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Nurs 136- MCA II > Week 4 - Heart > Flashcards

Week 4 - Heart Flashcards

1
Q

Cardiac output - amount of __________________________________

A

blood pumped by each ventricle in one minute

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2
Q

Stroke volume - amount of blood ___________________________ during each systolic cardiac contraction

A

ejected out of the heart’s left ventricle

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3
Q

cardiac output = ______ x _______

A

stroke volume x heart rate

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4
Q

Afterload -

A

resistance

[work to eject volume of ventricle]

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5
Q

_________ is a common med for heart failure (to increase contractility)

A

Digoxin

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6
Q

Ejection fraction normal range

A

55-70%

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7
Q

Heart failure - complex clinical syndrome resulting in ________________________________________ to tissues and organs

A

Heart failure - complex clinical syndrome resulting in insufficient blood supply / oxygen to tissues and organs

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8
Q

Heart failure risk factors

Hypertension
Coronary artery disease
DM
Metabolic syndrome

A

HTN
CAD
DM
Metabolic syndrome

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9
Q

Types of heart failure

HFrEF
HFpEF
ADHF

A

HFrEF [impaired systolic function]
HFpEF [impaired diastolic function]
ADHF

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10
Q

Heart failure S&S

Pulmonary _________: anxious, pale, cyanoticl
cool and clammy skin
dyspnea, orthopnea, tachypnea
cough with frothy, ________________
crackles, wheezes
tachycardia, hypertension/hypotension
abnormal s3 or s4
FACES Fatigue, Activites limitation, Chest congestion/cough, Edema, Shortness of breath
weight ______
chest pain

A

Pulmonary edema: anxious, pale, cyanoticl
cool and clammy skin
dyspnea, orthopnea, tachypnea
cough with frothy, blood-tinged sputum
crackles, wheezes
tachycardia, hypertension/hypotension
abnormal s3 or s4
FACES Fatigue, Activites limitation, Chest congestion/cough, Edema, Shortness of breath
weight gain
chest pain

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11
Q

Heart failure Dx

Echocardiagram
EKG
Chest x-ray
BNP

A

Echocardiagram
EKG
Chest x-ray
BNP

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12
Q

Heart failure NM

VS
Rhythm
Urine output
O2 supplement
Strict I&O
daily weight
high fowler’s
BIPAP/ MV
Hemodynamic monitoring
Ultrafiltration
IABP
LVAD
Pt teaching

A

VS
Rhythm
Urine output
O2 supplement
Strict I&O
daily weight
high fowler’s
BIPAP/ MV
Hemodynamic monitoring
Ultrafiltration
IABP
LVAD
Pt teaching

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13
Q

Heart failure complications

_________ effusion
Dysrhthmia
left ventricular _________
hepatomegaly
________ failure

A

Pleural effusion
Dysrhthmia
left ventricular thrombus
hepatomegaly
renal failure

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14
Q

Classifications of HF

A
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15
Q

Drug therapy for HF- Diuretics

Decrease volume _________ (preload)

Loop diuretics Furosemide (_______)

A

Decrease volume overload (preload)

Loop diuretics Furosemide (Lasix)

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16
Q

Drug therapy for HF- Vasodilators

_________ circulating blood volume and improve cornary artery __________

IV nitroglycerin
Sodium nitroprusside
Nesiritide (natrecor)

A

Reduce circulating blood volume and improve cornary artery circulation

IV nitroglycerin
Sodium nitroprusside
Nesiritide (natrecor)

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17
Q

Drug therapy for HF- Morphine

Reduces _________ & _________
Relieves dyspnea and anxiety

A

Reduces preload and afterload
Relieves dyspnea and anxiety

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18
Q

Drug therapy for HF- Positive inotropes

______ agonists (dopamine, dobutamine, norephinephrine (Levophed)

Phosphodiesterase inhibitor (milrinone)

Digtalis

A

Beta agonists (dopamine, dobutamine, norephinephrine (Levophed)

Phosphodiesterase inhibitor (milrinone)

Digtalis

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19
Q

Drug therapy for HF- RAAS inhibitors - reduce BP

ACE inhibitors

Angtiotensin II receptor blockers

Aldosterone antagonists

A

ACE inhibitors

Angtiotensin II receptor blockers

Aldosterone antagonists

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20
Q

Drug therapy for HF- Beta-blockers

____________ (lopressor)

A

Metroprolol (lopressor)

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21
Q

Heart failure - nurtitional therapy

Low ________ (2g/ day)
________ restriction, if required (under 2L/ day)
Daily _________ important (same time, clothing)

Weight gain of 3lb over 2 days, or 3-5 lbs oer a week REPORT TO HCP

A

Low sodium (2g/ day)
Fluid restriction, if required (under 2L/ day)
Daily weights important (same time, clothing)

Weight gain of 3lb over 2 days, or 3-5 lbs oer a week REPORT TO HCP

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22
Q

Ischemic stroke- thrombotic or embolic

blood supply to part of the brain is blocked or reduced

A

Thrombotic - caused by a blood clot that develops in the blood vessels inside the brain.

