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Ch 210 Cardiac
Ch. 29-32
| Question | Answer |
|---|---|
| Mitral Valve Prolapse | few s/s except "mitral click", mitral valve leaflets balloon back into the atrium |
| Medical Mgmt for Mitral Valve Prolapse | eliminate caffeine/alcohol/smoking |
| Nsg Mgmt for Mitral Valve Prolapse | inherited, risk for endocarditis, no surgical tx |
| Mitral Regurgitation | blood flowing back into L atrium causing hypertrophy |
| S/S mitral regurgitation | high pitched systolic murmur blowing snd, dyspnea, fatigue, cough, crackles, S3, S4 |
| Medical mgmt for Mitral regurgitation | rest, low Na diet, lasix, nitrate, ACE inhibitors, ARBs, beta blockers |
| Mitral Stenosis | obstruction of blood flowing from L atrium to L vent caused by rheumatic endocarditis. Back up to R vent causing strain. Low pitch diastolic murmur |
| What heart dysrhythmia does most stenosis cause | Atrial fibrillation cause strain on atrium |
| Aortic regurgitation | back flow into L vent from aorta. hypertrophy of L vent so incr sys BP, |
| s/s aortic regurgitation or L vent failure | orthopnea, breathing issues, high pitched diat murmur, PP widens, |
| Medical mgmt for aortic regurgitation | rest, CCB, ACE inhibitors, hydralazine |
| Aortic Stenosis | narrowing bn L vent and aorta amniodarone- beta blocker |
| Valvuloplasty(repair) Closed/open commissurotomy annuloplasty chordoplasty | closed-break stuck valve open- open heart surgery annul: ring, leaflet repair chor: tighten chordae tendinaea |
| Xenografts homografts autografts | xeno: pig, no clots(no coumadin needed), >70y and women of childbearing age bc no coumadin homo: cadaver, throw clots auto: self, no clots |
| nsg mgmt for grafts | VS, INR want to b 2-3.5, if >4 not give. This is above norm of 2-3 x normal of 1 |
| Mechanical Valve replacements are going to need what med 4ever? | coumadin cause mechanical not as smooth. Also BP will change with new valve, so educate on new meds |
| cardiomyopathies(heart muscle prob) | dilated: enlarged vent area, less muslce to pump: HF hypertrophic: overgrowth in septum, vent can't fill, decr CO, avoide dehydration restrictive: rigid vent walls, stiff muscles |
| Med mgmt for dilated cardiomyopathy? hypertrophic? | dil: dig, vasodilators, diuretic, decr Na diet, sit up/legs dangle hyper: beta blockers(to maintain CO), rest, CCB(relax so can squeeze more) |
| What drug helps body not reject transplant? | cyclosporine |
| Orthotopic transplantation? Heterotopic? VAD? | cut off bottom and attach donor to bottom half. Het: new heart parallel to old Vad: vent assisted device, pt must gradaully incr excercise bc no nerve |
| Infective Endocarditis is occuring where? and caused by? | inner lining cause: strep, rheumatic heart dis, staff after valve replacement, IV drug users Pt at risk for repeat, so prophylaxis at dentist |
| s/s of infective endocarditis | fever, heart murmur, chills, malaise, wt. loss, Roth's spots(eye), Osler nodes(fingers), splinger hemm(fingernails) |
| nsg mgmt | get three sets of blood cultures, need rest wtih ADL's, watch for emboli, oral hygiene |
| Myocarditis | cause: radiation, lead poison/lithium/cocaine/HIV s/s: flulike Nsg: sensitive to dig toxicity/use PAS hose |
| s/s of dig toxicity: | Dig: Incr squeeze, lower HR dysrhythmias, anorexia, HA, N/V, green/yellow halo If pulse <60, don't give |
| Pericarditis | inf in sac around the heart, sac strangles heart so can't pump or fill s/s: friction rub, tamponade, chest pain tx: sit up and lean forward |
| Rheumatic Endocarditis | due throat culture for strep nsg: finish antibiotics |
| Cardiac Tamponade | s/s: decr BP cause heart can't pump, PP narrows, distant heart sounds, rising venous pressure, pulsus paradoxus(weak pulse on insp/strong-exp), friction rub(rest til gone) |
| preload | amt of blood presented to vent b4 systole determined by venous return to heart |
| what lowers preload | hypertrophic cardiomyopathy of vent, stiff fibrotic tiss after MI All these incr press and load on heart so lead to HF |
