cardiac concepts for exam 2

preload:

myocardial stretch at end of diastole and before contraction

afterload:

pressure or resistance that V to eject blood through valves to peripheral vessels

what are the goals of venous insufficiency?

prevention of infection, edema, decreased and promotes venous blood return, improve wound healing

what are the s/s of left sided hf

- lung fluid - pulmonary edema--> crackles - frothy pink sputum - dyspnea - orthopnea

how do you manage LV, RV, HF?

LV: - pulmonary edema - hemolytic monitoring RV: decrease pulses, CO, JVD drug therapy: - nitrated & dopamin

what are the medication for pericarditis?

NSAIDS, pain meds, steroids (not bacterial) AVOID: aspirin, anticoagulants with risk of cardiac tamponade

What is left sided heart failure?

The most common failure. Backup of blood into the left atrium and pulmonary veins.

what happens to the cardiovascular system as we age?

- decrease pacemaker cells and SA nodes & CO - wide QRS complex - vessels thicken/stiff and increase hypertrophy - decreases sensitivity

what are the heart failure priorities?

- decreased gas exchange due to ventilation/perfusion imbalance - potential for decreased perfusion due to inadequate CO - potential for pulmonary edema due to left sided HF

what are the priorities after ACD interventions?

- managing fluid and elec balance - edema - hypotension - hypothermia - hypertension - managing pain - neuro status - drug rxn

what is left sided HF?

- most common - CHF - decrease tissue perfusion from poor cardiac output and pulmonary congestion from increased pulmonary vessels

what are the s/s of right sided HF

- peripheral edema - weight gain (3lb/day & 5lb/wk) - edema - JVD -abdominal growth (ascites, hepatomegaly, splenomegaly)

what is the goal for managing acute pain?

- profusion improves pain decrease pain and oxygen demand increase perfusion drugs: - nitroglycerin - oxygen admin if sata < 90% - beta blockers (assess BP, HR, Wheeze) - opiates morphine

what does the vascular system do?

- provides a route for blood to travel from the heart to nourish the various tissues of the body - carries cellular wasters to the excretory organs - allows lymphatic flow to drain tissue fluid back into the circulation - returns blood to the heart for recirculation

what are the interventions of reperfusion therapy (no cath lab)

- thrombolytic therapy -fibrinolytic therapy (stemi <30 min of arrival) - tissue plasminogen activator (IPA, alteplase, reteplase)

adverse effects from beta blockers

-bradycardia - breathing problems (wheezing) - worsen HF pts (new edema, worsening crackles, rapid weight gain, new JVD) - blood sugar masking (digoxin masks s/s of low bs)

what are the interventions with increasing myocardial tissue perfusion?

-increase perfusion - improve CO - stable VS and NSR drugs: antiplatelet therapy (325mg chewable aspirin) prevent clots with anticoagulant beta blockers (monitor BP, HR, LOC, chest pain, HF, wheeze)

What is an acute coronary syndrome?

-unstable angina - plaque becomes unstable and ruptures causing thrombus and vasoconstriction

what are the heart medications?

A: ace and arbs B: beta blockers C: calcium channel blockers D: digoxin D: dilators D: diuretics

a client is diagnosed with left sided HF failure. which client assessment findings will the nurse anticipate? a. peripheral edema b. crackles in both lungs c. tachycardia d. ascites e. tachypnea f. F3 gallop

B C E F

what are the diagnostic testing/imaging? what is the normal?

BNP: - 100 or less (normal) - 300+ mild - 600 + moderate - 900+ severe echo hemodynamic analyze

how do you treat infective endocarditis?

IV: cephalosporins/penicillin surgical: remove valve or repair congenital or repair valve or drain abscess

what is treatment for angina pectoris?

Nitroglycerine and rest

what does an NSTEMI look like on and ECG?

