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Foundations: Exam 2 > Week 5: Cardiovascular System > Flashcards

Week 5: Cardiovascular System Flashcards

1
Q

Heart disease

A

Disease that affects the heart’s structure and function (heart’s vessels, valves, and muscles)

Co-morbidities: MI, CAD, PAD, CHF, HTN, aneurysm, congenital heart disease, stroke, arrhythmia, cardiac arrest, atherosclerosis

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2
Q

Cardiovascular disease

A

Diseases that involve the heart AND circulatory system (blood vessels)

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3
Q

Lifestyle and risk factors

A

Lifestyle: Unhealthy diet/poor nutrition, lack of exercise, obesity, smoking, drug abuse, excessive alcohol use, uncontrolled stress/anger

Risk factors: Age, sex, race, hypercholesterolemia, DM, HTN, FHX

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4
Q

S/S

A

CHF: SOB, fatigue, weakness, B/L extremity edema, weight gain, tachycardia, dysrhythmia, persistent cough/wheezing

Arrhythmia: Fluttering in chest, tachy/bradycardia, angina, SOB, dizziness, fainting

Stroke: Numbness, difficulties with balance, speech and understanding, blurred vision, facial drooping, dysphagia, change in LOC

MI: Angina, numbness/pain in left arm, jaw or back

Cardiac arrest: Can occur without warning (CPR, AED, 911)

HTN: HA, fatigue, vision problems, angina, dyspnea, dysrhythmia

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5
Q

Cardiac drugs

A

Cardiac glycosides (increase cardiac contractility, decrease HR)

Antihypertensives (decrease BP)

Vasopressors/ADH (increase BP)

Antiarrythmics (regulate heart rhythm)

Nitrates (relieve angina)

Antilipids (decrease cholesterol levels)

Diuretics (reduce fluid volume; decrease BP)

Anticoagulants (decrease potential for clot formation)

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6
Q

Cardiac tests/treatments

A

EKG

Telemetry

Duplex ultrasound

Angiogram

Percutaneous Transluminal Coronary Angioplasty (PTCA)

Coronary artery stent

Stress test

Echocardiogram

CABG

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7
Q

EKG electrode placement

A 
Precordial leads:
V1: 4th ICS, right of sternum
V2: 4th ICS, left of sternum
*V3: between V2 and V4
V4: 5th ICS, midclavicular
*V5: between V4 and V5
V6: 5th ICS, midaxillary

Limb leads (4 total): paced bilaterally on extremities

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8
Q

Basic cardiac rhythm

A

Normal sinus rhythm (60-100 bpm):
P-wave: atrial depolarization

QRS complex: ventricular depolarization

ST segment: complete ventricular depolarization

T-wave: ventricular repolarization

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9
Q

EKG

A

A 12-view snapshot that requires 6 precordial and 4 limb electrodes

Paper grid:
Small square (1 mm.) = 0.04 sec.

Large square (5 mm.) = 0.2 sec. (five small squares)

Five large squares = 1 sec.

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10
Q

Telemetry

A

Continuous monitoring that requires 5 electrodes (RA, RL, V1, LA, LL)

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11
Q

Nursing intervention

A

EKG (10 view snapshot)

Telemetry (monitors continuous rhythm)

Assist with leg exercises, positioning, SCDs/TEDS

Medicate: Anticoagulation prophylaxis (clot prevention; heparin SQ 5,000 units bid/tid and is generally 1cc), diuretics, I&O

Assessment

Education

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12
Q

Duplex ultrasound test

A

Combines traditional ultrasound (solid objects) and doppler (moving objects) to see how blood moves through arteries and veins

No preparation (NPO, etc.) is needed

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13
Q

Angiography/angiogram

A

Use of radiopaque dye to outline vessels for blockage or narrowing

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14
Q

Percutaneous Transluminal Coronary Angioplasty (PTCA)

A

Minimally invasive procedure, monitored with fluoroscopy, to open blocked coronary arteries; catheter is placed intravenously, in neck, arm or groin

Ballon catheter tip inflates/deflates to compress blockage; possible stent placement

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15
Q

Coronary artery stent

A

Placed with balloon catheter; locks in position when inflated

Post-op.: Monitor for dysrhythmias, administer anticoagulant meds.

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16
Q

Return from angiography/PTCA

A

Check peripheral pulses and VS

Assess pain

Assess bleeding or hematoma formation at insertion; if bleeding, apply pressure dressing and NHO

Maintain pressure dressing, immobilize limb for 6 hr.

