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FNP~Cardiac
Assessment, Dx, Tx
| Question | Answer |
|---|---|
| In S1, which valves are open/closed | semilunar open...mitral/tricuspid (AV) valves closed |
| In S2, which valves are open/closed | AV open...arotic/pulmonic (semilunar) closed |
| Systole = | the period between S1 and S2 |
| Diastole = | the period between S2 and S1 |
| S3 = | "Kenn-tuck-y" sound; associated with ^ fluid states (pregnancy, CHF) |
| S4 = | "Ten-ne-ssee" sound; associated with previous MI, chronic HTN, L Ventricular hypertrophy, stiff wall |
| Pnuemonic~MS.ARD | Mitral Stenosis Aortic Regurg = Diastolic Murmur |
| Pnuemonic~MR.ASS | Mitral Regurg Aortic Stenosis = Systolic Murmur |
| Aortic Stenosis is heard where? | 2nd R ICS usually radiating to the neck |
| When is Aortic Stenosis heard and what sound best describes it? | Systolic, "blowing", rough and harsh |
| Aortic Regurg is heard where? | 2nd L ICS |
| When is Aortic Regurg heard and what sound best describes it? | Diastolic "blowing" |
| Mitral Stenosis is what kind of murmur? | loud S1 murmur, low pitched, mid-diastolic; apical "crescendo" rumble |
| Mitral Regurg is heard where? | 5th ICS MCL (apex); may radiate or left axilla; musical, blowing, or high pitched |
| What is Mitral Regurg? | S3 with systolic murumur |
| Acute Heart Failure? | abrupt onset usually following an acute MI or valve rupture |
| Chronic Heart Failure? | usually develops over time as a reult of inadequate compensatory mechanisms |
| Systolic Heart Failure? | inability to contract = decrease in cardiac output |
| Diastolic Heart Failure? | inability to relax and fill = decrease in cardic output |
| Non-Pharmacological management of CHF | Na+ reduction, rest/activity balance, wt reduction |
| CHF labs and diagnostics | ABG, UA, CXR (pulm edema), Echo (contractile/relaxation, valve function, ejection fraction), ECG (acute MI, dysrhythmia), BMP (normal unless chronic failure present) |
| What is Pharm management of CHF? | ***Diuretics, ACE inhibitors...Digitalis (systolic failure), CCB's, Vasodilators, BB's, Angiotensin II/Alpha adrenergic receptor antagonists |
| What sound is heard during LVH? | S4 |
| Describe H/A related to "Severe HTN" (location/duration)? | subocciptal and pulsating, present early in AM and resolving throughout the day |
| Normal B/P? | S <120 & D <80 |
| Pre~HTN | S 120-139 or D 80-89 (>120/80) |
| HTN Stage 1 | S 140-159 or D 90-99 (>140/90) |
| HTN Stage 2 | S > or equal to 160 or D > or equal to 100 (> 160/100) |
| HTN baseline studies | LABS: UA, BMP, CBC, CA+, Phos, uric acid, chol, triglycerides, BUN/Cr...ECG (dysrhythmias, LVH)...CXR (PA and lateral) |
| HTN Stage 1 Pharm Management | thiazide-diuretic; consider ACEI, ARB, BB, CCB, or combo |
| HTN Stage 2 Pharm Management | 2 drug combo; usually thiazide type diuretic + ACEI, or ARB, or BB, or CCB |
| Recommended Meds for HTN + Heart Failure | thiazides, BB, ACEI, ARBs, aldosterone antagonists |
| Recommended Meds for HTN + Post MI | BB, ACEI, aldosterone antagonists |
| Recommended Meds for HTN + ^CVD risk | thiazides, BB, ACEI, CCB |
| Recommended Meds for HTN + DM | thiazides, BB, ACEI, ARBs, CCB |
| Recommended Meds for HTN + CKD | ACEI, ARBs |
| Recommended Meds for HTN + Recurrent stroke prevention | thiazides, ACEI |
| Examples of BBs... | "~ol"...Propranolol (Inderal), Atenolol (Tenormin), Nadolol (Corgard), Acebutolol (Sectral) |
| BBs are usually effective with... | ~African Americans ~migraines ~angina ~part of 1st line therapy or in combo with diuretics |
| Examples of CCBs... | "~ine"...Diltiazem (Cardizem), Verapamil (Calan/Isoptin SR), Amlodipine (Norvasc), Nicardipine (Cardene SR), Felopidine (Plendil) |
| CCBs are usually effective with... | ~Caucasians ~monotherapy when BBs are contraindicated ~A-Fib/Tach ~migraines ~DM |
| An example of a Loop Diuretic is... | Furosemide (Lasix) |
| Examples of ACE inhibitors... | "~pril"...Captopril (Capoten), Enalopril (Vasotec), Benzapril (Lotensin), Ramipril (Altace) |
| ACE inhibitors are effective with... | ~Caucasians <65 yrs old ~usually drug of choice with DM ~***watch for cough and bronchospasms, if cough occurs switch to ARB |
| Examples of Adrenergic inhibitors... | Clonodine (Catapress), Methyldopa (Aldomet), Prazosin (Minipress), Labetalol (Normondyne/Trandate), Carvedilol (Coreg) |