Embolic - caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to one of the blood vessels in the brain through the bloodstream.

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22
Q

Hemorrhagic stroke- -ruptured ________ __________

A

blood vessel

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23
Q

TIA- transient episode of _____________________ w/out acute infarction of brain

Transient ischemic attack

A

neurologic dysfunction

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24
Q

Stroke risk factors

Non-modifiable VS modifiable

A

Non-modifiable
-Age, gender, race, family Hx

Modifiable:
-HTN, Afib, smoking, sleep apnea, metabolic syndrome, illicit drugs

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25
Q

Stroke S&S

BEFAST - ???

Weakness/paralysis, receptive & expressive aphasia, numbness, cobfusion, vision problem, slurred speech, dysphagia, N & V, HA, abnormal VS

A

B - balance
E - eye siggt
F - face (sudden change weakness/numbness/paralysis)
A - arms/legs weakness
S - Speech. Trouble speaking.

T - Time to call 911. Also call 911 if you have other stroke symptoms. They include:
Sudden confusion.
Sudden trouble understanding simple statements.
Fainting.
A seizure.
A sudden, severe headache.

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26
Q

Stroke Dx

FSBG
Labs
CT
CTA
MRI

A

FSBG
Labs
CT
CTA
MRI

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27
Q

Stroke NM

Stroke process
VS
EKG
NPO
NIH
_________ test
Neuro
ER> ICU> Rehab

A

Stroke process
VS
EKG
NPO
NIH
Swallowing test
Neuro
ER> ICU> Rehab

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28
Q

Stroke - drugs

Ischemic: <4.5 hrs; LKW = _____ (tissue plasminogen activator) or _____ (tenecteplase), thrombectomy
~not candidate for these: Permissive HTN

Hemorrhagic: BP & ICP control; HOB 30 degrees, seizure prophylaxis, no anticoagulant, Vit. K, Kcentra, FFP, burr hole

A

Ischemic: <4.5 hrs; LKW = tPA (tissue plasminogen activator) or TNK (tenecteplase), thrombectomy
~not candidate for these: Permissive HTN

Hemorrhagic: BP & ICP control; HOB 30 degrees, seizure prophylaxis, no anticoagulant, Vit. K, Kcentra, FFP, burr hole

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29
Q

Acute decompensated heart failure (ADHF) is a sudden ____________________________________

A

worsening of the symptoms of heart failure

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30
Q

HTN - Primary VS secondary

A

Primary hypertension does not have a definitive cause, while secondary hypertension has a known cause

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31
Q

HTN risk factors

Age
Family Hx
ETOH
obesity
tobacco
DM
^ _______, _________, __________

A

Age
Family Hx
ETOH
obesity
tobacco
DM
^ Na, ^ Lipids, ^ stress

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32
Q

HTN S&S

“___________”
fatigue, dizziness
palpitations, angina
Dyspnea

A

“silent killer”
fatigue, dizziness
palpitations, angina
Dyspnea

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33
Q

HTN dx

BP
Labs
EKG
UA
Echo

A

BP
Labs
EKG
UA
Echo

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34
Q

HTN NM

_________ reduction
_________ eating plan
Reduce __________
Moderation of alcohol
Physical activity
avoid tobacco
Drug Tx, Pt teaching

A

Weight reduction
DASH eating plan
Reduce sodium
Moderation of alcohol
Physical activity
avoid tobacco
Drug Tx, Pt teaching

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35
Q

Hypertensive crisis

Hypertensive urgency- BP over 180/120

Hypertensive emergency- BP over 180/120 w/ organ damage

tx: IV sodium nitroprusside
>decreases BP 20-25%

A

Hypertensive urgency- BP over _____ ______
Hypertensive emergency- BP over 180/120 w/ _______ _________

tx: IV sodium nitroprusside
>decreases BP 20-25%

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36
Q

Peripheral artery disease (PAD) involves progressive narrowing and _____________________________ of upper and lower extremities