| afterload | amt of resistance to ejection of blood from vent overcoming resistance. Incr will decr SV cause vent work harder |
| What affects afterload | diameter/stretch of vessels and open/competence of lunar valves incr after: HTN, vasoconstriciton, stenosis..incr work of heart |
| contractility | force of contraction from condition of myocardium. Sympathetic stimulation incr and MI with damaged cells lower contractility. Lower afterload to lower contractility |
| Assess rt vent preload? L vent afterload? | R vent pre: measure jugular venous distention(JVD) L vent after: MAP |
| CHF-congested Heart Failure? | fluid overload/not tissue perfusion so not enuf CO for body's needs, progressive |
| Two types: systolic heart failure? diastolic HF? | sys: squeeze failure, weak heart muscle, EF reduced diast: weak fill, stiff/ noncompliant heart muscle, EF normal Assess ejection fraction to determine which one it is |
| Understanding fluid vol overload in HF | decr EF from vent, SNS stim vasoconstiction, kidney perfusion decr due to low CO so renin tells angio I to make II to incr bp and afterload. II gets aldosterone released to save Na/H2O and ADH holds H2O so fluid overload |
| How overload stresses heart and cause diastolic HF | fluid overload incr afterload/preload so BNP/ANP released from overdistended chambers and promote vasodilation/diuresis. Contractility decr, incr vent filling and size, so thickens walls |
| Causes of HF | Cornoary art dis, cardiomyopathy, HTN, valvular disorders, renal disorders, |
| S/s L heart failure? R heart failure? | L: pulmonary congestion bc L atrium press incr, incr pulmonary press making pulmonary edema and impaired gas exchange s/s: dyspnea, cough, crackles, low O2, S3(lg vol of fluid enter vent beg of diast) |
| more s/s of L sided heart failure | PND: paroxysmal nocturnal dyspnea- fluid gathers at night so sit up. Pink frothy sputnum(pul edema), oligura(kidney reduce output cause low blood flow), |
| R sided heart failure s/s | dependent edema, hepatomegaly, ascites, wt gain |
| Diagnostic findings with HF | elevated BNP. Normal: <100 suggestive HF: 100-300 mild HF: >300 moderate HF: >600 severe HF: >900 |
| Pharm therapy for HF: Ace inhibitors? | ACE: for systolic HF, "prils", promote vasodilation/diuresis by decr after/preload, block angio I to II |
| how do ACE help with diuresis | decr secretion of aldosterone and stim kidney to release Na/h2o while retaining K. SE: cough, hyperkalemia |
| Affects of ARBs | "sartans", block affect of angio II at receptor, decr bp, incr CO, if ACE give cough, give ARB |
| hydralazine/Isosorbide Dinitrate(nitrate) | venous dilation so lower amt of blood return to heart so lower preload |
| Beta blockers | Nothing goes up, "olols" block sympathetic stimulation, dilate SE: hypotension, dizzy, bradycardia tx: start at low dose and not give to asthma pt |
| diurectic | loop:lasix, hypoK thiazide:HCTZ, hypoK K-sparing: |
| Dig(Lanoxin) | incr force of contraction and slows conduction thru AV node, can see heart blocks, assess apical 1m, |
| CCB | Verapamil(Calan), nifedipine (Procardia), diltiazem (Cardizem), Amlodipine(Norvasc), Plendil....vasodilation, shades on not see SA node |
| cardiogenic shock | decr CO leads to inadequate tissue perfusion and initiation of shock usually caused by MI |
| Test for PE | D-dimer tests for pieces of clots in blood |
| How much volume of blood is in venous sys | 75% of blood |
| What is the most important factor in regulating blood flow of peripheral blood vessels | sympathetic (adrenergic) NS...vasoconstriction by norepi |
| intermittent claudication | muscle cramping in extremities wtih excercise adn relieved by rest in pt w/ arterial insuff. |
| color of skin | rubor: reddish-blue seen in 20 sec-2m after placed in dependent position, suggests art damage and can't constrict |
| Calculate ABI ankle brachial index | ratio of syst bp in andle to sys bp in arm... pt in supine pos norm in ankle is 1.0. pt with claudication have .95 to 0.50 |
| What does angiography show? | dx of occlusive arterial dis, aneurysm(abn dilation of vessel) |
