Week 4 - Heart Flashcards
Cardiac output - amount of __________________________________
blood pumped by each ventricle in one minute
Stroke volume - amount of blood ___________________________ during each systolic cardiac contraction
ejected out of the heart’s left ventricle
cardiac output = ______ x _______
stroke volume x heart rate
Afterload -
resistance
[work to eject volume of ventricle]
_________ is a common med for heart failure (to increase contractility)
Digoxin
Ejection fraction normal range
55-70%
Heart failure - complex clinical syndrome resulting in ________________________________________ to tissues and organs
Heart failure - complex clinical syndrome resulting in insufficient blood supply / oxygen to tissues and organs
Heart failure risk factors
Hypertension
Coronary artery disease
DM
Metabolic syndrome
HTN
CAD
DM
Metabolic syndrome
Types of heart failure
HFrEF
HFpEF
ADHF
HFrEF [impaired systolic function]
HFpEF [impaired diastolic function]
ADHF
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
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
Heart failure Dx
Echocardiagram
EKG
Chest x-ray
BNP
Echocardiagram
EKG
Chest x-ray
BNP
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
VS
Rhythm
Urine output
O2 supplement
Strict I&O
daily weight
high fowler’s
BIPAP/ MV
Hemodynamic monitoring
Ultrafiltration
IABP
LVAD
Pt teaching
Heart failure complications
_________ effusion
Dysrhthmia
left ventricular _________
hepatomegaly
________ failure
Pleural effusion
Dysrhthmia
left ventricular thrombus
hepatomegaly
renal failure
Classifications of HF
Drug therapy for HF- Diuretics
Decrease volume _________ (preload)
Loop diuretics Furosemide (_______)
Decrease volume overload (preload)
Loop diuretics Furosemide (Lasix)
Drug therapy for HF- Vasodilators
_________ circulating blood volume and improve cornary artery __________
IV nitroglycerin
Sodium nitroprusside
Nesiritide (natrecor)
Reduce circulating blood volume and improve cornary artery circulation
IV nitroglycerin
Sodium nitroprusside
Nesiritide (natrecor)
Drug therapy for HF- Morphine
Reduces _________ & _________
Relieves dyspnea and anxiety
Reduces preload and afterload
Relieves dyspnea and anxiety
Drug therapy for HF- Positive inotropes
______ agonists (dopamine, dobutamine, norephinephrine (Levophed)
Phosphodiesterase inhibitor (milrinone)
Digtalis
Beta agonists (dopamine, dobutamine, norephinephrine (Levophed)
Phosphodiesterase inhibitor (milrinone)
Digtalis
Drug therapy for HF- RAAS inhibitors - reduce BP
ACE inhibitors
Angtiotensin II receptor blockers
Aldosterone antagonists
ACE inhibitors
Angtiotensin II receptor blockers
Aldosterone antagonists
Drug therapy for HF- Beta-blockers
____________ (lopressor)
Metroprolol (lopressor)
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
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
Ischemic stroke- thrombotic or embolic
blood supply to part of the brain is blocked or reduced
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.
Hemorrhagic stroke- -ruptured ________ __________
blood vessel
TIA- transient episode of _____________________ w/out acute infarction of brain
Transient ischemic attack
neurologic dysfunction
Stroke risk factors
Non-modifiable VS modifiable
Non-modifiable
-Age, gender, race, family Hx
Modifiable:
-HTN, Afib, smoking, sleep apnea, metabolic syndrome, illicit drugs
Stroke S&S
BEFAST - ???
Weakness/paralysis, receptive & expressive aphasia, numbness, cobfusion, vision problem, slurred speech, dysphagia, N & V, HA, abnormal VS
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.
