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Unit 5 - Test 2

The Cardiovascular System

TermDefinition
Cardiac problem result from either _______ or _____ problems. Pressure imbalance or pump not contracting (like it should)
Hypotension is a systolic blood pressure below what? What can sever hypotension cause? 90. Death!!
Low fluid volume (hypovolemia), prolonged immobilization, some meds and neurological disease/damage can cause what? Hypotension
What are some S/S of hypotension lightheadedness, dizziness, fainting (syncope) pallor, diaphoresis, visual disturbances.
what are three treatments for hypotension? Fluid bolus, blood transfusion or fluid volume expanders
___________ is a form of low blood pressure that happens when standing up from a sitting or lying down. Orthostatic (postural) hypotention
In Orthostatic pressure circumstances ______ rate is often more sensitive than blood pressure changes and will ________ to compensate for low blood volume. heart, increase
In Vasovagal hypotension blood circulating tends to go to the legs instead of the head, depriving the brain of O2. This happen because of what? Bradycardia due to the a reflex of the Vagus nerve. Heart slows down, blood pressure drops and blood tends to go to the legs instead of the heart.
What do you need to do after you each 500 mL bolus? Take blood pressure and auscultate lungs
Orthostatic hypotension vs Vasovagal hypotension: Why does blood pressure drop for each of these? O: hypovolemia-------V: Vagus nerve
Orthostatic hypotension vs Vasovagal hypotension: What happens to the heart and why? O: tachycardia - hearts attempt to compensate for low B/P -----V: Bradycardia - results from stimulation of the parasympathetic system
Orthostatic hypotension vs Vasovagal hypotension: Treatment needed? O: Give IV or oral fluids until B/P is normal and treat the cause.---- V: self resolving (no treatment needed)
Hypotention is most often due to what? Hypovolemia
What does shock always cause? Hypotension
When shock happens what does it cause in the body that can lead to death? hypotension due to hypovolemia leads to poor perfusion (not enough blood getting into body tissues) leads to low 02 leading to organs losing functionality and dying.
What are the 3 stages of shock? Compensatory, Progressive, Irreversible/ refractory.
What stage of shock: Epi and norepi are excreted to activate "fight or flight" part of the Adrenergic Nervous system. The are mechanism activated to maintain perfusion to the heart and brain. Vital = low BP Stage 1: compensatory
What stage of shock: Cells switch to anaerobic metabolism which lead to lactic acid build up and leads to acidosis. Cells dies/break open/ releasing K+ leading compounding acidosis affect. Inflammatory response triggered. Stage 2. Progressive stage
What stage of shock: Starts as compensating mechanisms fail to maintain homeostasis. Tissues become hypoxic due to poor perfusion. Stage 2. Progressive
What stage of shock: Depressed myocardial function leading hypoxia that promotes the release of endothelial mediators causing VASODILATATION and endothelial abnormality leading to venous pooling and increase CAPILLARY PERMEABILIT increasing risk of DIC Stage 2. Progressive
What stage: Permanent organ damage occurs. Hypotension results from increased capillary permeability. Lactate (lactic acid) builds up due to anaerobic metabolism. Stage 3. Irreversible
What stage of shock: Circulatory and respiratory failure occurs - death is inevitable Stage 3 Irreversible
A high lactate level in blood test is a ____ ____ for patients. Poor prognosis
List 9 s/s of shock. (LORD HATCH) 1. LOC 2. Tachycardia and Tachypnea 3. Cool and pale 4. Diaphoretic skin (cool/ clammy feeling) 5. Hypotension 6. Oliguria - decrease urine output 7. Acidosis 8. Heart Dysrhythmias 9. Respiratory Failure
What are the treatment for shock? ABCs!!!1. Intubate as needed 2. Give O2 3. Cardiac monitoring 4. maintain perfusion with drugs and IV fluids 5. treat underlying causes.