ST depression T wave inversion caused by: coronary vasospasm, spontaneous dissection, sluggish blood flow due to vasoconstriction of coronary arteries

how does mitral stenosis cause right HF?

a narrowed mitral valve interferes with blood flow the pressure may increase in the lungs, leading to fluid build up (congestion) and SOB the fluid build up strains the right side of the heart leading to Right sided HF

contractility:

affects stroke volume and cardiac output and force of contraction

when would you see permanent deficits with ACS post CABG?

after 8 hours - intraoperative stroke - abnormal pupil response - seizures - absence of sensory or motor function - coma

What is amiodarone?

an antiarrhythmic/K+ channel blocker slows action potential tx of: A fib w. RVR (rapid ventricular response) SVT, VT, VF AE: HF, AV block. pulmonary toxicity, painful breathing, cough, SOB, weakness in arms/legs, trouble walking, dizziness, lightheadedness assess: BP, RR, apical & radial pulses, renal and LFT

what is the primary factor in the development of CAD?

atherosclerosis

what is metoprolol

beta blocker decreases HR AE: N/V, bradycardia, P hypoT, fatigue, bronchospasms, hyperglycemia, head/dizz, drowsiness, CHF, ED monitor for: ortho BP LFTs, weight daily, avoid alc, rise slowly

deep vein thrombosis (DVT)

blood clot in the peripheral vessels in arms or legs causes: age, CVD, immobilization, valve defective, sedentary More common: surgical: orthopedic (high risk), weight bearing is limited (peripheral pumping problem)

clinical manifestations of pulmonary embolus

chest pain, confusion, dyspnea acute vital signs hypotension depends on level of PE

what are the lab cues for pericarditis? causes? s/s?

elevated WBC + blood cultures st elevationin all leads, AF is common, pericardial effusion

overall physical assessment of cardio:

general appearance, skin, VS decrease perfusion (cool, pale, moist skin) differentiate peripheral vs central cyanosis edema, clubbing, pain, muscle fatigue pulses and bruits heart tones

Atheriosclerosis

hardening of the arteries

cardiac output =

heart rate x stroke volume

interventions with PE or severe DVT

heparin IV followed by warfarin for up to 3 months

what is the number one risk factor for CHF

hypertension

how do you identify and manage dysrhythmias?

identify the rhythm, stable or unstable, and is there chest pain? inferior( bradycardia w ischemia) anterior ACS (ventricular irritability with frequent PVC)

aortic insufficiency

inability of the aortic valve to perform at the proper levels, which results in blood flowing back into the left ventricle from the aorta causes: infectious endocarditis, congenital aortic valve, HTN, marfan's syndrome s/s: dyspnea, palpitations, wide pulse pressure, murmur

what is mitral insufficiency?

incomplete closure of mitral valve causes: MVP rheumatic disease infective endocarditis MI Cardiomegaly marfans syndrome s/s: weakness, dyspnea, chest pain, RHF, JVD, hepatomegaly, edema

what is infective endocarditis?

infection of the endocardium caused by: IV drug use, valve replacement complication causing sepsis ports of entry: oral cavity skin rashes, lesions, abscesses, infections, surgery/procedures

risk factors for DVT:

orthopedic surgery: - #1 hip or knee - prostate - cancer - ulcerative colitis - heart failure - infection - obestity ** all high risk*** - acute MI, CVA, Trauma - prolonged sitting, bedrest lab assessment - d dimer ( < .50)

what are the abnormal heart tones?

pericardial friction rub (inflammation, infection, infiltration) gallops and murmurs ( S3: ventriculuar gallop (<3 failure or ventricular septal defect), S4: atrial gallop ( HTN, anemia, ventricular hypertrophy, MI, stenosis, PE))

what is the treatment for acute cardiac tamponade

pericardiocentesis (remove fluid in pericardial space) drain (temporary) pericardium portion removal (window)

what is a high risk complication of DVT?

pulmonary embolus

what is heart failure?

pump failure inability of the heart to work effectively as a pumo arterial vessels carry O2 to vital organs

tachypnea

rapid respiratory rate with or without the patient realizing

what is infarction

severe ischemia causing cell death of necrosis

what is acute cardiac tamponade? causes? s/s?

small volumes of fluid accumulate in pericardium and sudden decrease in CO causes: pericarditis ventricular wall rupture s/s: JVD paradoxical pulse tachycardia muffled heart tones hypotension

What are telangiectasias?

spider veins are distilled intradermal veins

what are the right HF assessment cues?

systemic congestion fluid retention edema in all extremities, abdominal, all areas nausea and ascites weight gain

what OTC medications should be AVOIDED with chf

think "cann" C: cold and flu meds A: acetaminophen N: antacids N: NSAIDs

risks of CAD:

uncontrolled: gender, age, ethnic, family hx and genetics controlled: smoking, sedentary lifestyle/nutrition, socail hx

What is mitral valve prolapse?

when the mitral valve doesn't close right (valves enlarge and prolapse the LV during systole) causes: marfans congenital defects, genetics s/s: chest pain, dizziness, syncope, palpitations, apex murmurs

is angina progressive?

yes new onset vasospastic pre-infarction myocardial infarction

what are the causes of HF?

