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PVCC NUR171
Exam #2
| Question | Answer |
|---|---|
| CO | Cardiac output, the mechanical efficiency, volume of blood. |
| SV | Stroke volume. The amount of blood ejected from the ventricle with each heartbeat. |
| Goal with cardiac issues | Decrease SVR and control CO |
| Preload | The amount of blood in the ventricles at the end of diastole |
| Afterload | Peripheral resistance against which the ventricle must pump. |
| Afterload is affected by... | The size of the ventricle and arterial BP. |
| Contractility | Force of ejection. |
| Artioventricular valves | tricuspid and mitral |
| Semilunar valves | pulmonic and aortic |
| Heart sound S1 | Closing of the AV valves at the end of systole |
| Heart sound S2 | Closing of the semilunar valves |
| Coronary vessels | Supply blood to the heart |
| Coronary veins drain into... | The right atrium. |
| Pacemaker of the heart | Sinoatrial node |
| Backup pacemaker | Atrioventricular node |
| Ions needed for electrical stimuli of the heart muscle | Na, K, and Ca |
| Hyperkalemia has (greater or lesser effect?) than Hypokalemia on heart rhythm. | Hyperkalemia is worse. Can cause severe dysrhythmias. |
| First diagnostic test for cardiac issues. | EKG or ECG |
| EKG may detect | electrolyte and conduction abnormalities. |
| Ejection Fraction | Percentage of ventricular blood pumped out. |
| Normal ejection fraction | 60-70% |
| Factors affecting blood flow | Force of contractions and volume of blood |
| Arteriosclerosis | Changes in the arteries that leave the vessel less elastic (harder) |
| Atherosclerosis | Build up of junk in the arterial lumen. Causes turbulence and blockages. |
| Most common cause of morbidity and mortality in geriatrics. | CAD r/t atherosclerosis, HTN, CHF. |
| Post menopausal women are 3x more likely to have .... issues. | Cardiac issues. Due to estrogen levels. |
| Signs of altered cardiac function | V/S, decreased peripheral pulses, abnormal heart sounds, peripheral or pulmonary edema, pallor, cold extremities, decreased O2 sat, fatigue, dizziness, diaphoresis, altered LOC, SOB, tachypnea, angina, JVD, clubbing |
| CK-MB | Cardiac marker that reflects damage to cardiac muscle. |
| Troponin | Specific for proteins released with MI |
| Labs for suspected MI, and frequency of lab draws. | Cardiac Enzymes (CK-MB and Troponin) drawn q 8 hrs x3. |
| CXR | Noninvasive x-ray of chest. No consent needed. |
| Echocardiography | Blood flow through the heart. Detect valvular function, wall motion, congenital defects, ejection fraction |
| Nursing implications for Echocardiography | Place patient in supine position on left side. |
| Drug given to patients for stress test when the are unable to get on the treadmill. | Dobutamine |
| Holter Monitoring | Records EKG for 24-48 hrs, pt keeps a diary and correlates S/S with rhythm changes. |
| Nursing implications with EKG | Inform pt there will be no discomfort. Assure privacy. Prepare skin, avoid moving to eliminate artifact, verify lead placement. |
| Nuclear Scanning (Cardiolite Scanning) | RADIOACTIVE ISOTOPE injected. Pt exercises to circulate isotope. Isotope is taken up in the area of MI. Two phases of test: rest and stress |
| Nursing implications with Nuclear Scanning (Cardiolite Scanning) | Hold all Caffeine/light meal between phases. |
| Cardiac Catheterization | Locate and assess severity of blockage, collateral circulation and LV function |
| PCI | Mechanical re-perfusion by angioplasty/stent. |
| Nursing Implications for Cardiac Catheterization | NPO prior to procedure. POST-OP: monitor EKG, Assess bleeding/bruising, pulses distal, v/s, usually bedrest 6-12 hrs after, EXTEND extremity 4-6 hrs after, give FINGER FOODS at 15 degree angle, observe for aspiration. |
| What should the RN do if bleeding is observed post-op after a cardiac catheterization. | Notify the PCP. Bleeding is not normal following this procedure. |
| Pre-op nursing implications for Cardiac catheterization and PCI | Consent, check for iodine sensitivity, NPO, PT education: watch for bleeding, report and numbness, tingling or cold extremities following the procedure. |
| Post-op nursing implications for Cardiac Catheterization and PCI | Assess circulation Q 15 mins for 1 hour. Assess catheter insertion site Q 15 mins for 1 hr. Keep accessed leg straight, monitor V/S, pt on bedrest. |
| Primary or essential HTN | Cause unknown |
| Secondary HTN | Hypertension caused by other disease processes. |
| #1 cause of mortality in women | Cardiovascular disease |
| Prehypertensive BP | Systolic 120-139 |
| Optimal BP | 110/70 |
| Drugs that cause hypertension | Estrogen, birth control pills, corticosteroids. |
| HTN organ damage effects... | Cardiac (CAD, MI, hypertrophy, CHF). Stroke, dementia, renal disease, retinal damage (blindness), PVD |