Explain ABCD assessment ( 3 second assessment) ABCD ------ Airway/ breathing ------ cardiac/circulation ------- deficit of neuro functions
What are the 3 causes (types) of shock. 1. hypovolemic 2. cardiogenic (obstructive) 3. distributive: septic, anaphylactic, neurogenic
Hemorrhage is ___________ shock. Hypovolemic
________ shock is secondary to heart failure. It is the inability of the heart to fill properly or obstruction to outflow from the heart. Pump failure Cardiogentic (obstructive)
__________ Shock is caused by infection from gram negative bacteria resulting in massive Vasodilation. Septic Shock
_______ shock is the result of overwhelming immune response (Vasodialation) to an allergen Anaphylactic Shock
_______ shock is the result of loss of blood vessel tone as the result of vascular volume displacement away from the heart and central nervous system. Example spinal shock or spinal cord injury. Neurogenic shock
B/P consistently higher than 140/90 = Hypertension
A major cause of hypertention is due to _______ ______ (blood clots) which lead to arterial constriction. Arterial injury
What is the normal BP range for adults 100/60 to 140/90
What is an inflammatory process that causes abnormal thickening and hardening of arterial wall from deposition of collagen into vessel walls leading to diminished distensability. (Wall) Arteriosclerosis
What is the narrowing of the artery because of plaque build-up. It is a form of arteriosclerosis resulting from fat being deposited in vessel walls that reduce lumen size. Atherosclerosis
True of False (explain) - All patients with artiosclerosis have atherosclerosis. False - All patients with atherosclerosis have arteriosclerosis. but those with arteriosclerosis might not have atherosclerosis.
What are the 5 steps of Atherosclerosis? 1. Ulceration of vessel 2. Fatty Streak 3. Fibrous plaque 4. Complicated lesion 5. Thrombus to Embolus
What is a thrombus and how does it form stationary blood clot that result from fibrous plaque becoming calcified and penetrating into the vessel's muscular layer as well as extending into the lumen producing an occlusion. Step of Atherscelerosis
What is an Embolus? All of or a portion of Calcified plaque that chips of a thrombus and floats freely through the vascular system.
Why is an embolus bad? They can get stuck and block blood flow - could result in localized tissue necrosis to death from pulmonary embolism.
Primary Hypertension VS Secondary Hypertension: Etiology P: unknown (genetic or environmental). Hi risk groups: family genetics, race, age, insulin resistance, diet, obesity, alcohol and smoking. ----------- S: Attributable to another disease process
Primary Hypertension VS Secondary Hypertension: Incidence P: 90-95% ------- S: less than 5%
Primary Hypertension VS Secondary Hypertension: Pathophysiology: increased blood volume, increased vasoconstriction, increased resistance in vesssels------S: many different cause (endocrine disease, kidney disease and tumors. Can also be a side effect of medications)
Primary Hypertension S/S and treatment Usually none - treatment: diet, exercise, medication (life-long)
Secondary Hypertension S/S and treatment Usually none or those associated with disease process. Treatment - treat underlying cause
What is a serum maker for cardiac inflammation? C-reactive proteins
If CRP level are elevated in the blood it is considered a major risk factor for _____ and ______. Atherosclerosis and Vascular disease
This is a known by product of inflammation and indicates a risk of heart disease. C- Reactive Protein
Arterial vs Venous occlusions: Cause A: Vasospasm, atherosclerosis, Vessel injury --------- V: Sedentary, bed bound, Vessel injury
Arterial occlusions : S/s for Pulse, Edema, Color, Temp and Pain 5 - "p"s, Pulse - Decrease or absent, Edema - none, Color - Pale to mottled, Temp - Cool to cold, Pain - Sharp, numb
Venous occlusions: S/s for Pulse, Edema, Color, Temp and Pain SHARP, Pulse - Present, Edema - present, Color - pink to red, Temp - Warm to hot, Pain - Aching, throbbing
Arterial vs Venous occlusions: Treatment A: Thrombolytic Embolectomy ----- V: Anticoagulant Embolectomy
What are the 5 "P" associated with S/S of Arterial occlusions? Pain, Pallor, pulselessness, parasthesia, paralysis
What are some factors that increase the risk of Venous Thromboembolism? Smoking, obesity, Age > 60, Prior VTE, Venous Stasis, injury to Vasculature, hypercoagulability, Immobilization, Medication Therapy and nephrotic syndrome ( kidney problem result in to much protein in urine)
What is the most significant risk factor for DVT and PE? Prior VTE
What are two venous disorders? Varicose veins and Deep Vein Thrombosis (DVT)
Varicose Veins: Etiology Gravity, increased abdominal pressure and valve incompetence.
Deep Vein Thrombosis: Etiology Diminished blood flow (especially in legs) and pressure
Varicose Veins: Incidence: Risk factors include prolonged sitting and pregnancy
Deep Vein Thrombosis: Risk Factors Prior history of DVT, smoking, sitting for long times (driving/flying. desk jobs) Birth Control Pills, obesity, Pregnancy
What is the #1 risk factor for DVT Prior history of DVT
Varicose Veins: Pathophysiology Venous pooling ---- Distended Vein----- edema and further engorgement
Deep Vein Thrombosis: PAthophysiology Hemostasis ------ activation of intrinsic clotting cascade ------- thrombus formation that is the source of the blood clot that breaks off and travels (emboli) ------ usually travels to lungs and causes Pulmonary Emboli.
