Week 5 - Cardiac Dysfunction, Rhythm Changes, Heart Failure, and Circulatory Problems Flashcards
1
Q
What is sinus bradycardia?
A
Heart rate < 60 bpm; linked to vagal tone and medications.
2
Q
Goal of therapy for acute heart failure?
A
Improve ventricular function by reducing volume and enhancing oxygenation.
3
Q
Devices for heart failure management?
A
Includes CRT-D, ICD, and ventricular assist devices.
4
Q
Managing physical activity in heart failure?
A
Activity as tolerated; avoid strain and monitor for complications.
5
Q
Significance of reducing anxiety in heart failure?
A
Improves comfort and may enhance heart function.
6
Q
Role of vasodilators in heart failure?
A
Reduce afterload, improving cardiac output.
7
Q
Goals for myocardial contractility?
A
Enhance contractility; decrease preload and afterload.
8
Q
Drugs enhancing myocardial contractility?
A
Nitrates, Loop Diuretics, ACE inhibitors, Beta Blockers.
9
Q
Modalities for complicated cardiomyopathy?
A
Ventricular assist device, surgery, heart transplant.
10
Q
Forms of nitrates?
A
Sublingual, oral, IV, transdermal, sprays.
11
Q
Common adverse effects of nitrates?
A
Headaches, dizziness, reflex tachycardia.
12
Q
Preventing nitrate tolerance?
A
Regular nitrate-free periods.
13
Q
Mechanism of nitroglycerin?
A
Causes vasodilation, improving coronary blood flow.
14
Q
Purpose of rapid-acting nitroglycerin?
A
Treat acute anginal attacks.
15
Q
Role of anticoagulants?
A
Prevent clot formation by inhibiting clotting factors.
16
Q
Anticoagulants vs. antiplatelets?
A
Anticoagulants inhibit clotting; antiplatelets inhibit aggregation.
17
Q
Significance of the clotting cascade?
A
Amplifies reactions leading to clot formation.
18
Q
Pathways in the clotting cascade?
A
Intrinsic and extrinsic pathways.
19
Q
Function of antiplatelet drugs?
A
Prevent platelet plugs; no effect on existing clots.
20
Q
Effect of nitrates on ischemic tissue?
A
Increases oxygen delivery.
21
Q
Instructions for transdermal nitrate patches?
A
Remove at bedtime; apply new patch in the morning.
22
Q
Consequences of an embolus in a coronary artery?
A
Causes myocardial infarction.
23
Q
Embolus obstructing a brain vessel?
A
Causes a stroke (CVA).
24
Q
Embolus effect on lungs?
A
Causes pulmonary embolus (PE).
25
Embolus in a leg vein?
Leads to deep vein thrombosis (DVT).
26
Define thromboembolic events.
Include MI, stroke, PE, and DVT.
27
Mechanism of action of warfarin?
Inhibits Vitamin K dependent clotting factors.
28
Antagonist for warfarin?
Phytonadione (Vitamin K).
29
Administration of unfractionated heparin?
Administered as an anticoagulant.
30
Lab values for warfarin monitoring?
Monitor INR and PT.
31
Therapeutic INR range?
2-3.5 seconds.
32
Risks of warfarin therapy?
High bleeding risk; monitor for signs.
33
Dosing frequency for warfarin?
Dosed daily.
34
Time to peak effect of warfarin?
About 4 hours.
35
Elimination half-life of warfarin?
3-5 days.
36
Common drug interactions with warfarin?
Includes various antibiotics.
37
Normal PT range without warfarin?
0.8-1.2 seconds.
38
Primary use of warfarin?
Prevent thromboembolic events.
39
INR's role in coagulability?
Standardizes PT results across methods.
40
Nursing management for anticoagulants?
Monitor bleeding, educate on fall risks.
41
What is DVT prophylaxis?
Preventive measures to reduce DVT risk.
42
Mechanism of action of tinzaparin?
Inhibits factor Xa and thrombin.
43
Indications for tinzaparin?
Prevention and treatment of DVT and PE.
44
Contraindications for tinzaparin?
Active bleeding and severe thrombocytopenia.
45
Common adverse effects of anticoagulants?
Internal and superficial bleeding.
46
Nursing management for tinzaparin?
Monitor for bleeding and check platelet counts.
47
Dosage determination for tinzaparin?
Based on weight and indication.
