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75 Cards in this Set
- Front
- Back
What is cardiac output (CO)?
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hearts ability to pump blood systemically is measured by CO
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CO=?
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heart rate (HR) x stroke volume (SV)
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What is stroke volume?
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amount of blood pumped out of the ventricle with each contraction
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What are modifiable risk factors?
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weight, social activities (smoking, drinking), diet, exercise
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What are non-modifiable risk factors?
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age, gender, family hx, race
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What are the clinical manifestations of adults with alterations in cardiac output and tissue perfusion?
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chest pain, dyspnea, peripheral edema, wt gain, fatigue, dizziness, syncope, changes in LOC
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What is diastole?
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relaxation phase, simultaneous
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What is systole?
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contraction of the atria and ventricles, not simultaneous
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What is the primary pacemaker of the heart?
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sinoatrial (SA) node
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What is preload?
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degree of stretch of the ventricular cardiac muscle fibers at the end of diastole
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What is afterload?
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resitance to ejection of blood from the ventricle
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What is contractility?
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force generated by the contracting myocardium
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What are the priority nursing actions for a pt with an alteration in cardiac output and tissue perfusion?
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monitor VS, auscultate heart for sounds and rhythm, monitor ECG for dysrhythmias, watch for trends in VS/hemodynamics, assess labs and cardiac biomarker, measure UO, observe and monitor for changes in skin color and temp, nail beds, lips, ears, extremities and buccal mucosa, administer prescribed meds, record pain, consult with nutrition
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What is coronary artery disease?
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atherosclerosis of the inner lining of the blood vessels that supply blood to the heart
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Medications for CAD
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HMG-CoA or statins, nicotinic acids, fibric acids, bile acids, cholesterol absorption inhibitor
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What is prescribed with every chest pain?
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MONA-morphine, O2, Nitro, ASA
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What is the difference between angina and a heat attack?
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angina will be relieved by rest and nitroglycerin
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What is angina?
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syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest by insufficient coronary blood flow
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What are the types of angina?
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Stable angina, unstable angina, intractable or refractory angina, variant angina, and silent ischemia
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What are the clinical manifestations of angina?
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chest pain, radiation to neck, jaw, shoulders or inner arm, weakness or fatigue, parasthesia in arms, wrists and hands, anxiety, SOB, pallor, dizziness, NV
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What are the education/safety needs for the angina patient?
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educate on nitrate admin, side effects and contraindications, teach when to report pain, teach when to call MD, educate on activities to avoid and rest periods, educate on risk of antiplatelet/anticoagulant medications
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Medications for angina:
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Nitrates, beta blockers, calcium channel blockers, antiplatelet, ASA, Plavix, Ticlid, Reopro, anticoagulant, heparin, Lovenox
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Time=
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muscle
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What is an MI
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acute onset of angina caused by an interruption in coronary artery blood flow which causes prolonged oxygen deprivation and permanent myocardial tissue death
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What are the education/safety needs for the MI patient?
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obtain 12 lead ECG, assess pain, administer meds, reassure patient on task performing and fears, teach what will be done next, keep family informed
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Medications for MI
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ASA (keeps platelets from sticking), nitroglycerin (vasodilation), morphine (IV), IV beta blocker or ACE inhibitor, platelet-inhibitors/thrombolytics, analgesic, supplemental O2
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What is HF (heart failure)
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inability of the heart to pump enough blood to meet the needs of the tissues for oxygen and nutrients supplied by the blood. AKA CHF
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systolic heart failure
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inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract
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diastolic heart failure
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inability of the heart to pump sufficiently because of an alteration in the ability of the heart to fill
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Congestive heart failure
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ineffective heart pump, fluid overload, inadequate tissue perfusion, reversible, progressive, lifelong, systolic or diastolic
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Right sided HF
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RV cannot eject sufficient amounts of blood and blood backs up in the venous system/peripheral tissues and viscera
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What does right sided heart failure result in?
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peripheral/dependent edema, hepatomegaly, ascites, JVD, anorexia, nausea, weakness and wt gain
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Left sided HF
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LV cannot pump blood effectively to the systemic circulation, pulmonary venous pressures increase
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What does left sided HF result in?
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pulmonary congestion with dyspnea, cough, crackles and impaired O2 exchange, extra heart sounds may occur (S3 or ventricular gallop), oliguria/nocturia, pale/ashen skin, cool/clammy, palpitations, weak pulses
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How does HTN affect afterload, BP and fluid volume?
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BP increases, afterload increases and fluid volume increases
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Management of HF includes:
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eliminate/reduce etiologic or contributory factors, reduce workload of the heart by reducing afterload and preload, optimize pharm and therapeutic regimens, prevent acute exacerbations of HF, supp O2, promote healthy lifestyle
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What oral meds are used for HF therapy?
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ACE inhibitors, ARBs, hydralazine and isosorbide dinitrate, beta-blockers, diuretics, digitalis, CCBs
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What does digitalis do for HF?
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increases the force of contraction
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What do CCBs (calcium channel blockers) do for HF?
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vasodilation and decreases HR
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What IV meds are used for HF therapy?
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Nesiritide(Natrecor), Milirinone(Primacor), Dobutamine(Dobutrex), Inotropin(Dopamine)
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The IV medications Nesiritide(Natrecor), Milirinone(Primacor) and Dobutamine(Dobutrex) are:
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+ inotropes. These will increase the force of contraction
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Why is inotropin (Dopamine) prescribed for a patient with HF?
