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FINAL- Test 2

HF/Cor/Pericarditis/MI/ANGINA/PCI/Hemodynamics/Thombolytics

QuestionAnswer
What are the signs of R sided HF peripheral dependent edema, JVD, hepatomegaly, anasarca, ascites, nausea, right upper quad pain
What are the signs of L sided HF pulmonary edema, crackles, pink frothy sputum, s3 s4 heart sounds, pmi displaced, LV hypertrophy, changes in LOC, paroxysmal nocturnal dyspnea, restlessness, confusion, orthopnea, shallow respirations
What is Cor Pulmonae alteration function of the right ventricle (RV) of the heart caused by COPD, PE. Pulmonary HTN increases the workload of the right ventricle and causes right ventricular hypertrophy and eventually HF. Can go on for 2 years before diagnosis.
What are the s/s of cor pulmonae right vent hypertrophy and pulm artery, dyspnea on exertion, lethargy, fatigue, peripheral edema; weight gain; POLYCYTHEMIA fm chronic hypoxemia,jvd; full, bounding pulse; ascites, hepatomegaly, chronic cough.
What is the treatment for Cor Pulmonale Treat underlying pulmonary disease. Low-flow O2 therapy, Bronchodilators, Diuretics, Low-sodium diet, Vasodilators, Calcium channel blockers,positive inotropes, blood thinners, phlebotomy for polycythemia.
What are the classic drugs used to treat HF Loop or thiazides (bumex, lasix, hydrochlorothiazide), morphine, aces, sartans, nitro's/nitrates, hydralazine, beta blockers, and positive inotropes (dig, dobutamine), anti-coags
Pericarditis is and what causes it Hallmark sign pericardial friction rub best heard at the lower left sternal border with the pt leaning forward. Caused by rheumatic fever, chest trauma, infections like sepsis, dressler syndrome, drug procanamide, SLE, hydralyzine
Tx for Pericarditis Antibiotics treat bacterial pericarditis, and nonsteroidal antiinflammatory drugs (NSAIDs) (e.g., salicylates [aspirin], ibuprofen [Motrin]) control the pain and inflammation of acute pericarditis. Corticosteroids are used unless immune issue.
Define an MI sustained ischemia >20min CP not relieved by rest or drugs, morning most common time
What will your pt with an MI look like Myocardial ischemia= st depression/ Myocardial infarction = St elevation (injury) Cool, clammy, diaphoretic, n/v, dysrhythmia (vfibb, heart block, pvcs to v-tach) chest pain that radiates to the neck jaw and arms, low back and fatigue in women
How do we treat an MI 90 minutes from start of symptoms to treat if STEMI, MONA,stent, cabg
What kind of labs will we look for in an MI Troponin >2.3 most definete indicator
What is Stable angina vs unstable Stable is relieved by nitro and rest and the other is not.
What is MONA Treat MI morphine, nitro, oxygen, asprin
Thombolytic drugs are.... recombinant plasminogen activator (rPA; reteplase) tissue plasminogen activator (tPA; alteplase) TNK-tPA (tenecteplase
Thrombolytics are used when and for in cardiac... STEMI in an MI
What is sinus brady and how do we treat it Treat the underlying cause first. Symptomatic brady is treated with Atropine or pacemaker if unresponsive to drugs. Normal in athletes or during sleep.
What is sinus tach and how do we treat it Treat the underlying cause first. Then beta blockers to reduce hr. Valgal maneuver.
What is a first degree heart block and how do we treat it Monitor it.
How do you count a heart rate in a 6 second strip Count the QRS intervals and times by 100
How do we treat PVCs and what are they PVCs are assoc w/stimulants such as caffeine, alcohol, nicotine, epinephrine/ Treat underlying cause- electrolytes, O2. Drug therapy:β-adrenergic blockers, procainamide, amiodarone, or lidocaine.
How do we treat Vtach Procainamide, Lidocaine, Amiodarone, and cardioversion if pulse is present. If the patient becomes unstable or has poor left ventricular function, IV amiodarone or lidocaine is given followed by cardioversion.