A

degeneration of arteries

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37
Q

Peripheral artery disease (PAD) risk factors

Age
DM
Tobacco
Obesity
^ ________

A

Age
DM
Tobacco
Obesity
^ Lipids

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38
Q

Peripheral artery disease (PAD) dx

Doppler Ultrasound
ABI [anckle brachial index BP test]
MRI

A

Doppler US
ABI
MRI

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39
Q

Peripheral artery disease (PAD) S&S

Intermitten ____________
paresthesia
thin, shiny, taut skin
Loss of _____ on lower legs
Diminished/absent ___________
________ of foot with leg elevation
Reactive hyperemia of foot with dependent position
______ at rest
critical limb ischemia (CLI)

A

Intermitten claudication
paresthesia
thin, shiny, taut skin
Loss of hair on lower legs
Diminished/absent pulses
Pallor of foot with leg elevation
Reactive hyperemia of foot with dependent position
Pain at rest
critical limb ischemia (CLI)

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40
Q

Peripheral artery disease (PAD) NM

____________ assessment
__________ cessation
Pt teaching
_______ inhibitors
Antiplatelets
Pletal
Trental
Monitor for complications

A

Circulatory assessment
tobcco cessation
Pt teaching
Ace inhibitors
Antiplatelets
Pletal
Trental
Monitor for complications

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41
Q

Right sided HF Sx:

Peripheral ______
____________
____________

A

Peripheral edema
Splenamegaly
Hepatomegaly

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42
Q

_________ disease is AKA thromboangiitis obliterans

A

Buerger’s

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43
Q

Buerger’s disease - nonathertosclerotic, segmental, recurrent ___________________________________________________ of arms and legs

A

inflammatory disorder of the small and medium arteries and veins

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44
Q

Buerger’s disease etiology & dx

unknown, but usually young men with long history of _________________ use without other CVD risk factors

NO diagnosis tests

A

unknown, but usually young men with long history of tobacco/marijuana use without other CVD risk factors

NO diagnosis tests

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45
Q

Buerger’s disease S&S

Intermittent claudication
rest pain
ulceration
color and temp changes
paresthesia
superficial vein thrombosis
cold sensitivty

A

Intermittent __________
rest pain
ulceration
color and temp changes
paresthesia
superficial vein thrombosis
______ sensitivty

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46
Q

Buerger’s disease NM

_________ cessation
___________

A

tobacco cessation
amputation

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47
Q

Raynaud’s phenomenon - episodic ____________ ____________of small cutaneous arteries - involves fingers & toes

A

vasospastic disorder

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48
Q

Raynaud’s phenomenon etiology

isolation
__________ disorder
scleroderma
lupus
_________ machinery
______ environments
heavy ________, high homocysteine levels

A

isolation
thyroid disorder
scleroderma
lupus
vibrating machinery
cold environments
heavy metal, high homocysteine levels

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49
Q

Raynaud’s phenomenon Dx

persistent sx x ___ _______

A

2 years

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50
Q

Raynaud’s phenomenon S&S

__________ induced color changes (_______________) of fingers or toes

A

Vasospasm induced color changes (white, blue, red) of fingers or toes

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51
Q

Raynaud’s phenomenon NM

wear loose, warm clothing
______ from the cold
immerse hands in ______ water
NO __________ products
avoid ___________ and other drugs with vasoconstrictive effects
_________ channel blockers (nifedipine)

A

wear loose, warm clothing
gloves from the cold
immerse hands in warm water
NO tobacco products
avoid caffeine and other drugs with vasoconstrictive effects
calcium channel blockers (nifedipine)

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52
Q

__________ is shortness of breath when lying down

A

Orthopnea

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53
Q

Heart failure mnemonic FACES

A

Fatigue, Activites limitation, Chest congestion/cough, Edema, Shortness of breath

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54
Q

Hypertension is frequently __________ until it becomes very severe

A

asyomptomatic

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55
Q

Hypertensive crisis tx: IV __________ ____________
>decreases BP 20-25%

A

sodium nitroprusside

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56
Q

Primary purpose of heart: to _____________ and drive hemoglobin to cells

A

pump blood

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57
Q

S1 heart sound - ___________________ valve closure

A

mitral and tricuspid

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58
Q

S2 heart sound - closure of the semilunar (_________________) valves

A

aortic and pulmonary

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59
Q

Normal cardiac output

A

4-8 L/Min

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60
Q

Normal stroke volume

A

60-120 mL/Beat

61
Q

3 factors that determine stroke volume

A

preload
afterload
contractility

61
Q

preload = amount of sarcomere stretch by cardiac muscle cells at the end of ventricular filling during diastole.