| What classifies a Hypertensive Urgency? | B/P S >220 or D >125 or symptomatic patients with S >200 & D >120 (or lower) + H/A, heart failure, angina, etc |
| Management of Hypertensive Urgency | Oral therapy...Clonodine (Catapress), Captopril (Capoten), Nifedipine (Procardia), loop diuretics, etc...*parenteral therapy is rarely required |
| What classifies a Hypertensive Emergency? | D > 130...immediate pressure reduction (within 1 hour) to prevent or limit target oragn damage |
| How is Hypertensive Emergency managed? | IV agents (Hydralazine/Apresoline)...*avoid rapid drop, may result in cerebral infarction |
| Stable Angina | classic or chronic- exertional(most common) |
| Printzmetal's Angina | variant- occurs at various times, including rest |
| Unstable Angina | pre-infarction, rest or crescendo, coronary syndromes |
| Microvascular Angina | metabolic syndrome |
| Management of Angina | ~reduction of risk factors ~lowering LDL ~low dose of EC ASA (81mg) daily ~nitrates ~BBs ~CCBs |
| If rest and Nitro don't work what is the probable diagnosis? | MI |
| MI PE findings... | ~dysrhythmia common ~presence of S4 common ~wheezing ~rales 2' to edema ~low grade fever first 48 hours ~tachycardia |
| ST elevation in MI = | infarct |
| ST depression in MI = | ischemia |
| DVT sx's... | ~sudden onset of pain (superficial) ~pain or tenderness esp when walking (deep) ~pain may be dull, achey or tight feeling (deep) |
| DVT PE findings... | ~localized heat ane erythema (superficial) ~*edema distal to occulsion (deep) ~low temp ~palpable cords in calfs ~skin may be cyanotic if severe ~skin cool |
| Management of "Superficial" DVT... | ~elevation ~warm compress ~non-steroidal agents ~D/C oral contraceptives |
| Management of "Deep" DVT... | ~bed rest & elevation until local tenderness subsides (7-14 days) ~walking slowly reintroduced ~Anticoagulants> Lovenox, Heparin, Coumadin with MD consult |
| What is Peripheral Vascular Dz? | arteriosclerotic narrowing of the lumen of arteries resulting in decreased blood supply to extremities |
| Sx's of PVD... | ~calf pain (claudication) *usually 1st sx ~cold/numb extremities ~progression to pain at rest |
| PVD PE findings... | ~*shiny hairless skin ~pallor (when LE elevated) ~cyanosis ~ulcerations ~dependent rubor (redness when LE is down) ~reduced pulses |
| What is DVT... | partial or complete occlusion of a vein by a thrombus with inflammation to the vessel wall |
| What is Chronic Venous Insufficiency? | impaired venous return due to destruction of valves or changes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure (CHF) |
| Sx's of Chronic Venous Insufficiency... | ~aching LE relieved by elevation ~edema after prolonged standing ~night cramps of LE |
| Chronic Venous Insufficiency PE findings... | ~*trophic changes with brownish discoloration ~stasis leg ulcers ~edema of LE ~dermatitis ~cool to touch |
| Management of Chronic Venous Insufficiency... | ~bedrest with LE elevated ~TED hose ~wt reduction if obese ~treatment of dermatitits or ulcers if indicated |
| What is the action of ACEI's | expansion of blood vessels and decrease of resistance by lowering levels of angiotensin II. Allows blood to flow more easily & makes work easier for the heart |
| What is the action of ARB's (Beta-Andrenergic Blocking Agents)? | keeps blood pressure from rising by prevention Angiotensin II from having any affects on the heart |
| What is the action of BB's? | decreases the heart rate and cardiac output; makes the heart bet more slowly and with less force |
| What is the action of CCB's? | interupts movement of Ca+ into cells of the heart and blood vessels; may decrease the heart's pumping strength and relax blood vessels |
| What is the action of diuretics? | rids the body of excess fluids and Na+ through urination; helps relieve workload of the heart |
| What is the action of vasodilators (nitrates)? | relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload; often given to pt's who can't tolerate ACE |
| What is the action of digitalis (digoxin)? | increases the force of the heart's contractions, which can be beneficial in systolic heart failure and for irregular heart beats |
Created by:
KimmiNP
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