| what is arteriosclerosis? atherosclerosis? | art:"hardening", thickened artioles/aa ath: intima of lg aa of blocked w/ plaques, stenosis |
| Risk factors for atherosclerosis | smoking/diet/htn/dm/obesity/stress/elevated C-reactive protein/age/female |
| What is nsg intv for using hot water bottle to help dilate extremities? | put hot water bottle on abd cause reflex vasodilation in extremities |
| PAD Peripheral Arterial Occlusive Disease is usually where? s/s? | Usually bn renal and popliteal aa s/s: intermittent claudication relieved by putting limb in dependent position tx: Trental, Pletal, excercise, aspirin, plavix, |
| Buerger's Disease s/s? | inflammation of int/sm aa, vv or lower/upper extremities, form thrombus, autoimmune, men20-35y s/s: pain in arch after excercise tx: stop smoking, keep circulation |
| Major cause of aneurysm? thoracic aortic aneu? Adb aortic aneu? | atherosclerosis s/s: pain, unequal pupils, dx w/ chest xray/TEE(grafts), pulsing abd |
| Arterial Embolism? thrombosis? | emboli from thrombi as a result of atrial fibrillation s/s: 6P's: pain/pallor/pulselessness/paresthesia/poikilothermia(coldness)/paralysis |
| What is Raynaud's Phenomenon? | arteriolar vasoconstriction get cold/pain/pallor figertips/toes. 2 types: Primary/idiopathic, Secondary s/s: vasospasms then stop (white, blue,red) tx: avoide cold, tobacco, stress |
| DVT and PE= Virchow's triad | VTE- venous thromboembolism triad: stasis of blood(immobility), vessel wall injury(fracture, IV meds), altered blood coagulation(off anticoagulation med) |
| Phlebitis(inflammation of vein walls) can accompany thrombus | |
| nsg intv for DVT | mark circumference of extremity, check temp, redness, tenderness, not do Homan's sign tx: compression stockings(remove at night), PAS hose, heparin with thrombolytic tx: warm moist packs |
| pharmacology for VTE | heparin, LMWH, coumadin, thrombolytic, thrombin inhibitor, Folndaparinux(prophylaxis) |
| Use of heparin and coumadin adn therapuetic ranges | hep is in range when aPTT is 1.5x(antidote: protamine sulfate) warfarin(antidote: VitK) effect is delayed so given w/ heparin til aPTT is 1.5-2x and INR is 2-3x |
| complications of heparin | hemorrhage, thrombcytopenia(decr in platelet count), |
| Venous insufficiency? Postthrombotic syndrome? | insuff: obstruction of valves or reflux of blood thru valves post: venous stasis w/ edema,pain, dermatitis(ulceration) tx: elevation, protect from trauma |
| varicose veins | abnormally dilated superficial vv cuased by incompetent valves |
| Cellulitis? | bacteria enter tissue w/ swelling, redness, pain, fever, chills, sweating tx: antibiotics |
| HTN? | 140-160/90-100, leads to hypertrophy of L vent tx: decr peripheral resis/blood volume/strength, rate of contraction |
| pharm for htn | 140-90: thiazide diuretic &/or ACE, ARB, BB, CCB? >160/100: thiaz+ace/arb/bb/ccb |
| Understanding drugs thiazide diurectic? loop? K-Sparing? aldosterone blocking | l: vol depletion, blocks reabsorption of Na/Cl/h2o Lasix, Bumex, demadex |
| Thia: decr blood vol, renal blood flow, CO, affect vascular smooth muscle, maintain BP | K-spar: block Na reabsorption in distal tubule, (hyperkalemia) (amiloride)Midamor, (triamtorene) Dyrenium |
| Aldosterone blocker: for MI and vent dysfx, hyperkalemia, spironalactone (aldactone), Inspra | Methyldopa- displaces norepi, good for pregnant Clonidine: lower bp, |
| BB beta blockers: block sympathetic ns, slow HR, decr BP, reduce pulse in tachy SE: cough, depression, check hr b4 | ACE inhibitors: lower peripheral resistance by inhibit conversion of angio I to II which vasoconsricts Can be used with thiazide and dig |
| ARBs: block angio II at receptor, reduce peripheral resistance | CCB: reduce cardiac afterload Dihydropyridines: rapid action, vasodilator, decr cardiac work load and O2 demand(cardene) |
| hypertensive emergency? hypertensive urgency? | emer: 180-120 tx: vasodilators(nitropress)... urg: nose bleeds, anxiety, HA tx: BB, ACE inh |
Created by:
palmerag
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