours.
A
  • Purpose is to remove or isolate ectopic foci in order to reduce rhythm disturbances.
  • Maze procedure
  • 3-4 hours
51
Q

Cardioversion:

  • What is the purpose?
  • Cardiac ________ implantation: provides pacer function to ensure regular rhythm.
  • Automatic implantable cardiac defibrillator: manages ventricular arrhythmia by defibrillating myocardium as needed to restore normal rhythm.
  • What are some PT considerations with cardioversion?
A
  • Purpose is to restore normal heart rhythm in tachycardia arrhythmic conditions.
  • pacemaker
  • closely monitor activity response with HR and BP (also know if device has rate modulation).
52
Q

Do all cardiac pacemaker implantations provide rate modulation? What is the importance of this?

A

No, patient’s HR may not change with activity during PT!

53
Q

External Defibrillator:

  • _____ ______ is a personal external defibrillator worn by patients at high risk of sudden cardiac arrest.
  • What are the 2 components?
A
  • Life Vest

- garment and monitor

54
Q

Ventricular Assistive Device?

  • Can be ____ or ______.
  • What is the purpose?
  • What are the precautions?
  • What are some complications?
A
  • left (LVAD) or right (RVAD)
  • Purpose is to unload R or L ventricle and support pulmonary/systemic circulation.
  • Know emergency procedures in case of battery failure, maintain patency of drive lines with external pump, monitor hemodynamics.
  • thrombus formation, CVA, hemorrhage, line infections, renal or hepatic insufficiency.
55
Q

PART 4: CHEST PAIN

A

PART 4: CHEST PAIN

56
Q

What is a starting point for many of the medical interventions?

A

An individual experiences chest pain and goes to the ED.

57
Q

What are some important things to consider when assessing chest pain?

A
  • Characteristics of the pain
  • Time of onset
  • Duration of symptoms
  • Vital signs
  • Overall cardiovascular status
  • Cardiac risk factors
  • Gastric, pulmonary disease
  • Psychological disorders
58
Q
  • _______ angina is usually predictable, triggered by physical and/or psychological stressors, occurs with constant frequency over time, and is relieved by rest or nitroglycerin.
  • ________ angina is a new onset, occurs at rest or minimal exertion, progressive in nature, refractory to previously effective medicine, and more likely to lead to MI.
A
  • Stable

- Unstable

59
Q

What is the Marburg Heart Scale?

A

Predicts likelihood of dx of CAD if they have 3+/5 of the following:

  • 55+ in men, 65+ in women
  • Known CAD or cardiovascular disease
  • Pain not reproducible by palpation
  • Pain worse with exercise
  • Patient’s assumption that pain is cardiogenic in origin
60
Q

What To Do If Patient Reports Chest Pain:

  • _____ the activity and let the patient rest in a position of comfort
  • Monitor _____ signs (BP, HR, O2sat, RR) and ________ (if applicable)
  • Use Angina Rating Scale and Canadian Cardiovascular Society classification of angina according to impact on physical activity
  • Determine if pain is cardiogenic or noncardiogenic, stable or unstable
  • If patient prescribed __________, have him/her take one dose
  • Educate patients on difference between _______ and _________ chest pain
A
  • Stop
  • vital and telemetry
  • nitroglycerin
  • stable and unstable
61
Q

PART 5: CARDIAC PT INTERVENTIONS

A

PART 5: CARDIAC PT INTERVENTIONS

62
Q

What are the (3) goals of cardiac PT interventions?