Monitor for urination (Normal: within 6 hr.; dye can affect kidneys)

Administer fluids, I&O

Document

17
Q

CABG

A

Using another vessel to bypass a blocked or damaged coronary artery

Vessels:
1. Left Internal Mammary Artery (LIMA): preferred vessel for CABG (it is a “live vessel” that is moved over)

  1. Left Anterior Descending (LAD) coronary artery (“widow maker”; common place for coronary blockages)
  2. Greater saphenous vein: less ideal for CABG (can handle less pressure, has valves, and needs to be removed)
18
Q

Stress test

A

Connected to EKG/telemetry rhythm strip to record continuous CV responsiveness to increased activity

19
Q

Echocardiogram

A

Uses ultrasonic waves to detect structural defects

Can be done at bedside

20
Q

DNR/DNI/MOLST

A

DNR: do not resuscitate

DNI: do not intubate

MOLST: Maryland Order for Life-Sustaining Treatment

21
Q

Peripheral Intravascular device (PIV)

A

Short-term peripheral device inserted by nurses/techs

Also called “medlock”/”heplock”/”salinelock”

22
Q

Multi-lumen CVAD

A

SHORT-term CVAD, placed at bedside, into the internal jugular and terminates into the SVC, above the RA; confirmed by XRAY before use

Risk for pneumothorax or air embolism

Requires each lumen (single/dual/triple) to be flushed individually to prevent mixing and crystallization of incompatible meds (lumens empty in different places)

23
Q

Hickman

A

LONG-term tunneled CVAD (“tunnels” under the skin through subcutaneous tissue), placed in the OR, that terminates into the SVC, above the RA; confirmed by XRAY before use

Dacron sheath: skin tissue creates an anchor and protective barrier

Infuses fluids, meds., draw blood, transfusions

24
Q

Peripherally Inserted Central Catheter (PICC)

A

LONG-term CVAD, small in diameter and placed at bedside; inserted in a peripheral vein and terminates in the subclavian or SVC

Inserted using ultrasound; confirmed by XRAY

Fewer chances for complications (pneumothorax, air embolus) because it is started in the arm

25
Q

Mediport

A

LONG-term CVAD, placed in the OR, that terminates in the SVC, above the RA

Self-sealing port; in the subcutaneous tissue

Huber needle: non-coring, 90-degree angle needle used to accesses mediport

26
Q

Code blue team

A

First responder

Bedside nurse

Charge nurse

Team/code leader (physician)

Recorder (time of compression/meds./etc.; records legal document)

Runner

Respiratory/anesthesia (manage airway/intubation)

Code cart nurse

Nursing supervisor

Security

27
Q

Rapid Response Team (RRT)

A

Alert criteria:
1. HR <45 or >130

  1. RR <8 or >30
  2. SBP <85 or >200
  3. O2 sat. <90% (despite >60% FiO2)
  4. Significant mental status change, especially persistent lethargy or unresponsiveness
  5. New seizure or prolonged seizure with apnea
  6. General concern about the pt (“something is not right”)
28
Q

Automated External Defibrillator (AED)

A

Can self diagnose life-threatening cardiac arrhythmias and deliver an electrical shock as needed

29
Q

Crash cart

A

Emergency meds

Defibrillator

Blood drawing supplies

Central line kit

Backboard

Laryngoscope

Oropharyngeal airway

30
Q

Ventricular dysrhythmias

A

Life-threatening conditions d/t MI, scarring, cardiomyopathy, etc.

Caused by:

  1. Abnormal stimulation of ectopic foci in walls of ventricles
  2. Decreased CO
  3. Intrinsic ventricular rate (without atrial depolarization) is only 20-40 bpm

*Atrial dysrhythmias can be managed with medication

31
Q

Premature Ventricular Contraction (PVC)

A

Extra heartbeats that begin in the ventricles and DISRUPTS regular heart rhythm; S/S: Fluttering, skipped beat in chest

It is a beat, NOT a rhythm

Caused by: Drinking coffee, stress; concerning if frequent, in groups

32
Q

Ventricular tachycardia

A

Foci in ventricles take over and heart beats too fast to count

Dangerous, life-threatening complication

Treatment: Cardioversion, CPR (code team); long-term: antiarrhythmic drugs, ICD

33
Q

Ventricular fibrillation

A

Rapid, CHAOTIC depolarization of ventricles; no coordination of ventricular and atrial contractions (no palpable pulse)

Treatment: Defibrillation, CPR; long-term: ICD

34
Q

Pulseless electrical activity (PEA)

A

Electrical activity is present, but NO muscular contraction

There is no pulse, no CO, and no tissue perfusion (death); it is non-shockable

Treatment: CPR to establish a viable, shockable rhythm

35
Q

Asystole

A

No electrical activity, no pulse

Immediate loss of oxygen supply to brain, heart, and tissue; it is non-shockable

Treatment: CPR, drugs

36
Q

Holter monitor

A

Records activity of heart in daily activities; worn for 1-3 days

37
Q

Pacemaker

A

Used to augment or replace the natural pacemaker of the heart; causes “pacemaker spike” on EKG

Can be used for bradycardia/tachycardia, damage to heart from MI, CHF

38
Q

Implantable Cardioverter Defibrillator (ICD)

A

Delivers shock to treat ventricular tachycardia and ventricular fibrillation

Shock feels like a “kick in the chest”; another person touching will feel shock

Foundations: Exam 2 (3 decks)

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