| Malignant HTN | Severe, emergent HTN crisis. Over 250/110. |
| Risk Factors for HTN | Family hx, obesity, smoking, ETOH, Stress, poor diet (sodium), African American decent, DM, ESRD. |
| Recommended sodium daily intake | 2 grams |
| DASH diet | Control or prevent HTN. High in fruits, vegetables, grains. Low fat dairy, lean meats, minimize sweets, control Na (2grams/day) |
| Nursing implications for HTN | Assess BP in both arms and orthostatic BPs. Educate on HTN and implications, teach how to take meds on schedule and don't stop suddenly, drugs control not cure, drug info, diet, exercise, smoking cessation... |
| Ischemia | Cells temporarily deprived of blood supply. Occurs when demand for oxygen exceeds the supply. May be asymptomatic, no heart damage. |
| Infarction | PERSISTENT ischemia or COMPLETE occlusion of a coronary arterty = heart attack. Actual heart damage occurs, irreversible. |
| Acute Coronary Syndrome (ACS) | Ischemia is prolonged and not immediately reversible. Leads to infarction. |
| Causes of ischemia | Spasm, increased lipids, increased blood viscosity, clot, aneurysm. |
| Primary cause of CAD | Atherosclerosis |
| Causes of CAD | Atherosclerosis, endothelial injury, aging, HTN, inflammation. |
| CAD risk factors | Family tx, hyperlipidemia, ETOH consumption, sedentary lifestyle, obesity, DM, Cigarette smoking, HTN, High cholesterol. |
| Reversible ischemia manifested by... | Anginal chest pain. |
| Angina | Chest pain from myocardial ischemia |
| NitroSL administration | 1 nitro, 5 mins apart x3 *If angina doesn't stop it may be MI. |
| S/S of angina | Burining in epigastric area, squeezing in chest, radiating pain to left jaw/arm. |
| (B) MONA | Medication order for angina. B-beta blockers, M-morphine, O-oxygen, N-nitrates, A-aspirin |
| Left sided heart failure | Blood backs up in the lungs. |
| Right sided heart failure | Blood backs up into venous circulation |
| Causes of CHF | HTN, COPD, age, previous MI. Can be acute or chronic. |
| S/S of left sided heart failure | Crackles, SOB, decreased O2, increased respiratory rate. |
| Cardiomegaly | Left ventricle becomes enlarged due to compensatory mechanisms (Ventricular dilation and Ventricular hypertrophy) in CHF |
| Heart failure compensatory mechanisms | Ventricular dilation (to increase CO). Ventricular Hypertrophy, Increased SNS, Neurohormonal response (renin-angiontensin) |
| Clinical manifestations of Heart Failure | Fatigue, dyspnea, tachycardia, edema, nocturia, chest pain, pulmonary edema |
| Complications of Heart Failure | Pulmonary edema, pleural effusion, dysrhythmias, LV thrombus, hepatomegaly |
| Nursing implications for Heart Failure | Monitor daily weights (no order needed), check back for edema, High Fowler's position (or what pt perfers), monitor O2, V/S, I&O, reduce anxiety, teach Na+ restriction |
| A client has COPD and elevated pulmonary vascular resistance. What type of HR can result? | Left sided |
| Most common abnormal rhythm | A-fib, especially after cardiac surgery (stent, cardiac cath, open heart surgery) |
| Drug tx for A-Fib | Heparin (blood may pool = clot) LMWH, coumadin |
| Comadin tx time-frame for 1)PE or DVT 2)after surgery 3)chronic A-Fib | 1)9 months 2)6 months 3)For life |
| Cranberry juice causes false reading of....(drug level) | Coumadin levels |
| Biggest risk with A-Fib | Risk for clot formation |
| Atherosclerosis | Plaque build up occludes lumen of blood vessel |
| Risk factors for atherosclerosis | Smoking, hyperlipidemia, HTN, DM, Obesity, lack of exercise, stress |
| Intermittent claudication | Muscle pain with activity, resolves with rest. |
| S/S of Peripheral Arterial Disease | Intermittent claudication, paresthesia, skin (blanching with elevation, redness when dependent. Loss of hair). Decreased pulses, cold/pale extremity. |
| Complications of PAD | Ischemic ulcers, gangrene, amputation |
| How often should the RN check pulses on a patient with PAD | Every shift, compare bilaterally. |
| Nursing interventions for PAD | Elevate legs (promote circulation *not above heart*), repositioning, maintaining skin integrity, pain control. |
| Education for Pt with PAD | Nutrition (control weight, low Na+), Exercise (rest when pain occurs then resume), Ginkgo biloba seems to help with claudication (be careful if also taking anticoagulants). |
| Raynaud's Disease | Vasospastic, episodic arterial insufficiency. Responds to cold, stress, caffeine, tobacco. |
| Nursing implications for Raynaud's disease | Wear gloves, loose clothing. Stress reduction, avoid caffeine and smoking. If episode is long lasting, notify PCP. |
| Drug tx for Raynaud's | Procardia and Cardizem. |
Created by:
crna2b
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