~related to ________________________

A

ventricular filling.

62
Q

To increase pre-load:

A

give fluids

63
Q

To decrease pre-load:

A

Diuretics

Vasodilators/ anti-hypertensives
-Nitroglycerin
-Morphine
-Any meds that decrease BP

64
Q

Why is EF not 100% ?

A

The heart never empties itself

64
Q

Digoxin will increase

A

contractility of heart

65
Q

2 major risk factors for Heart Failure

A

Hypertension
Coronary artery disease

[also Diabetes Mellitus & Metabolic syndromes]

66
Q

Metabolic syndrome - risk factor for heart failure

These include

A

Obesity
Hypertension
High lipids
High sugar

67
Q

HFpEF VS HFrEF

A

HFpEF - diastrolic failure

HFrEF - systolic failure

68
Q

Which assessment finding is consistent with right-sided heart failure (HF)?​

​

Jugular Vein Distention (JVD) ​

Presence of S3 and S4 heart sounds ​

Paroxysmal Nocturnal Dyspnea (PND)​

Displacement of the point of maximal impulse (PMI)

A

Jugular Vein Distention​

​

JVD is a sign of right sided HF. Right-sided HF occurs when the right ventricle does not pump effectively. When the RV fails, fluid backs up into the venous system. That causes movement of fluid into the tissues and organs (e.g. peripheral edema, abdominal ascites, hepatomegaly, JVD. All the other choices are associated with LEFT sided HF. ​

68
Q

When teaching drug therapy for chronic heart failure, the nurse would explain that which mechanism is blocked by angiotensin-converting enzyme (ACE) inhibitors?​

​

Aldosterone-secreting effects of angiotensin II​

Natriuretic peptide system ​

Conversion of angiotensin I to angiotensin II​

Aldosterone activation ​

A

C. Conversion of Angiotensin I to Angiotensin II​

​

ACE inhibitors block the renin-angiotensin-aldosterone System (RAAS) by inhibiting the conversion of angiotensin I to II. ACE inhibitors are first-line drugs in patients with heart failure with reduced ejection fraction (HFrEF). They reduce afterload and systemic vascular resistance (SVR) and slow ventricular remodeling by inhibiting ventricular hypertrophy.

69
Q

Which primary manifestation results from the decreased filling of the cardiac ventricles associated with diastolic failure?​

​

Decreased afterload​

Decreased left ventricular ejection fraction​

Decreased left ventricular end-diastolic pressure​

Decreased stroke volume and cardiac output ​

A

D. Decreased Stroke Volume and Cardiac Output​

​

HF with preserved ejection fraction HFpEF is DIASTOLIC Failure. It results from the inability of the ventricles to relax and fill during diastole. Decreased filling volume in the ventricles results in decreased stroke volume and reduced cardiac output. Diastolic failures are characterized by high filling pressures because of stiff ventricles, increasing afterload, and left ventricular end-diastolic pressure. Venous engorgement in both the pulmonary and systemic vascular systems causes a decreased left ventricular ejection fraction. In HFpEF, the left ventricle is generally stiff and noncompliant, causing high filling pressures.​

69
Q

The nurse would monitor for which side effect in a patient who takes an angiotensin-converting enzyme (ACE) inhibitor to treat chronic heart failure (HF)?​

​

Cough​

Anemia​

Hyperpigmentation​

Increased body temperature​

A

Cough​

​

ACE inhibitors can cause a dry, persistent cough due to increased bradykinin levels.

69
Q

Jugular Vein Distention (JVD) ​is a sign of ____________

A

right sided HF

70
Q

ACE inhibitors can cause a ___________________ due to increased bradykinin levels.

A

dry, persistent cough

71
Q

The nurse would question which item that is listed on a hospital discharge plan for a patient with chronic heart failure?​

​

Eat small, frequent meals​

Obtain the annual flu vaccine​

Avoid extremes of heat and cold​

Report a weight gain of 3 pounds in one week ​

A

D. Report a weight gain of 3 lbs in one week​

​

The nurse should tell patients to call the HCP about a weight gain of 3 lb over 2 days or a 3-5 lb gain over a week. Eating small, frequent meals is a component of dietary therapy. The patient should be instructed to receive the annual flu vaccination for health promotion. The patient should be instructed to avoid extremes of heat and cold to prevent stress on the heart

72
Q

A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks whether the medication can be stopped because the blood pressure (BP) is now within the normal range. Which response would the nurse provide?​