Stroke Dx
FSBG
Labs
CT
CTA
MRI
FSBG
Labs
CT
CTA
MRI
Stroke NM
Stroke process
VS
EKG
NPO
NIH
_________ test
Neuro
ER> ICU> Rehab
Stroke process
VS
EKG
NPO
NIH
Swallowing test
Neuro
ER> ICU> Rehab
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
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
Acute decompensated heart failure (ADHF) is a sudden ____________________________________
worsening of the symptoms of heart failure
HTN - Primary VS secondary
Primary hypertension does not have a definitive cause, while secondary hypertension has a known cause
HTN risk factors
Age
Family Hx
ETOH
obesity
tobacco
DM
^ _______, _________, __________
Age
Family Hx
ETOH
obesity
tobacco
DM
^ Na, ^ Lipids, ^ stress
HTN S&S
“___________”
fatigue, dizziness
palpitations, angina
Dyspnea
“silent killer”
fatigue, dizziness
palpitations, angina
Dyspnea
HTN dx
BP
Labs
EKG
UA
Echo
BP
Labs
EKG
UA
Echo
HTN NM
_________ reduction
_________ eating plan
Reduce __________
Moderation of alcohol
Physical activity
avoid tobacco
Drug Tx, Pt teaching
Weight reduction
DASH eating plan
Reduce sodium
Moderation of alcohol
Physical activity
avoid tobacco
Drug Tx, Pt teaching
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%
Hypertensive urgency- BP over _____ ______
Hypertensive emergency- BP over 180/120 w/ _______ _________
tx: IV sodium nitroprusside
>decreases BP 20-25%
Peripheral artery disease (PAD) involves progressive narrowing and _____________________________ of upper and lower extremities
degeneration of arteries
Peripheral artery disease (PAD) risk factors
Age
DM
Tobacco
Obesity
^ ________
Age
DM
Tobacco
Obesity
^ Lipids
Peripheral artery disease (PAD) dx
Doppler Ultrasound
ABI [anckle brachial index BP test]
MRI
Doppler US
ABI
MRI
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)
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)
Peripheral artery disease (PAD) NM
____________ assessment
__________ cessation
Pt teaching
_______ inhibitors
Antiplatelets
Pletal
Trental
Monitor for complications
Circulatory assessment
tobcco cessation
Pt teaching
Ace inhibitors
Antiplatelets
Pletal
Trental
Monitor for complications
Right sided HF Sx:
Peripheral ______
____________
____________
Peripheral edema
Splenamegaly
Hepatomegaly
_________ disease is AKA thromboangiitis obliterans
Buerger’s
Buerger’s disease - nonathertosclerotic, segmental, recurrent ___________________________________________________ of arms and legs
inflammatory disorder of the small and medium arteries and veins
Buerger’s disease etiology & dx
unknown, but usually young men with long history of _________________ use without other CVD risk factors
NO diagnosis tests
unknown, but usually young men with long history of tobacco/marijuana use without other CVD risk factors
NO diagnosis tests
Buerger’s disease S&S
Intermittent claudication
rest pain
ulceration
color and temp changes
paresthesia
superficial vein thrombosis
cold sensitivty
Intermittent __________
rest pain
ulceration
color and temp changes
paresthesia
superficial vein thrombosis
______ sensitivty
Buerger’s disease NM
_________ cessation
___________
tobacco cessation
amputation
Raynaud’s phenomenon - episodic ____________ ____________of small cutaneous arteries - involves fingers & toes
vasospastic disorder
Raynaud’s phenomenon etiology
isolation
__________ disorder
scleroderma
lupus
_________ machinery
______ environments
heavy ________, high homocysteine levels
isolation
thyroid disorder
scleroderma
lupus
vibrating machinery
cold environments
heavy metal, high homocysteine levels
Raynaud’s phenomenon Dx
persistent sx x ___ _______
2 years
Raynaud’s phenomenon S&S
__________ induced color changes (_______________) of fingers or toes
Vasospasm induced color changes (white, blue, red) of fingers or toes
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)
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)
__________ is shortness of breath when lying down
Orthopnea
Heart failure mnemonic FACES
Fatigue, Activites limitation, Chest congestion/cough, Edema, Shortness of breath
Hypertension is frequently __________ until it becomes very severe
asyomptomatic
Hypertensive crisis tx: IV __________ ____________
>decreases BP 20-25%
sodium nitroprusside
Primary purpose of heart: to _____________ and drive hemoglobin to cells
pump blood
S1 heart sound - ___________________ valve closure
mitral and tricuspid
S2 heart sound - closure of the semilunar (_________________) valves
aortic and pulmonary
Normal cardiac output
4-8 L/Min
Normal stroke volume
60-120 mL/Beat
3 factors that determine stroke volume
preload
afterload
contractility
preload = amount of sarcomere stretch by cardiac muscle cells at the end of ventricular filling during diastole.