When do we cardiovert a patient have a pulse- unstable vtach, afib
Normal or goal Hemodynamic ranges are.... PAWP- 8-12 CVP- 2-8 in shock goal is >8 MAP 70 or goal >60 SV 60-150ml/min CO- 4-8L Cardiac Index- 2.2-4L UOP 0.5ml/kg/hr
Afterload is... the pressure from the left ventricle wall contraction
Preload is... end diastolic stretching of L or R ventricles during filling
Drugs that decrease afterload are Aces's, CCB's, Beta Blockers, Vasodilator
Drugs that decrease the preload are Diuretics
What are the function of ace inhibitors? Vasodilates, Prevents remodeling, ↓ Preload, ACE inhibitors reduce the RAAS, ↓afterload, and ↓BP- can cause a cough
Determinants of Cardiac Output Contractility, preload, afterload, HR
Decreases preload and afterload Morphine and nitro
Meds we give to a pulseless arrest Atropine, EPI, Vasopressin
What is a Cardiac Tamponade blood or fluids fill the pericardial sac surrounding heart
Cardiac output is calculated how CO= SV x HR
Normal cardiac output is what 4-8L per min
Normal SV is Co divided by HR, normal is 60-150ml/min which is the amount ejected with each heart beat
BNP, indicator of HF, shows probaled HF at what range 100-500 or greater
Earliest symptoms of HF Fatigue, dry hacking cough, tachycardia, dyspnea, paroxysmal nocturnal dyspnea
How does nocturia happen in HF A person with chronic HF who has decreased CO will also have impaired renal perfusion and decreased urinary output during the day, when they lie down at night fluid movement is enhanced.
Normal Cardiac Index 2.2L-4L
PAWP normal range is 6-12- but >8-12 is the end goal for shock patients or pt's needing fluid resuscitation aka left atrial pressure
How to determine MAP systolic BP +2 x (diastolic pressure) / 3
Normal MAP 70 or goal >60
Normal UOP 0.5ml/kg/hour
Causes for increased preload are ↑ fluid volume and venous constricition
Causes for decreased preload are hypovolemia and vasodilation
Arterial or venous pressure monitoring complications hemorrhage, infection, thrombus formation, neuro impairment, loss of limb (allen test)
How do we manage arterial pressure monitoring continuous flush irrigation system, 3-6L NS per hr limits thrombus, assess neuro status of distal limb hourly
CVP is measurement of right ventricular preload and reflects FLUID STATUS. Normal range is 2-8 per lewis text, but TARGET GOAL IS >8 in shock.
Do not inflate swanz-ganz balloon in PAWP for more than- 8-15 seconds at the end of a respiration no more than 4 resp cycles- slowly inflate until waveform changes
Manifestations of bradycardia are Hypotension, Pale, cool skin, Weakness, Angina, Dizziness or syncope, Confusion or disorientation, Shortness of breath
Manifestations of tachycardia are Dizziness, Dyspnea, Hypotension, Angina in patients with CAD
Causes of PACS Stress, Fatigue, Caffeine, Tobacco, Alcohol, Hypoxia, Electrolyte imbalance,
Treatment for PACS Monitor for more serious dysrhythmias Withhold sources of stimulation βeta blockers
PSVT is abrupt onset hr 150-220 trigger by a pac caused by overexertion, stress, deep inspiration, stimulants, disease, digitalis toxicity.
Treatment for PSVT Treat underlying cause first. Vagal stimulation, IV adenosine, IV βeta blockers, Calcium channel blockers, Amiodarone DC cardioversion
Calcium channel blockers are Amlodipine, Verapamil, Nifedipine, Diltiazem
Manifestations of PSVT HR > 180 leads to decreased cardiac output and stroke volume Hypotension, Dyspnea, Angina
Treatment of aflutter Cardioversion, ablation, cryotherapy (maze), BB, amioderone
1st degree heart block treatment pr>.20, asymptomatic, monitor.
Afib treatment calcium channel blockers (e.g., diltiazem), β-blockers, digoxin positive inotrope, and dronedarone (Multaq). Anti-dysrythmics amiodarone and ibutilide. Afib >48hrs warfarin for high risk and aspirin for low risk
Dronedarone (Multaq) is used in atrial flutter for patients whose hearts have returned to normal rhythm or for those who will undergo drug or electric shock treatment to restore a normal heartbeat
Afib usually occurs in the patient with CAD, rheumatic heart disease, cardiomyopathy, hypertensive heart disease, HF, pericarditis, thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances, stress, and cardiac surgery.
Risk factors for afib Moderate: Age ≥75 yrs, Heart failure, Htn, EF <35%, DM High: Previous stroke, TIA, or embolism, Mitral stenosis, Prosthetic heart valve
PVCs are associated with stimulants such as caffeine, alcohol, nicotine, aminophylline, epinephrine,isoproterenol, and digoxin.