​

“you may stop the medication now because your BP is normal”​

“begin taking half-doses of the medication because the BP has decreased”​

“you may stop taking the medication only if you maintain a healthy lifestyle” ​

“continue the medication unless your HCP advises discontinuing it” ​

A

D. “continue the medication unless your HCP advises discontinuing it”​

​

Antihypertensive medications are effective at reducing BP. However, the medications should not be stopped abruptly because this can cause severe hypertensive reaction. The medications should be discontinued only after consulting with the HCP. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects.​

73
Q

A client is admitted following a thrombotic stroke. What priority assessment is most important to perform in the first 24 hrs? ​

​​

a. 12 lead EKG​

b. Assess if bowel sounds are hypo or hyperactive ​

c. Pupil size and pupillary response ​

d. Coagulation lab test ​

A

c. Pupil size and pupillary response​

​

The nurse should assess pupil size and pupillary responses, which may indicate changes associated with the complications of the stroke. Neuro assessment is the first priority with a stroke patient.

74
Q

The emergency department nurse receives a client with an ischemic stroke, and prepares to administer tissue plasminogen activator (t-PA). What question should the nurse ask first before administering the t-PA?​

a. Ask the client which arm or leg is affected.​

b. Ask the client if speech was slurred.​

c. The nurse will ask the time of onset of stroke.​

d. Ask what home medications the client takes.​

A

c. The nurse will ask the time of onset of stroke​

​

The emergent need is to determine if the client is a candidate for t-PA administration. Timing of onset of stroke is important when receiving t-PA. The patient should receive thrombolytic medication with in 3-4.5 hours after the onset of a stroke for best outcomes. ​

75
Q

Which patient statement supports a history of intermittent claudication?​​

a. “When I stand too long, my feet start to swell.”​​

b. “My legs cramp when I walk more than a block.”​​

c. “I get short of breath when I climb a lot of stairs.”​​

d. “My fingers hurt when I go outside in cold weather.”​​

A

b. “My legs cramp when I walk more than a block.”​

​
Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication. Finger pain associated with cold weather is typical of Raynaud’s phenomenon. Shortness of breath that occurs with exercise is not typical of intermittent claudication, which is reproducible. Swelling associated with prolonged standing is typical of venous disease.

76
Q

Cramping that is precipitated by a consistent level of exercise is descriptive of _________________________

A

intermittent claudication.

77
Q

After teaching a patient with newly diagnosed Raynaud’s phenomenon about how to manage the condition, which action by the patient best demonstrates that the teaching has been effective?​

​
a. The patient exercises indoors during the winter months.​
b. The patient immerses hands in hot water when they turn pale.​
c. The patient takes pseudoephedrine (Sudafed) for cold symptoms.​
d. The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).​

A

The patient exercises indoors during the winter months.​

​

Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm rather than hot water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking NSAIDs with Raynaud’s phenomenon

78
Q

EF of HFpEF VS HFrEF

A

HFpEF - 50%

HFrEF - under 45%

79
Q

Vasodilators - contraindicated with:

A

viagra

[both are vasodilators so BP will lower too much]

80
Q

With _____ , it is reversible deficit lasting under 24 hours

With stroke, symptoms last over 24 hours and do not resolve without intervention

A

TIA

81
Q

tPA and TNK are IV _____________ - “clot-busting” drugs that break up and dissolve blood clots that get in the way of your blood flow

A

thromolytics

82
Q

tPA and TNK are only given in

A

the ED

82
Q

________________________ is a medical technique where healthcare professionals intentionally maintain a patient’s systolic blood pressure at a higher level than the normal range for a certain period, to achieve specific treatment objectives. This approach is commonly used when reducing blood pressure quickly may be harmful or result in adverse health outcomes, and so a higher blood pressure is allowed temporarily.

A

Permissive hypertension

83
Q

DASH diet for HTN

A

Dietary approaches to stop HTN

Fruits, veg, fat free, low fat dairy, whole grains, fish, poultry, beans, seeds/nuts

84
Q

Side effect of all BP meds

A

Orthostatic hypotension

85
Q

You do not want to drastically drop BP because you may ______________ the brain

A

under perfuse

Brain is used to high BP

86
Q

Make sure to educate pts on calcium channel blockers - AVOID taking with

A

grapefruit juice

87
Q

Grapefruit juice enhances absorption of ____________________, which can lead toxicity

A

calcium channel blockers

88
Q

PAD - symptoms begin when blood vessels are ________ % blocked

A

60-75

89
Q

Intermitten claudication is due to build up of __________ from anaerobic metabolism