48
Anticipation for bleeding in IV heparin patients?
Hold heparin, check PTT, and prepare for endoscopy.
49
Significance of monitoring PTT levels?
Ensures therapeutic anticoagulant effect.
50
Most common adverse effect of anticoagulants?
Internal and superficial bleeding.
51
Instructions for subcutaneous tinzaparin?
Use a new, sterile needle.
52
Define Peripheral Artery Disease (PAD).
Thickening of artery walls, narrowing of extremities.
53
PAD symptoms in lower extremities?
Intermittent claudication, paresthesia, and coldness.
54
Leading cause of PAD?
Atherosclerosis related to inflammation.
55
Risk factors for PAD?
Tobacco use, diabetes, and hypertension.
56
Significance of intermittent claudication?
Indicates inadequate blood flow during activity.
57
Clinical features of PAD?
Intermittent claudication, coldness, and diminished pulse.
58
Atherosclerosis and PAD?
Leads to arterial wall thickening and narrowing.
59
Consequences of critical limb ischemia?
Rest pain, ulcers, and gangrene.
60
Condition of arterial wall thickening?
Peripheral Artery Disease (PAD).
61
Therapeutic approaches for PAD?
Antiplatelets, exercise, and surgery.
62
Diagnostic studies for PAD?
Doppler ultrasonography and angiography.
63
Complications of PAD?
Delayed healing and risk of amputation.
64
Risk factor modification in PAD?
Key to reducing disease progression.
65
Mechanism of acetylsalicylic acid (ASA)?
Acts as an antiplatelet and NSAID.
66
Indications for clopidogrel (Plavix)?
Prevention of blood clots.
67
Nursing management for ASA?
Monitor for adverse effects and interactions.
68
Adverse effects of clopidogrel?
Bleeding and gastrointestinal upset.
69
Importance of smoking cessation in PAD?
Improves blood flow and reduces symptoms.
70
Lifestyle modifications for right-sided heart failure?
Reduce sodium, maintain weight, and manage stress.
71
Role of captopril in heart failure?
ACE inhibitor that lowers blood pressure.
72
Monitoring adverse effects of hydrochlorothiazide?
Check for electrolyte imbalances and dehydration.
73
Reason for switching to diltiazem?
Calcium channel blocker for better blood pressure control.
74
Diltiazem's effect on hypertension?
Inhibits calcium entry, lowering blood pressure.
75
Explain need for medication with BP 140/72?
Consistent management prevents complications.
76
Adverse effects of diltiazem?
Dizziness, headache, and bradycardia.
77
ECG findings in sinus tachycardia?
Heart rate > 100 bpm, normal P waves.
78
Define heart failure (HF).
Inability to pump sufficient blood; contractility issues.
79
Clinical manifestations of heart failure?
Shortness of breath, fatigue, and edema.
80
Diagnostics for heart failure?
Echocardiography and chest X-ray.
81
Management strategies for heart failure?
Lifestyle changes and medications.
82
Complications of PAD?
Critical limb ischemia and gangrene.
83
Clinical manifestations of PAD?
Intermittent claudication and leg weakness.
84
Collaborative care for PAD?
Lifestyle changes and possible surgery.
85
Modifiable risk factors for hypertension?
Obesity, inactivity, and high salt intake.
86
Non-modifiable risk factors for hypertension?
Age, family history, and gender.
87
Target organs damaged by hypertension?
Heart, kidneys, eyes, and brain.
88
Complications of hypertension?
Heart attack and stroke.
89
Pharmacological classifications for hypertension?
Diuretics, ACE inhibitors, and beta-blockers.
90
Define dysrhythmias.
Abnormal cardiac rhythms needing assessment.
91
Importance of assessing dysrhythmias?
Critical for effective treatment.
92
Properties of cardiac cells?
Automaticity, excitability, conductivity, contractility.
93
Role of vagus nerve in heart rate?
Decreases heart rate and contractility.
94
Sympathetic nervous system effect on heart?
Increases heart rate and contractility.
95
Pathway of normal cardiac impulse?
SA node → AV node → bundle of His → Purkinje fibers.
96
Function of the SA node?
Natural pacemaker of the heart.
97
ECG waveforms and cardiac activity?
Reflect electrical impulses of the heart.
98
Effect of vagus nerve activation?
Slows heart rate by decreasing SA node firing.
99
Sequence of impulse transmission?