- CAD - systemic HTN - MI - valve stenosis most HF begins with failure in the left ventricle and progresses to failure of both ventricles

What are the compensatory mechanisms of the heart

1. cardiac systems tries to compensate for low CO 2. stimulation of SNS results in hypoxia 3. increase HR and CO --> increasing O2 demand 4. receptors increase HR & BP with vasoconstriction

a nurse enters an adult client's room and finds him unresponsive. after determining that the client is not breathing and does not have a pulse, which of the following actions should the nurse take first? a. summon the code team b. begin chest compressions c. administer rescue breathing d. open the client's airways a

A after determining that the client is in respiratory or cardiac arrest the nurse should first summon the code team before initiating CPR

a nurse is caring for a client who develops a ventricular fibrillation rhythm. the client is unresponsive, pulseless, and apneic. which of the following actions in the nurse's priority? a. defibrillation b. airway management c. epinephrine admin d. amiodarone admin

A greatest risk is death from a lack of CO v fib is a lethal rhythm where the ventricle are in a quivering pattern and there is no atrial activity

the nurse is caring for a client with chest pain. what assessment data would cause the nurse to suspect unstable angina? A. st changes B. toponin T 0.6 ng/ml C. pain lasts 15-25 minutes D. increased number of angina attacks E. the intensity of chest pain has increased

A C D E

The nurse is conducting an admission assessment on a male client. which assessment data does the nurse identify as a risk factor for cardiovascular disease? A. BMI of 26 B. BP of 120/66 C. triglycerides 140mg/dL D. moderate exercise for 20-30 min weekly E. exposure to secondhand cigarette smoke F> HX of repeated streptococcal tonsillitis G. Fam hx of cardiovascular disease

A D E G

a nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization, which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury? a. atorvastatin b. metformin c. nitroglycerine d. carvedilol

B metformin interacts with contrast dye and can cause acute kidney disease

a nurse is caring for a client who has infective endocarditis. which of the following manifestations is the priority for the nurse to monitor for? a. anorexia b. dyspnea c. fever d. malaise

B ABC approach is to monitor for dyspnea, as it can be an indication of Left sided HF or a pulmonary infarction due to embolism

a nurse enters a client's room and finds him unresponsive. after notifying rapid response which of the following actions should the nurse take first? a. attach defibrillator pads to the client b. check for carotid pulse c. begin chest compressions d. deliver two breaths

B the first action should check circulatory status before doing other interventions

the nurse is assessing the client's heart sounds. Which instruction will the nurse provide if there is difficulty in hearing sounds? A. Please roll onto your left side B. Lay all the way down on your back C. Please hold your breath while I use my stethoscope D. I will just take your pulse instead

C

a nurse is caring for a client who has atrial fibrillation and is receiving heparin, which of the following findings is the nurse's priority? a. the clients ECG tracing shows irregular HR without P waves B. the client has an aPPT of 80 seconds C. the client experiences sudden weakness of one arm and leg D. the client's urine output is cloudy and odorous

C sudden weakness or numbness of the face and one arm or leg is indication of stroke client may appear confused, slurred speech, loss of balance, dizziness or sudden severe headache

a nurse in an emergency department is caring for a client who present with manifestations that indicate a myocardial infarction. which of the following prescriptions should the nurse take first? a. attach the leads for a 12-lead ECG b. obtain a blood sample c. initiate oxygen therapy d. insert IV catheter

C the greatest risk to the clients safety is myocardial ischemia and cell death, the priority action is to administer oxygen to help minimize this possibility

a nurse in an emergency department is caring for a client who has anaphylaxis following a bee sting, which of the following actions should the nurse take first? a. asses the client's LOC b. admin epinephrine C. auscultate for wheezing d. monitor for hypotension

C when using the ABC approach, the nurse should place the priority on assessing the client's Respiratory status, bronchoconstriction or closure of the upper airway may occur, which places the client at risk for respiratory arrest

a nurse is caring for a client who just returned from the PACU with an IV fluid infusion and an NG tube in place following abdominal surgery. which of the following data is the priority for the nurse to assess? a. the coping ability of the client b. the client's bowel sounds 24-48 c. the surgical dressing d. the patency of the NG tube