Varicose Veins: S/s Primary - Appearance ------ Secondary - edema, tired, aching legs
Deep Vein Thrombosis: S/S tenderness, swelling, redness/warmth in affected leg
Varicose vein: Rx improve venous return, scierosis, and ligation
Deep Vein Thrombosis: Rx anticoagulants (heparin, Coumadin, Plavix or Lovenox) and prevention
What is PAOD? Peripheral Arterial Occlusive Disease
What Causes PAOD? Atherosclerotic Blockage is large arteries like carotid and femoral.
When do S/S of PAOD usually start to show When the artery is 50% occluded?
What is the most common symptom of PAOD? Claudication (Intermittent Claudication)
What is Claudicaition? reproducible ischemic muscle pain
When and Why does Claudication occur? Claudication occurs during physical activity and is relieved after a short rest. Pain develops because of inadequate blood flow.
This is a disease of the arteries and veins in the arms and legs. Thrombangitis obliterans (Buerger's Disease)
Incidence and pathophysiology of Thrombangitis (Buerger's Disease) Men younger than 35 who are heavy smokers. Peripheral arterial inflammation-----thrombus formation/vasospasm----occlusion
Thrombangitis (Buerger's Disease): S/S Pain, tenderness, dependent rubor (s/s of inflammation =Sharp)
Thrombangitis (Buerger's Disease): Treatment stop smoking, vasodilators, amputation
Raynaud's Disease: Etiology and incidence Unknown -Possible genetics----- incidence - young women
Raynaud's Disease: Pathiogysiology Triggers (cold, stress, drugs)------- digital arterial vasospasm ----- distal to proximal that causes reduced blood flow to the extremities.
Raynaud's Disease: S/s Fingers turning white after temp change or emotional event, Pallor/cyanosis, numbness, cold progressing from distal to proximal part of the limb followed by redness and throbbing pain.
Raynaud's Disease: Treatment Avoiding triggers, vasodilators
What is the #1 killer in america CAD (Coronary Artery Disease) or just heart disease
CAD Etiology Atherosclerosis, Vasospasm, thrombi
CAD incidence 50% all Deaths (35% in 35 to 65 years of age)
CAD modifiable and non modifiable cause M: hyperlipidemia, hypertention, smoking, obesity, sedentary lifestyle, Type II diabetes -----NM: age>60, gender (males), genetic predisposition, type 1 diabetes
CAD Pathology coronary artery occlusion --- decreased myocardial perfusion ---myocardial ischemia---angina---ischemia persists (> 20 minutes)--ischemic cell injured--- injured cell nercrosis (Myocardial infarction)--- myocardium scars over dead tissue.
Dead tissue as a result of Myocardial infarction will not what and results in what? Will not conduct electricity and result in abnormal EKG readings
DX tests for Coronary Artery Disease EKG, Blood tests (CBC, troponin, electrolytes, cardiac enzymes, etc.), Chest X- ray, Echocardiogram, Angiography (angiogram)/Cardiac catheterization to open the blocked artery.
Angina Pectoris vs infarction: Cause A: Temporary cardiac ischemia caused by increased workload myocardial work load.-----I: Irreversible ischemia produces infarction (necrosis and scaring)
Angina Pectoris vs infarction: EKG Changes A: None or transient ----I: Permanent abnormal changes
Angina Pectoris vs infarction: Plasma enzyme levels. A: Normal ------ I: Elevated Troponin and CK-MB
Angina Pectoris vs infarction: Pain relief A: rest, nitroglycerin ----- I: O2, Nitroglycerin, Nercotics
Angina Pectoris vs infarction: treatment A: Beta Blockers, Ca++ channel blockers----- I: Anticoagulants, Thrombolytics, Angioplasty
What is the treatment for chest pain? (M.O.N.A) M - Morphine---O - Oxygen---- N-nitroglycerin----A- Aspirin ******A - Anticoagulants (Aspirin, Heparin, Coumadin)
Cardiomyopathies: list the 3 types and the etiology 1.Idiopathic dilated cardiomyopathy (IDC)- idiopathic, chronic ETOH abuse, infection 2. Hypertrophic- genetic predisposition, idiopathic 3.Restrictive- ingiltrative disease, idiopathic.