SA node → atrial myocardium → AV node → bundle of His.
100
Normal range for sinus rhythms?
60 to 100 beats per minute.
101
Define sinus bradycardia (SB).
Heart rate < 60 bpm with regular rhythm.
102
ECG presentation of sinus tachycardia (ST)?
Heart rate > 100 bpm, regular rhythm.
103
Causes of sinus bradycardia?
Decreased SA node firing and increased vagal tone.
104
Clinical significance of sinus bradycardia?
Decreased cardiac output and potential syncope.
105
Treatment for symptomatic sinus bradycardia?
Atropine and possible pacemaker.
106
Rules for sinus bradycardia?
Rate < 60 bpm, regular rhythm, normal P waves.
107
Causes of sinus tachycardia?
Increased SA node firing from various factors.
108
Clinical significance of sinus tachycardia?
Dizziness and potential myocardial ischemia.
109
Treatment for symptomatic sinus tachycardia?
Treat underlying cause and consider drug therapy.
110
ECG characteristics of normal sinus rhythm?
Heart rate 60-100 bpm, regular rhythm.
111
Normal sinus bradycardia in athletes?
Can occur in trained athletes and with certain maneuvers.
112
Complications from sinus tachycardia?
Angina due to increased myocardial oxygen demand.
113
Heart rate range for sinus tachycardia?
Greater than 100 beats per minute.
114
Common conditions leading to arrhythmias?
Heart failure and myocardial infarction.
115
Non-cardiac conditions causing arrhythmias?
Electrolyte imbalances and drug effects.
116
Dysrhythmias and treatment options?
Cause influences specific management strategies.
117
Priority assessments for bradycardia or tachycardia?
Vital signs and heart evaluation.
118
Define arrhythmias and causes.
Irregular heartbeats from various conditions.
119
Role of diagnostic tests in dysrhythmias?
Evaluate dysrhythmias and treatment effectiveness.
120
Lifestyle factors contributing to arrhythmias?
Alcohol and caffeine use.
121
Significance of electrolyte imbalances?
Can disrupt heart's electrical activity.
122
Impact of hypoxia on cardiac rhythm?
Can lead to arrhythmias due to impaired function.
123
Myocardial infarction and arrhythmias?
Can cause arrhythmias from heart muscle damage.
124
Heart failure and its impact?
Impaired pumping and filling, reduced quality of life.
125
Calculating cardiac output in heart failure?
CO = HR x SV.
126
Primary risk factors for heart failure?
Coronary artery disease and hypertension.
127
Define heart failure with reduced ejection fraction (HF-REF).
Inability to pump blood effectively.
128
HF-PEF vs. HF-REF?
HF-PEF is filling issue; HF-REF is pumping issue.
129
Heart failure prevalence in Canada?
1 in 5 over 40 will experience heart failure.
130
Diabetes mellitus and heart failure?
Type 2 diabetes linked to heart failure risk.
131
Heart failure of mixed origin?
Compounded systolic and diastolic dysfunction.
132
Common symptoms of heart failure?
Impaired exercise tolerance and pulmonary congestion.
133
Obesity's role in heart failure risk?
Increases strain on the heart.
134
Main types of heart failure?
HFrEF and HFpEF.
135
Define myocardial hypertrophy.
Enlargement of heart muscle, affecting function.
136
Decreased cardiac output and recovery?
Slowed recovery and symptoms like dyspnea.
137
Significance of valvular rigidity?
Causes turbulence and contributes to heart failure.
138
Arterial wall stiffness and blood pressure?
Prevents stretching, increasing blood pressure.
139
SDOH increasing diabetes risk in Indigenous populations?
Intergenerational trauma and food insecurity.
140
Diagnosing HFpEF?
Symptoms with EF ≥ 50%.
141
Normal ejection fraction range?
55% to 70%.
142
Characteristics of mixed heart failure?
Poor systolic function with filling issues.
143
Common causes of heart failure?
Hypertension and myocardial ischemia.
144
Heart failure and cardiovascular disease in older adults?
Leading cause of death in those 85+.
145
Systolic vs. diastolic heart failure?
Systolic: impaired pumping; diastolic: impaired filling.
146
HR, SV, and CO relationship?
CO = HR x SV.
147
Poor ejection fractions in heart failure?
Indicate severe heart failure and high pulmonary pressures.