C ABC approach--> monitoring surgical dressing hemorrhage is a major complication post op nurse should assess for early indications of bleeding

a nurse is caring for a client who is at risk for shock. which of the following findings is the earliest indicator that this complication is developing? A. hypotension b. anuria (no urine) c. increased RR d. Decreased LOC

C when shock occurs, the body attempts to compensate for the decreased level of oxygenation and tissue perfusion additional compensatory manifest. of shock are: increased HR, decreased urine output and cold clammy skin

a client who is receiving heparin therapy is started on warfarin. which nursing explanation is appropriate? a. you will need to take both drugs long term to provide long term anticoagulation b. warfarin is easier on your stomach so you can take it long term c. it takes several days for warfarin to begin working, so both drugs are required for a short time d. these drugs work the same, but one is taken by mouth, so it is easier to take at home

c. it takes several days for warfarin to begin working, so both drugs are required for a short time

what kind of drug is diltiazam?

calcium channel blocker decreased conduction AE: AV block (prolonged PR interval), bradycardia, hypoT, pul. edema, CHF, dizziness, headache, rash, flushing, fever, chills implications: I &O s/s of CHF daily weight pain lvl assess BP and HR take with meals

What is digoxin?

cardiotonic decreased conduction of electrical impulses tx: SVT, A fib, CHF/HF AE: toxicity, N/V/D, brady/tachy, PVC, bi/trigeminy, visual changes (late sign) asess: BP, AP, lung sounds, JVD, weight, sputum, extremity edema,

assessment of current cardio symptoms:

chest pain (sudden squeeze, stabbing, sharp, achy, dull pressure dyspnea fatigue palpitations syncope leg tenderness (vascular, DVT, arterial occlusion)

What is angina pectoris?

chest pain caused by a temporary imbalance between the coronary arteries ability to supply oxygen and cardiac muscle's demand for oxygen

how do we know if heart med is successful?

clear lung sounds and decreased HR

what is aortic stenosis?

common cardiac valve dysfunction aortic valve narrows and obstructs LV flow during systole causes: wear and tear, congential bicuspid aortic valves, rheumatic disease, atherosclerosis (age) s/s: dyspnea, angina, syncope w exertion

atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries

what causes left sided hf

damage to the myocardium, making the heart weak weak heart= weak pump ischemic heart disease= narrowing =low o2 MI= cant contract

what is the drug therapy for valvular disease

diuretics beta blockers ace inhibitors digoxin oxygen

what is pericarditis? causes? s/s?

inflammation of the pericardium caused: : Immune system response after heart damage due to a heart attack or heart surgery s/s: right HF JVD hepatomegaly, edma, fatigue, SOB, fever, inspiration pain and worse when lying flat, substernal chest pain radiatges to left side of neck/back

what is ischemia

insufficient oxygen to the heart

what can acute coronary syndrome lead to?

left ventricular dysfunction and then lead to HF

interventions with DVT

low molecular weight heparin enoxaparin or daltaparin

what do ace and arbs do

lower BP, vasodilator "relax man" "-pril" -lisinopril -losartan -captopril - ramipril - tandolapril - fosinapril tx for: HTN, CAD, SVT, A fib/flutter, junctional dysrhythmia, chronic stable angina

What do beta blockers do?

lowers HR and BP - ends in -lol - atenlol - carvedilol - metoprolol - sotalol tx for: HTN, AV block, SVT, a fib/flutter, bradycardia, impaired peripheral circulation, stable angina

What do calcium channel blockers do?

lowers HR and BP, decease conduction - "-ine" -verapamil - diltiazem -amlodipine - nifedipine - felodipine - nicardipine tx for: HTN, A fib/flutter, SVT, junctional dysrhythmia, chronic stable angina

mitral stenosis

valve thicken by fibrosis/calcification causes: pulmonary congestion, RHF progesses to LHF S/S: asymptomatic (early), dyspnea, hemoptysis (coughing up blood), pulmonary edema, hepatomegaly, edema, AF

what are the Left HF assessment cues?

weakness SOB chest discomfort pulmonary congestion/fluid filled alveoli nonproductive cough(early) productive cough( severe HF or pulmonary edema)