Cardiomyopathies: pathophysiology muscle disease --> altered ventricular chamber --> ineffective contraction --> impeded perfusion --> heart failure
S/S of ICD (idiopathic dilated cardiomyopathy) fatigue, weakness, palpitations, dysrhythmias, LEFTheart failure
S/S of Hypertrophic Cardiomyopathy dyspnea, angina, fatigue, syncope, dysrhythmias, LEFt heart failure
S/S of Restrictive Cardiomyopathy dyspnea, fatigue, tachydysrhythmias, RIGHT heart failure
Cardiomyopathies: Rx support and maintain function , transplantation
Another name for heart failure Congestive heart failure
Why is heart failure a medical management challenge for doctors and nurses? Most people dont follow recommended low salt diets or they fail to take hear failure meds as prescribed
Etiology of Left heart failure (congestive heart failure) MI, Hypertension, Aortic valve disease
Dx testing for Left Side heart failure Chest x-ray and BNP lab test
What excreted from cardiac tissue when the ventricle are stretched? BNP
Finish the pathology of Left Heart Failure ---Decrease left ventricle emptying (decrease perfusion to body tissues) --> increase volume/pressure in left ventricle -> increase volume/pressure in left atrium -> increased volume in pulmonary veins-> increased volume in capillary bed--> fluid transudate moves from capillaries to alveoli---> Alveolar space fills with Fluid --> Pulmonary Edema
S/S of Left Heart Failure (Congestive Heart Failure) (5) 1.Exertional and nocturnal dyspnea 2. Hemoptyis 3. Orthopnea 4. cyanosis 5. Elevated pulmonary capillary pressure
Difficult or labored breathing Dyspnea
what is Hemoptysis and in what heart condition could you find it and why? blood tinged sputum - Left sided heart failure due to blood backing up in the lungs.
What is Cor Pulmonale Right Heart Failure
What is the most common cause of heart failure in the US? Coronary Artery disease
Congestion from from right heart failure effects what? liver, GI tract, limbs and the right ventricle may be unable to pump blood efficiently to lungs and left ventricle
What are the cause of Left heart failure? congenital heart failure, clots in pulmonary arteries, pulmonary hypertension and heart valve disease.
s/s for right heart failure swelling of the feet and ankles, shortness of breath, distended Jugular veins, irregular fast heart beat, fatigue, Weakness, fainting, nocturia, palpitations (feeling the heart beat)
List some conditions that may trigger episodes of heart failure increase intake of fluids or salt, fever, infection, anemia, blockage in the coronary arteries, arrhythmias, hyperthyroidism, kidney disease
Rx for Right Heart Failure treat underlying cause.. diuretics to reduce edema and fluid overload, give cardio tonic drugs to improve heart performance
Dx for heart failure Chest xray, BNP lab test
What does BNP stand for? where does it come from? Brain Natriuretic Peptide - excreted from cardiac tissue (ventricles)
Another Name for BNP B-type natruiretic Peptide
Pathology of right side heart failure decrease right ventricle emptying --> decrease blood supply to lungs--> increased volume/pressure cause back up thru-out blood stream, increase volume in distensible organs, increase cap. pressure, peripheral edema and serous effusion
S/S of Right Side Heart Failure Fatigue, Distended jugular vein, enlarge liver and spleen, Elevated BNP, Dependent edema
BNP levels are used in helping to establish the diagnosis of ____? heart failure in urgent care pts
____ is specific for heart failure and______ and ______ are specific for MI (tissue death) BNP, CK-MB and Troponin
Treatment for Right or left heart failure Medication, lifestyle changes, pacemaker
Dx Diagnosis
HX History of ____-
PX Pain
RX Prescription or medication
SX or S/S Sign/symptoms
What are the ABCD's drugs of treating hypertension that help lower blood pressure? A: ace inhibitors ("pril"), ARBS ("sartan"), Alpha-blockers ("sin")----B: Beta Blockers ("olol"----Calcium channel blockers (diltiazem, Nifedipine, Verapamil)-----D: Diuretics (Furosemide), (HCTZ),(Spironoiactone)
What do all the ABCD drugs do? Low blood pressure
What are the side effect if ABCD drugs work to well? not enough vital organ perfusion----> Brain (dizzy, fainting, fall risk)---Cardiovascular (Dysrhythmias)---- Lungs (wheezing, cough- caused by blocking B2 receptors) ----- Kidneys: decrease urine and kidney damage
What are the ABCDs of non drug treatments for hypotention A: Avoid Salt--- B: Be Active ---- C: Cease Tobacco/caffeine---- D: Diet (drop 5% of body weight)
What are some nursing considerations with ABCD drug treatments for hypertension? Monitor B/P, heart rate, record urine output, assess fall risk, assist patient to b-room
Created by: sbertelsen