PVCs are also assoc with other than stimulants... electrolyte imbalances, hypoxia, fever, exercise, and emotional stress. Disease states associated with PVCs include MI, mitral valve prolapse, HF, and CAD.
Treatment for PVCs Treat underlying cause first. then Drug therapy includes βblockers, procainamide, amiodarone, lidocaine.
Vtach treatment in a patient with a pulse is procainamide, sotalol, amiodarone, or lidocaine is used. I fhtey become hemodynamically unstable then IV amiodarone or lidocaine is given followed by cardioversion..
Vtach in a pt w/o pulse treatment (CPR) and rapid defibrillation are the first lines of treatment, followed by vasopressors (e.g., epinephrine) and antidysrhythmics (e.g., amiodarone) if defibrillation is unsuccessful.
Vfib CPR, defib, EPI, and vasopressors, amiodarone lastly.
Drugs given during a code cardiac arrest 1st epi if not a shockable rhythm after then atropine- vasopressin was said in class but not mentioned in book.
Steps to defibrilation turn defib on, select joules, turn sync switch off, Apply pads, Charge the defibrillator, paddles. Call all clear, Deliver the charge. CPR.
Indications for permanent pacemakers • Second-degree AV block • Third-degree AV block • slow Atrial fib • Cardiomyopathy • Heart failure • SA node dysfunction • Tachydysrhythmias
three types of temporary pacemakers: transvenous, epicardial, and transcutaneous
Indications for temp pacemakers during surgery or postop recovery cardiac cath or angioplasty, drug therapy that may cause brady, and before a permanent pacer implant, prophylaxis post open heart surgery, MI w/blocks, MI w/ brady,
Transvenous pacer is leads that are threaded transvenously to the right atrium and/or right ventricle and attached to the external power source until dysrhythmia resolves
Epicardial pacer is attaching an atrial and ventricular pacing lead to the epicardium during heart surgery. The leads are passed through the chest wall and attached to the external power source. Epicardial pacing leads are placed prophylactically post op.
Transcutaneous pacer is provide adequate HR and rhythm to the patient in an emergency situation- provide analgelisa.
Failure to sense is pacemaker fails to recognize spontaneous atrial or ventricular activity, and it fires inappropriately.
Failure to capture electrical charge to the myocardium is insufficient results in bradycardia or asystole.
Drug of choice to treat pulmonary edema Morphine
Complications of pericarditis Cardiac tamponade and pericardial effusion
increases contractility- positive inotropics are: Dobutamine, digoxin, norepi, epi, dopamine, primacor
Complications of large pericarditis effusion are cough, dyspnea, and tachypnea. Phrenic nerve compression can induce hiccups, and compression of the laryngeal nerve may result in hoarseness. Heart sounds are generally distant and muffled, although blood pressure (BP) usually is maintained.
Signs of cardiac tamponade a complication of pericarditis is DYSPNEA first early on. ↓(CO), muffled heart, narrowed pulse pressure. tachypnea, tachycardia, JVD and pulsus paradoxus.
Pulsus paradoxus is a decrease in systolic BP with inspiration that is exaggerated in cardiac tamponade
General causes of heart failure are CAD and MI • Hypertension, including hypertensive crisis • Rheumatic heart disease • Pulmonary htn • Cardiomyopathy • Hyperthyroidism • mitral stenosis
Diastolic heart failure is Inability to FILL and RELAX, can be caused by LV hypertrophy valve issues, HTN
Systolic heart failure is Inability to pump the blood FORWARD, can be caused by cardiomyopathy, EF <45%
Most common artery of hear for thombis Left anterior descending artery
Myocardial Ischemia is defined as When the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen
Angina and the 5 E's to ask your pt Exertion, Extreme temps, Emotions, Eating (last meal), Exposure (stimulants, sex, smoking)
Chronic stable angina treatment antiplatelet, nitro, B blockers, CCB, Aces and Arbs, statins,
Acute Coronary Syndrome/unstable angina treatment 12 lead EKG, cardiac monitor, MONA, Heparin, BB, Aces, Arbs
STEMI treatment is MONA,stent , heparin, CABG
NSTEMI treatment is Nitro, heparin, plavix, coronary angiography PCI
Created by: matthew0116