A
  • Assess hemodynamic response during self-care and functional mobility
  • Maximize activity tolerance
  • Patient/caregiver education for activity/behavior modification
63
Q
  • __________ response: Patient cannot meet physiologic demands due to pathologic process.
  • _______ response: Patient can perform function independently without over exertion.
A
  • Unstable (hemodynamically)

- Stable (hemodynamically)

64
Q

Absolute Indications to Withhold Treatment:

  • ___________ CHF
  • _______-degree heart block with PVCs
  • _______-degree heart block
  • > ___ PVCs/min at rest
  • ______ pain with new ST segment changes
  • New onset __-____ with rapid ventricular response at rest (HR > 100 bpm)
A
  • Decompensated
  • Second
  • Third
  • > 10 PVCs/min
  • Chest
  • A-fib
65
Q

Relative Indications to Modify or Withhold Treatment:

  • Resting HR > ____ bpm
  • Resting HTN > ____ systolic and > ___ diastolic
  • ___________ at rest (< 80 systolic)
  • Ventricular ectopy at rest
  • __-___ with rapid ventricular response at rest (HR > 100 bpm)
  • Psychosis/unstable psych condition
A
  • 100 bpm
  • 160 SBP, 90 DBP
  • hypotension
  • A-fib
66
Q

Monitoring Activity Tolerance (Heart Rate):

  • Linear relationship between ___ and work
  • ___-___ beat increase from resting HR generally safe intensity level
  • Patients on ____-_______: do not exceed 20 beats above resting HR
  • AICD: target HR ___-___ beats below threshold rate on defibrillator
  • Post-heart transplant: Cannot use ___ to prescribe exercise
  • HRR (HR recovery): difference between peak HR with exercise minus HR at 60 seconds
A
  • HR
  • 20-30
  • beta-blockers
  • 20-30
  • HR
67
Q

Monitoring Activity Tolerance (Blood Pressure):

-Normotensive systolic blood response: increase __-___ mm Hg per increase in METs

A

-5-12

68
Q

Monitoring Activity Tolerance (RPE):

  • ______ RPE scale
  • General guideline for intensity: __ or less on 10-point scale; __ or less on 6-20 scale
A
  • Borg

- 5, 13

69
Q

What are (3) other ways we can monitor activity tolerance?

A
  • Heart Sounds
  • Breath Sounds
  • ECG Rhythm
70
Q

Cardiac Interventions:

  • Usually bedside, very _________-based
  • Always check with the patient’s nurse before treatment, report patient status after treatment, especially if there were any problems
  • Can be very low level: working on rolling, bridging, getting to EOB
  • Can be higher level: standing balance, ambulation within room and/or outside in hallway
  • Thoughts on supine or any OKC therex: you’re a better PT than that!
  • Treatment is tailored around what is going to get that patient out of bed and transitioned to a lower level of care (ie, D/C off the acute floor)
A

-function

71
Q

Phases of cardiac interventions?

A
  • Warm-up
  • Conditioning
  • Cool-down

-Also patient education on things such as self-monitoring and symptom recognition, safe and sustainable exercise program, lifestyle modifications medication management.

72
Q
  • Cardiac rehabilitation is a long term program to establish safe exercise and activity parameters and consists of ____ phases.
  • What is the goal of cardiac rehabilitation?
A
  • three phases

- Goal is to achieve optimal physical, psychosocial, and functional status within limits of heart disease.

73
Q

Cardiac Rehabilitation (Phase I):

  • When is it started?
  • Where does it begin?
  • What are the goals?
  • Education about ____ factors and ________ modifications are ESSENTIAL.
A
  • Started as soon as patient is stable
  • Begins in inpatient setting (acute care, TCU, subacute, SNF)
  • Goal: tolerate ADLs, walking functional distances, climbing stairs (1-4 METS) with appropriate VS and no cardiovascular symptoms
  • Education about risk factors and lifestyle modifications ESSENTIAL
74
Q

Cardiac Rehabilitation (Phase II):

  • When is it started?
  • Where does it begin?
  • Continues patient ______ and progresses exercises and activities.
A
  • Starts about 2 weeks after cardiac event
  • Begins in early outpatient rehab
  • education
75
Q

Cardiac Rehabilitation (Phase III):

  • When is it started?
  • Involves ________ and __________.
A
  • Usually begins 2-3 months after cardiac event

- maintenance and prevention

S4- Acute Care (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions