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1
coronary artery disease
| Question | Answer |
|---|---|
| creatine Kinase (CK/CPK) | normal: male 55-170 units/L, female 30-135 units/L (values are higher after exercise). Found in the heart muscle, skeletal muscle and brain. elevated when injury to muscle or nerve cells |
| C-Reactive Protein (CRP) | normal: 1-3 mg/dl. Indicates the presence of disease, bacterial infection, inflammatory disorders. CRP is a protein produced primarily by the liver during acute inflammatory process or other disease. |
| Troponins | normal: cardiac troponins T ( <0.2 ng/ml), cardiac troponins I (<0.03 ng/ml); biochemical markers for cardiac disease. Used to test for acute coronary ischemic syndromes. Can be used to predict the likelyhood of future cardiac events. |
| CK-MB | normal:0% (Isoenzyme) useful in timing onset of infarction and the degree of mycardial infarction |
| Drugs that affect the Renin-Angiotension system | Angiotension-Converting Enzyme (ACE) Inhibitors (Captopril).,Angiotension II Recptor Antsgonists (Lorsartan). |
| Agents that affect the heart and blood vessels | Verapamil (Calcium channel blockers |
| Agents that affect the blood vessels primarily | Nifedipine (Calcium channel blockers) |
| Calcium channel blockers | affect the heart and blood vessels |
| Drugs for hypertension | Loop diuretics, Potassium sparing diuretics, beta-adrenergic blockers, alpha-adrenergic blockers, combined alpha/beta blockers, centrally acting antiadrenergics |
| Furosemide | Loop diuretics |
| Spironolactone | Potassium sparing diuretics |
| Propranolol | beta-adrenergic blockers |
| Prazosin | alpha-adrenergic blockers |
| Labetalol | combined alpha/beta blockers |
| Clonidine | centrally acting antiadrenergics |
| Drugs for Angina Pectoris | Organic Nitrates |
| Nitroglycerin | for angina |
| Drugs for Hyperlipidemias (Statins) | |
| systolic portion of the cardiac phase | The LUB sound, the L ventricle fills through the mitral and tricuspid valves close causing the first heart sound (S1) |
| Diastolic portion of the cardiac phase | The Dub sound, the ventricles contract and blood flows through the aortic and pulmonic valves into the aorta after the ventricles empty. The aortic and pulmonic valves close causing the second heart sound (S2) |
| Sternoclaviclular area | sternal angle about 5cm from sternal notch |
| aortic area | 2nd intercostal space, right sternal boder (2ICS,RSB) |
| Pulmonic area | 2nd intercostal space, l sternal border (2ICS, LSB) |
| Erb's point | 3rd intercostal space, left sternal border (3ICS, LSB) |
| Tricuspid area | men 4th - 5th ICS, LSB; women 5ICS,LSB |
| Mitral area | 5th intercostal space, L midclavicular space (5LICS, MCL) |
| Point of maximal intensity (PMI) | same as mitral valve only slightly medial |
| epigastric area | directly below Xiphoid process. Best for Bruits, Don't palpate if aneurysm is suspected. |
| Bruit | a blowing, swishing sound occuring from blood flow turbulence. |
| precordium | refers to anterior surface of the chest wall overlying the heart and great vessels. |
| Murmur | sound caused by increased turbulent blood flow( a blowing sound) |
| Thrill | abnormal vibration produced by turbulent blood flow from a narrowing obstruction. It is felt rather than heard. Feels like a purring cat. |
| SNAP | high- pitched abnormal sound heard medially to the apex after S2 |
| Ejection click | abnormal, high pitched sound heard at te apex during mid or late systole |
| pericardial function rub | rubbing, grating sound, high pitched, heard in systole or diastole at the L sternal border |
| Heave (Lift of chest wall) | caused by a greatly increaed force of the ventricles. One inspects for the Heave |
| Base of heart | at top of pericardium |
| Apex of heart | at bottom of pericardium |
| Splitting sounds | are 2 discerncomponents of the heartbeat LUB...DUB. The first sound is from the L-sided vaalvular closure with the second sound being right valvular closure |
| Ischemia | revesible deficiency in oxygen supply to tissue |
| nicotine | causes vasoconstriction and spasms of the arteries |
| cardiac output | amount of blood ejected from the L ventricle to the aorta per minute |
| S1 | normal systolic heart sounds caused by closure of the mitral and tricuspid valves |
| S2 | normal diastolic sound caused b the closure of aortic and pulmonic valves |
| S3 | early diastolic sound associated with heart failure; ventricular gallop |
| S4 | late diastolic sound associated with HTN |
| pericardial friction rub | adnormal high- pitches systolic sound and diastolic sound heard at the L sternal border |
| stroke volume | amount of blood ejected by the L ventricle into the aorta per beat |
| 2 things commonly found in the aging client related to physiological changes of the cardiovascular system are: | HTN and arteriosclerosis |
| the bell of the stethoscope can be used to hear low pitched sounds such as: | heart murmurs |
| noninvasive cardiac assessment | echocardiography |
| which position should client be in to hear friction rub most clearly? | seated, forward leaning position |
| How can you tell in pain in anginal and not MI? | pain is relieved by rest |
| when palpating peripheral pulse nurse should note | strength (0-3+/4+) |
| population most at risk for heart disease | African-American women |
| What increases the risk of cardiovascular disease 2-8 fokd? | diabetes |
| What doubles the risk for cardiovascular disease and heart failure? | HTN |
| what is blood pressure? | systemic vascular resistance X cardiac output |
| SBP | Peak pressure in the arteries during systole |
| DBP | Lowest pressure during diastole |
| arterial BP | CO X SVR |
| SVR | systemic vascular resistance (force that opposes the flow of blood in the arteries) |
| BP assessment | Palpate brachial or radial artery, inflate above where pulse disappears. Appropriate cuff size. Release valve 2 mm Hg every sec. take in both arms initially. use arm with higher reading for future readings. |
| Orthostatic assessment | 1. supine after resting for 2-3 mins. 2. sitting after 1-2 mins. 3. standing after resting 1-2 mins |
| normal SBP | <10mm hg DBP & HR increase |
| orthostatic hypotension | decrease of > or = to 20mm SBP, decrease 10mm Hg DBP and/or > or = 20 beats/min in HR |
| BP parameters: normal | Systolic <120 and diastolic <80 |
| BP parameters: pre-HTN | systolic 120-139 or diastolic 80-89 |
| population most at risk for heart disease | African-American women |
| What increases the risk of cardiovascular disease 2-8 fokd? | diabetes |
| What doubles the risk for cardiovascular disease and heart failure? | HTN |
| what is blood pressure? | systemic vascular resistance X cardiac output |
| SBP | Peak pressure in the arteries during systole |
| DBP | Lowest pressure during diastole |
| arterial BP | CO X SVR |
| SVR | systemic vascular resistance (force that opposes the flow of blood in the arteries) |
| BP assessment | Palpate brachial or radial artery, inflate above where pulse disappears. Appropriate cuff size. Release valve 2 mm Hg every sec. take in both arms initially. use arm with higher reading for future readings. |
| Orthostatic assessment | 1. supine after resting for 2-3 mins. 2. sitting after 1-2 mins. 3. standing after resting 1-2 mins |
| normal SBP | <10mm hg DBP & HR increase |
| orthostatic hypotension | decrease of > or = to 20mm SBP, decrease 10mm Hg DBP and/or > or = 20 beats/min in HR |
| BP parameters: normal | Systolic <120 and diastolic <80 |
| BP parameters: pre-HTN | systolic 120-139 or diastolic 80-89 |
| BP parameters: HTN- sustained elevation of BP Stage 1 HTN | systolic 140-159 or diastolic 90-99 |
| BP parameters: Stage 2 HTN | systolic > or = 160 or diastolic > or = 100 |
| HTN classifications: Primary HTN (essential or idiopathic) | w/out identified cause, 90-95% of all cases |
| HTN classifications: Secondary | W/ specific cause, suspected if <20 or >50 |
| Primary HTN | Heredity, Sodium sensitivity, Renin-Aldosterone Functioning, prolonged stress, insulin resistance, endothelial cell dysfunction |
| Symptoms of HTN | Primarily a "Silent killer"- No symptoms. secondary symptoms: fatique, activity intolerance, dizziness, palpitations, angina |
| primary HTN risk factors: modifiable | alcohol, smoking, diabetes, high cholestrol, high sodium, sedentary lifestyle, obesity, stress, low k+ levels |
| primary HTN risk factors: non-modifiable | age, gender, men- early and middle adulthood, females>55, family history, ethnicity, socioeconomic status. |
| secondary HTN R/T: | congenitaal narrowing of the aorta, renal disease, endocrine disorder (Cushing's), Cirrhosis, Neuro (brain tumors/injury), sleep apnea, cocaine, estrogen replacement therapy, birth control pills, NSAID, pregnancy |
| Uncontrolled HTN complications | organ damage; CAD, LVH (left ventricular hypertrophy), HF, CVA, PVD (reduced or absent pulses), ESRD, retinal damage |
| HTN drug therapy goal: | decrease volume of circulating blood and SVR |
| Drug therapy includes: | diuretics (Thiazide, Loop, Potassium sparing), Alpha and Beta Andrenergic Antagonists (Direct vasodialators, ACE inhibitors, Angiotension II Receptor blockers, Calcium channel blockers) |
| How they work: Potassium sparing (Aldactone) | Inhibits sodium retention (watch for hypotension, hypercalcemia, is contraindicated in renal pts., caution in pt w/ ACE inhibitors |
| How they work: vasodialators | dialate arteries and veins, relaxes |
| How they work: Ace inhibitors | relax blood vessels, increase CO |
| How they work: calcium channel blockers | dialate coronary arteries |
| licorice can promote | hypokalemia |
| aloe can | decrease serum K levels causing hypo Kalemia |
| ginko can | increse BP when taken w/ thiazides can cause low llibido |
| nursing considerations for Diuretics: | take w/ food or milk, take in AM, I&O, daily weights (report gain of 2kg in 1-2 days), protect skin from sun, diet high in K+ for loop and Thiazide diuretics, diet low in K+ for K+ sparing diuretics, know herbal interactions |
Created by:
gemjema
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