~related to ________________________
ventricular filling.
To increase pre-load:
give fluids
To decrease pre-load:
Diuretics
Vasodilators/ anti-hypertensives
-Nitroglycerin
-Morphine
-Any meds that decrease BP
Why is EF not 100% ?
The heart never empties itself
Digoxin will increase
contractility of heart
2 major risk factors for Heart Failure
Hypertension
Coronary artery disease
[also Diabetes Mellitus & Metabolic syndromes]
Metabolic syndrome - risk factor for heart failure
These include
Obesity
Hypertension
High lipids
High sugar
HFpEF VS HFrEF
HFpEF - diastrolic failure
HFrEF - systolic failure
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)
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.
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
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.
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
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.
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
Cough
ACE inhibitors can cause a dry, persistent cough due to increased bradykinin levels.
Jugular Vein Distention (JVD) is a sign of ____________
right sided HF
ACE inhibitors can cause a ___________________ due to increased bradykinin levels.
dry, persistent cough
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
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
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”
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.
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
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.
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.
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.
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.”
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.
Cramping that is precipitated by a consistent level of exercise is descriptive of _________________________
intermittent claudication.
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).
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
EF of HFpEF VS HFrEF
HFpEF - 50%
HFrEF - under 45%
Vasodilators - contraindicated with:
viagra
[both are vasodilators so BP will lower too much]
With _____ , it is reversible deficit lasting under 24 hours
With stroke, symptoms last over 24 hours and do not resolve without intervention
TIA
tPA and TNK are IV _____________ - “clot-busting” drugs that break up and dissolve blood clots that get in the way of your blood flow
thromolytics
tPA and TNK are only given in
the ED
________________________ 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.
Permissive hypertension
DASH diet for HTN
Dietary approaches to stop HTN
Fruits, veg, fat free, low fat dairy, whole grains, fish, poultry, beans, seeds/nuts
Side effect of all BP meds
Orthostatic hypotension
You do not want to drastically drop BP because you may ______________ the brain
under perfuse
Brain is used to high BP
Make sure to educate pts on calcium channel blockers - AVOID taking with
grapefruit juice
Grapefruit juice enhances absorption of ____________________, which can lead toxicity
calcium channel blockers
PAD - symptoms begin when blood vessels are ________ % blocked
60-75
Intermitten claudication is due to build up of __________ from anaerobic metabolism
lactic acid
Lack of __________ with PAD leads to tingling, thin skin, pallor, reactive hyperemia
blood flow
For Buerger’s Disease, the pt must choose between keeping them affected limb or stopping ____________________
all tobacco/marijuana use
NIH stroke scale
(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
Formula for cardiac output
CO = SV x HR
_____________ : amount of blood pumped by each ventricle
Cardiac output
HR: count by checking _________
pulses
Normal CO
4-8 L/Min
___________________: volume of blood ejected w/ each heart beat (normal: 60-120 mL/beat)
Stroke Volume
Normal stroke volume range
60-120 mL/beat
Valve Function: continue unidirectional flow to ________________________________________________
prevent blood from moving back and forth
s1 VS s2
Lub-Dub
s1 tricuspid and mitral valve closing [AV valves]
s2 pulmonic and aortic valves closing [Semilunar valves]
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)
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)
Preload: amt of blood in the ventricles at ________________
the end of diastole
Afterload: __________ the heart must overcome to eject blood into the systemic circulation during systole
resistance
Contractility: ability of myocardium to contract (ability of the heart to ________)
squeeze
Ejection Fraction
Normal: ________%