A

lactic acid

90
Q

Lack of __________ with PAD leads to tingling, thin skin, pallor, reactive hyperemia

A

blood flow

91
Q

For Buerger’s Disease, the pt must choose between keeping them affected limb or stopping ____________________

A

all tobacco/marijuana use

92
Q

NIH stroke scale

A

(0, 1-4, 5-15, 16-20, 21-42).

the larger the number, the worse the patient is

a patient with a significant stroke deficit will have a higher score

93
Q

Formula for cardiac output

A

CO = SV x HR

94
Q

_____________ : amount of blood pumped by each ventricle

A

Cardiac output

95
Q

HR: count by checking _________

A

pulses​

95
Q

Normal CO

A

4-8 L/Min

96
Q

___________________: volume of blood ejected w/ each heart beat (normal: 60-120 mL/beat) ​

​

A

Stroke Volume

97
Q

Normal stroke volume range

A

60-120 mL/beat

98
Q

Valve Function: continue unidirectional flow to ________________________________________________

A

prevent blood from moving back and forth

99
Q

s1 VS s2

Lub-Dub

A

s1 tricuspid and mitral valve closing [AV valves]

s2 pulmonic and aortic valves closing [Semilunar valves]

100
Q

3 Determinants of Stroke Volume​

_________: amt of blood in the ventricles at the end of diastole​

___________: resistance the heart must overcome to eject blood into the systemic circulation during systole​

___________: ability of myocardium to contract (ability of the heart to squeeze)

A

Preload: amt of blood in the ventricles at the end of diastole​

Afterload: resistance the heart must overcome to eject blood into the systemic circulation during systole​

Contractility: ability of myocardium to contract (ability of the heart to squeeze)

101
Q

Preload: amt of blood in the ventricles at ________________

A

the end of diastole​

102
Q

Afterload: __________ the heart must overcome to eject blood into the systemic circulation during systole​

A

resistance

103
Q

Contractility: ability of myocardium to contract (ability of the heart to ________)

A

squeeze

104
Q

Ejection Fraction​

Normal: ________%​

Heart Failure: <___% (can go as low as 5-10%) ​

A

Normal: 55-70%​

Heart Failure: <45% (can go as low as 5-10%) ​

105
Q

Heart Failure​ - Heart can’t pump sufficient blood to maintain adequate __________​

Heart muscle is too _______ to push blood forward​

Ventricle can’t ________ and receive enough blood to maintain CO​

A

Heart can’t pump sufficient blood to maintain adequate perfusion​

Heart muscle is too weak to push blood forward​

Ventricle can’t relax and receive enough blood to maintain CO​

106
Q

HFpEF (Diastolic Failure)​
-Heart Failure w/ Preserved Ejection Fraction​
-Inability of ventricles to ______ and _____ during diastole​

HFrEF (Systolic Failure)​
-Heart Failure w/ Reduced Ejection Fraction​
-Inability of the heart to ____________ effectively on left ventricle​
-EF: <45%, as low as 5-10%

A

HFpEF (Diastolic Failure)​
-Heart Failure w/ Preserved Ejection Fraction​
-Inability of ventricles to relax and fill during diastole​

HFrEF (Systolic Failure)​
-Heart Failure w/ Reduced Ejection Fraction​
-Inability of the heart to pump blood effectively on left ventricle​
-EF: <45%, as low as 5-10%

107
Q

Heart Failure Risk Factors ​

A

HTN​
CAD​
DM​
Metabolic Syndrome​
Other Factors: Tobacco, Advanced Age, Vascular Disease​

108
Q

Heart Failure - Nursing Management​

Monitor Vital Signs (hourly)​
Urinary Output (hourly)​
O2 Supplement ​
Daily Weight (fluid status)​
Strict I/O’s ​
High Fowler’s​
BIPAP or Mechanical Ventilation​
Hemodynamic Monitoring ​
Ultrafiltration​
IABP (Intraaortic balloon pump)​
VAD (ventricular assist device)​
Surgical Implant, used for pts waiting for heart transplant​