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at low doses, it will increase renal perfussion
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As a nurse, what patient teaching will be done for the patient with HF?
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Take meds as prescribed, low Na diet and fluid restriciton, monitor for signs of excess fluids, hypotension, daily wts and symptoms of disease exacerbations, stress management, avoid ETOH, cease smoking, prevent infection, know when and how to contact HCP, include family in teaching
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What is pulmonary edema?
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abnormal build up of fluid in the air sacs of the lungs which leads to shortness of breath
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Is pulmonary edema chronic or acute?
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it is an acute event that results from left ventricular failure
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What are some causes of pulmonary edema?
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HF, poisonous gas, severe infection/sepsis, med side effects, major trauma, kidney failure, complications of MI, narrowed heart valves, cardiomyopathy
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What are s/s of pulmonary edema?
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restlessness, anxiety, sense of suffocation, cyanotic nail beds, ashen skin, cold and moist skin, weak and rapid pulse, confusion, stupor, JVD
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How is pulmonary edema managed?
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O2 therapy, morpine, diuretics, IV vasodilators
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What is the nurses role in education/safety needs for PE?
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recognize s/s, proper positioning, assist in reducing anxiety and fear, observe for adverse effects of treatment, monitor O2 sats, continually monitor ECG
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What is PVD?
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refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain
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What is PAD?
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a condition of the blood vessels that leads to narrowing and hardening of the arteries that supply the legs and feet
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What is the purpose of the continuous-wave Doppler ultrasound?
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detects blood flow combined with computation of ankle or arm pressures, helps characterize the nature of PVD
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What are the s/s of PVD/PAD?
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whooshing sound with stethoscope over artery (arterial bruits), decreased BP in affected limb, loss of hair on legs or feet, weak or absent pulses in limb
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What is the s/s of PVD/PAD that is severe?
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withering calf muscles, hair loss over toes and feet, painful non-bleeding ulces on feet or toes that are slow to heal, paleness of skin or blue color of toes or foot, shiny tight skin, thick toenails
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What treatments/medications are used to treat patients with PVD/PAD?
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antiplatelet agents, Cilostazol, cholesterol lowering medications, pain relievers, surgery
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As a nurse, what will you teach to a patient with PVD/PAD?
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modify risk factors, take meds as directed, avoid vasoconstriciton, lower extremities below level of the heart (to increase arterial blood supply), elevate extremities if venous in nature, encourage walking/ROM, discourage standing still or sitting for prolonged periods, maintain warmth, instruct ways to avoid trauma, written instructions on care of extremities and proper fitting of clothes, administer vasodilators and adrenergic blocking agents as prescribed
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What is Buerger's Disease?
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AKA Thromboangiitis Obliterans-recurring inflammation of intermediate and small arteries and veins of the lower and upper extremities, autoimmune disorder
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Progressive occlusion of vessels in Buerger's Disease results in?
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pain, ischemic changes, ulcerations and gangrene
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Risk factors for Buerger's Disease:
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men ages 20-35, tobacco use
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What is Raynaud's Disease?
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intermittent arterial vasoocclusion, usually in fingertips and toes
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What are the s/s of Raynaud's disease?
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sudden vasoconstriction results in color changes, numbness, tingling and burning pain
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What is HTN?
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systolic BP > 140mmHg and diastolic BP > 90mmHg based on average of 2 or more accurate BP taken during 2 or more contacts with HCP
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What are education/safety needs for adults with HTN?
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reduce wt, adopt DASH, Na reduction/restriction, increase physical activity, moderation in ETOH and tobacco consumption, teach pt that HTN can increase risk for other cardiovascuar problems
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What is a hypertensive emergency?
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BP > 180/120 and must be lowered immediately to prevent damage to target organs
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What is a hypertensive urgency?
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BP very high but no evidence of immediate or progressive target organ damage
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What are the therapeutic goals for a hypertensive emergency?
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reduce BP 25% in first hour, reduce to 160/100 over 6 hrs, gradual reduction to normal over a period of days, medications such as IV vasodilators, frequent monitoring of BP and cardiovascular status
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What are the therapeutic goals for a hypertensive urgency?
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close monitoring of BP and cardiovascular status, assess for potential evidence of target organ damage, fast-acting oral agents (labetalol, captopril, clonidine)
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What is postural (orthostatic) hypotension?
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low BP that occurs when the pt assumes an upright posture
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Postural hypotension can result in:
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dizziness, lightheadedness, or fainting
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What are the causes of postural hypotension?
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dehydration, blood loss, poor autonomic and vascular constriction mechanisms
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How do we assess for postural hyptoension?
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position pt supine and flat for 10 min before taking initial BP, position pt sitting on bed with feet dangling and wait 1-3 minutes before taking next BP, have pt stand next to bed, wait 1-3 min before taking next BP
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What is the normal postural response that occurs when a person stands or sits up from a lying position?
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HR increases 5-20 bpm above resting HR, unchanged systolic pressure or slight decreas of up to 10mmHg, slight increase of 5mmHg in diastolic pressure
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What is shock?
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condition in which a tissue perfusion is inadequate to deliver O2, nutrients to support vital organs, cellular function, affects all body systems
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What is hypovolemic shock?
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decrease intravascular volume by 15-30%, loss of 750-1500mL of blood in a 70kg person, caused by fluid losses externally or fluid shifts internally
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How is hypovolemic shock managed?
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treat underlying cause, fluid/blood replacement, redistribute fluid, pharm therapy, nurses administer blood/fluid safely, implement other measures
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