Heart Failure: <___% (can go as low as 5-10%)
Normal: 55-70%
Heart Failure: <45% (can go as low as 5-10%)
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
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
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%
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%
Heart Failure Risk Factors
HTN
CAD
DM
Metabolic Syndrome
Other Factors: Tobacco, Advanced Age, Vascular Disease
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
HF caused by interference w/ normal mechanism regulating ____________
cardiac output
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)
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)
CO regulated by preload, afterload, contractility -> Any changes in these factors can lead to ______________
heart failure
Low Perfusion activates RAAS
_____________ of blood vessels
Activates _____
Low Perfusion activates RAAS
Vasoconstriction of blood vessels
Activates ADH
Sympathetic Nervous System - _______________ release to increase HR and BP
Catecholamines
Heart Failure Precipitating Causes (increases the workload of the heart)
Anemia, Infection, PE, Dysrhythmias, Hypervolemia
Anemia, Infection, PE, Dysrhythmias, Hypervolemia
Wet or Dry, Cold or Warm used to Describe ______________ Failure
Forward/Backward
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
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
Warm and Dry: _________
Stable
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
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
120/80: ________________
Systole/Diastole
Systole (__________): Max pressure heart exerts while beating
Diastole (________): Peripheral arterial resistance
Systole (Contract): Max pressure heart exerts while beating
Diastole (Relax): Peripheral arterial resistance
Primary HTN vs Secondary HTN
Primary: HTN ______________
Secondary: Elevated BP with specific cause that can be _____________
Primary: HTN w/o identified cause
Secondary: Elevated BP with specific cause that can be corrected and identified
Hypertension Risk Factors (similar to HF)
Age
ETOH/Smoking
DM
___________ Syndrome
Obesity (sedentary)
Race (____________)
Stress
Excess ___________Intake
Age
ETOH/Smoking
DM
Metabolic Syndrome
Obesity (sedentary)
Race (African Americans)
Stress
Excess Sodium Intake
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
“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
_________ brain area - Vision, visual info and Eyesite
Occipital
_________ lobe (executive function)
Problem solving, concentration, reasoning, planning and organizing
Personality, behavior, mood and regulates emotions
Frontal
Broca’s area: controls expressive speech
“broken” – can ___________ but speech is disjoined
understand
Temporal lobe(“tempo”)
Somatic, visual and auditory
Wernicke’s receptive speech: speech ______________
comprehension
Precentral gryus
________ cortex = voluntary movement
Motor
Postcentral gryus
________________ = touch, pressure, temp and pain
Proprioception
________ AKA: cerebral vascular accident (CVA)
Stroke
Stroke - inability of oxygen rich blood to reach the brain due to ___________________________ in a vessel
blockage or bleeding
Transient Ischemic Attack (TIA) AKA
mini stroke
Transient Ischemic Attack (TIA)
______ duration
Blood flow __________ then spontaneously return
__________ sign for possible stroke to come
Short duration
Blood flow disrupted then spontaneously return
Warning sign for possible stroke to come
Ischemic Stroke - ____________ in vessel that supplies the brain with blood and oxygen
-decreased perfusion to a specific area of the brain
Blood clot
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
Broken blood vessel
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
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
Stroke S&S include
Confusion
Paralysis
Weakness
Numbness
Nausea & Vomiting
HA (specifically if hemorrhagic stroke)
Receptive & Expressive Aphasia
Abnormal VS
____ non contrast - ONLY way to differentiate hemorrhagic or ischemic stroke (can’t give clot buster if hemorrhagic**)
CT
PAD- referring to disease with __________
PVD- broad term for _______________
PAD- referring to disease with just arteries
PVD- broad term for any blood vessel (arteries, veins)
Progressive narrowing &/or degeneration of arteries in the upper & lower extremities is
PAD
Raynaud’s Phenomenon - Discoloration of fingers/ toes after _____________________________________
exposure to changes in temps
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
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