A
108
Q

HF caused by interference w/ normal mechanism regulating ____________

A

cardiac output

109
Q

Heart Failure​ - Clinical Manifestations​

​

_________ Edema (eventually respiratory failure)​

____________ (difficulty breathing when lying down)​

Crackles and Wheezes​

_________ with frothy, blood tinged sputum (blood and fluid going into lungs)​

_______ (Fatigue, Limitation of Act., Chest Congestion, Edema, SOB) ​

Weight _______ (fluid retention)​

Chest Pain (Lack of O2 in Cardiac Muscle) ​

Anxious, Pale, Cyanotic, Cool and Clammy Skin​

Hypotension and Hypertension​

Abnormal S3 or S4​

Tachypnea (not getting enough O2) ​

​

A

Pulmonary Edema (eventually respiratory failure)​

Orthopnea (difficulty breathing when lying down)​

Crackles and Wheezes​

Cough with frothy, blood tinged sputum (blood and fluid going into lungs)​

FACES (Fatigue, Limitation of Act., Chest Congestion, Edema, SOB) ​

Weight Gain (fluid retention)​

Chest Pain (Lack of O2 in Cardiac Muscle) ​

Anxious, Pale, Cyanotic, Cool and Clammy Skin​

Hypotension and Hypertension​

Abnormal S3 or S4​

Tachypnea (not getting enough O2) ​

110
Q

CO regulated by preload, afterload, contractility -> Any changes in these factors can lead to ______________

A

heart failure

111
Q

Low Perfusion activates RAAS​

_____________ of blood vessels​

Activates _____​

​

A

Low Perfusion activates RAAS​

Vasoconstriction of blood vessels​

Activates ADH​

112
Q

Sympathetic Nervous System​ - _______________ release to increase HR and BP

A

Catecholamines

113
Q

Heart Failure​ Precipitating Causes (increases the workload of the heart)​

Anemia, Infection, PE, Dysrhythmias, Hypervolemia​

A

Anemia, Infection, PE, Dysrhythmias, Hypervolemia​

114
Q

Wet or Dry, Cold or Warm used to Describe ______________ Failure​

A

Forward/Backward

115
Q

Wet: pulmonary congestion at rest (____________ effects) (orthopnea, JVD, Rales lung sound, S3 heart sound, edema)​

Cold: low persusion at rest (__________ effect) (low BP, narrow pulse pressure)​

Wet and Cold: EMERGENCY! Cardiogenic Shock​

A

Wet: pulmonary congestion at rest (backward effects) (orthopnea, JVD, Rales lung sound, S3 heart sound, edema)​

Cold: low persusion at rest (Forward effect) (low BP, narrow pulse pressure)​

Wet and Cold: EMERGENCY! Cardiogenic Shock​

116
Q

Warm and Dry: _________

A

Stable

117
Q

Nutritional Therapy​ for HF

Low Sodium Diet ​
-Individualize recommendations and consider cultural backgrounds​
-Avoid foods w/ Na levels > 400 mg/serving ​
-Recommend Dietary Approaches to Stop HTN (DASH Diet)​
-Sodium is usually restricted to __g/day​

______ Restriction​
-If required, <2L/day (if pts have HF and Renal Insufficiency)​
-Ice Chips, Gum, Hard Candy, Ice Pops to help with thirst​

A

Low Sodium Diet ​
-Individualize recommendations and consider cultural backgrounds​
-Avoid foods w/ Na levels > 400 mg/serving ​
-Recommend Dietary Approaches to Stop HTN (DASH Diet)​
-Sodium is usually restricted to 2 g/day​

Fluid Restriction​
-If required, <2L/day (if pts have HF and Renal Insufficiency)​
-Ice Chips, Gum, Hard Candy, Ice Pops to help with thirst​

118
Q

120/80: ________________

A

Systole/Diastole​

119
Q

Systole (__________): Max pressure heart exerts while beating​

Diastole (________): Peripheral arterial resistance​

A

Systole (Contract): Max pressure heart exerts while beating​

Diastole (Relax): Peripheral arterial resistance​

120
Q

Primary HTN vs Secondary HTN​

Primary: HTN ______________

Secondary: Elevated BP with specific cause that can be _____________

A

Primary: HTN w/o identified cause​

Secondary: Elevated BP with specific cause that can be corrected and identified

121
Q

Hypertension​ Risk Factors (similar to HF)​

Age​
ETOH/Smoking​
DM​
___________ Syndrome​
Obesity (sedentary)​
Race (____________)​
Stress ​
Excess ___________Intake​

A

Age​
ETOH/Smoking​
DM​
Metabolic Syndrome​
Obesity (sedentary)​
Race (African Americans)​
Stress ​
Excess Sodium Intake​

122
Q

Hypertension​ - Clinical Manifestations ​

“Silent Killer” (pts are often asymptomatic until it becomes severe enough to develop organ problems)​