148
Formula for calculating CO?
CO = HR x SV.
149
Compensatory mechanisms in heart failure?
Maintain CO through various adaptations.
150
SNS activation in heart failure?
Increases HR and contractility but worsens heart failure.
151
Neurohormonal response in heart failure?
RAAS activation increases blood pressure and contractility.
152
Ventricular dilation significance?
Adaptation to high pressures but decreases output over time.
153
Consequences of ventricular hypertrophy?
Poor contractility and risk for arrhythmias.
154
Counterregulatory mechanisms in heart failure?
Natriuretic peptides counteract heart failure effects.
155
Right-sided vs. left-sided heart failure?
Right: peripheral edema; left: pulmonary congestion.
156
Primary cause of right-sided heart failure?
Left-sided heart failure.
157
Left-sided heart failure and lungs?
Causes pulmonary congestion and edema.
158
Symptoms of acute decompensated heart failure?
Increased dyspnea and fatigue.
159
Skipping diuretic effects?
Fluid retention and worsening symptoms.
160
Define pulmonary edema?
Fluid in lungs, impairing gas exchange.
161
Vital signs indicating acute heart failure?
Elevated heart rate and blood pressure.
162
Fluid movement in pulmonary edema?
Increased pressure pushes fluid into alveoli.
163
Physical findings in pulmonary edema?
Tachypnea and respiratory distress.
164
Decreased CO and nocturia relationship?
Fluid shifts at night increase urination.
165
Behavioral changes in heart failure?
Depression and confusion.
166
Chronic edema skin changes?
Dusky coloration and shiny skin.
167
Early and later signs of pulmonary edema?
Increased respiratory rate and tachypnea.
168
Clinical manifestations of right-sided heart failure?
Peripheral edema and weight gain.
169
Left-sided heart failure clinical presentation?
Pulmonary edema and dyspnea.
170
Sudden weight gain significance in heart failure?
Indicates exacerbation of heart failure.
171
Behavioral changes in heart failure?
Restlessness and confusion.
172
Skin changes indicating heart failure?
Dusky and cool skin with pigmentation changes.
173
Respiratory symptoms in heart failure?
Dyspnea and pulmonary edema.
174
Signs of fluid retention in heart failure?
Peripheral edema and ascites.
175
Heart failure effects on heart rate?
Increased heart rate and pulsus alternans.
176
Gastrointestinal symptoms in heart failure?
Anorexia and nausea.
177
Crackles and heart sounds in heart failure?
Indicate pulmonary congestion and fluid overload.
178
Heart failure impact on nocturnal symptoms?
Leads to nocturia and breathing difficulties at night.
179
Heart failure and renal function relationship?
Can lead to renal failure and fluid retention.
180
Importance of monitoring chest pain in heart failure?
Indicates underlying cardiac issues.
181
Potential weight changes in heart failure?
Weight gain due to fluid retention.
182
Complications of heart failure?
Pleural effusion and arrhythmias.
183
Disorganized rhythms and stroke risk?
Increase thrombus formation risk.
184
Treatments for arrhythmias in heart failure?
Rate control and antiarrhythmic medications.
185
Primary goal in diagnosing heart failure?
Determine underlying etiology.
186
Diagnostic orders for suspected heart failure?
Chest X-ray and ECG.
187
Echocardiography in heart failure diagnosis?
Assesses function and measures ejection fraction.
188
Significance of measuring ejection fraction?
Differentiates HFrEF from HFpEF.
189
Laboratory data in heart failure assessment?
Cardiac enzymes and BNP levels.
190
History and physical exam in heart failure diagnosis?
Identify causes and severity.
191
Cardiac catheterization in heart failure diagnosis?
Provides hemodynamic assessment.
192
Loop diuretics in acute heart failure?
Decrease volume and improve function.
193
Morphine in heart failure management?
Reduces preload and improves oxygenation.
194
Define preload in heart failure?
Volume of blood returning to the heart.
195
Dietary recommendations for chronic heart failure?
Low sodium and limit saturated fats.
196
Importance of daily weight monitoring?
Detects worsening heart failure symptoms.
197
Oxygen therapy in heart failure?
Indicated when SpO2 < 90%.
198
Pharmacological treatments for chronic heart failure?
Includes diuretics and ACE inhibitors.
199
Purpose of inotropic drugs in heart failure?
Enhance contractility and improve output.