Fatigue, Dizziness, Palpitations, Angina (Chest Pain) (high BP increases workload of the heart = not good with patients with HF), Dyspnea​

​

A

“Silent Killer” (pts are often asymptomatic until it becomes severe enough to develop organ problems)​

Fatigue, Dizziness, Palpitations, Angina (Chest Pain) (high BP increases workload of the heart = not good with patients with HF), Dyspnea​

123
Q

_________ brain area - Vision, visual info and Eyesite

A

Occipital

124
Q

_________ lobe (executive function)

Problem solving, concentration, reasoning, planning and organizing ​

Personality, behavior, mood and regulates emotions ​

A

Frontal

125
Q

Broca’s area: controls expressive speech ​

“broken” – can ___________ but speech is disjoined

A

understand

126
Q

Temporal lobe(“tempo”)

Somatic, visual and auditory ​

Wernicke’s receptive speech: speech ______________

A

comprehension

127
Q

Precentral gryus ​

________ cortex = voluntary movement ​

A

Motor

128
Q

Postcentral gryus ​

________________ = touch, pressure, temp and pain​

A

Proprioception

129
Q

________ AKA: cerebral vascular accident (CVA)

A

Stroke

130
Q

Stroke - inability of oxygen rich blood to reach the brain due to ___________________________ in a vessel​

A

blockage or bleeding

131
Q

Transient Ischemic Attack (TIA) ​ AKA

A

mini stroke

132
Q

Transient Ischemic Attack (TIA) ​

______ duration ​​
Blood flow __________ then spontaneously return​​
__________ sign for possible stroke to come

A

Short duration ​​
Blood flow disrupted then spontaneously return​​
Warning sign for possible stroke to come

132
Q

Ischemic Stroke ​- ____________ in vessel that supplies the brain with blood and oxygen ​

-decreased perfusion to a specific area of the brain​

A

Blood clot

133
Q

1 cause: aneurysm ​

Hemorrhagic Stroke ​- ________________________ in the brain causes bleeding to occur causing damage to the tissue ​

Other causes: trauma to head, uncontrolled HT, aging, BC ​

A

Broken blood vessel

134
Q

Ischemic Stroke ​- 3 types

_________: ​​
*Clot that forms somewhere in the body travels to the brain ​​

__________: ​​
*Clot forms in one of the arteries supplying blood to the brain ​​
​​
____________: ​​
*Cerebral ischemia of obscure or unknown origin ​​

A

Embolism: ​​
*Clot that forms somewhere in the body travels to the brain ​​

Thrombus: ​​
*Clot forms in one of the arteries supplying blood to the brain ​​
​​
Cryptogenic: ​​
*Cerebral ischemia of obscure or unknown origin ​​

135
Q

Stroke S&S include

Confusion​

Paralysis
​
Weakness​

Numbness​

Nausea & Vomiting

HA (specifically if hemorrhagic stroke)​

Receptive & Expressive Aphasia

Abnormal VS

A
136
Q

____ non contrast - ONLY way to differentiate hemorrhagic or ischemic stroke (can’t give clot buster if hemorrhagic**) ​

A

CT

137
Q

PAD- referring to disease with __________

PVD- broad term for _______________

A

PAD- referring to disease with just arteries ​​

PVD- broad term for any blood vessel (arteries, veins)​

138
Q

Progressive narrowing &/or degeneration of arteries in the upper & lower extremities is

A

PAD

139
Q

Raynaud’s Phenomenon ​- Discoloration of fingers/ toes after _____________________________________

A

exposure to changes in temps ​

140
Q

PAD (peripheral artery disease) ​S/S​

Intermittent Claudication- Pain STOPS when resting​​
Paresthesia- numbness, tingling in fingers/toes resulting from nerve tissue ischemia ​​
Causes loss of pressure & deep pain sensation, so pt may not notice an injury ​​
-Thin, shiny & taught skin ​​
-Hair loss to lower extremity ​​
-Diminished or absent pulses ​​
-Elevation pallor or reactive hyperemia (dependent rubor)- Leg Up & Down​​

A

Intermittent Claudication- Pain STOPS when resting​​
Paresthesia- numbness, tingling in fingers/toes resulting from nerve tissue ischemia ​​
Causes loss of pressure & deep pain sensation, so pt may not notice an injury ​​
-Thin, shiny & taught skin ​​
-Hair loss to lower extremity ​​
-Diminished or absent pulses ​​
-Elevation pallor or reactive hyperemia (dependent rubor)- Leg Up & Down

Nurs 136- MCA II (12 decks)

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