Term
|
Definition
| The amount of blood volume to the right side of the heart and the muscle stretching that the volume causes. |
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Term
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Definition
| The pressure in the aorta and peripheral arteries that the left ventricle has to pump against to get the blood out. |
|
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Term
| Why can HTN lead to HF and Pulmonary Edema? (afterload related) |
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Definition
| With HTN there's even more pressure/resistance for the left vent to pump against. So HTN causes further decreased CO & blood forward flow. |
|
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Term
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Definition
Amount of blood ejected from ventricles with each beat.
SV = EDV - ESV |
|
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Term
| What is ejection fraction? |
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Definition
Volumetric fraction of blood pumped from ventricles w/ each heartbeat or cardiac cycle.
EF = (SV/EDV) * 100 |
|
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Term
| What's the difference between EF & SV? |
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Definition
| EF is a representation of SV in terms of a percentage. |
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Term
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Definition
|
|
Term
| What factors affect CO? (many different things, just some examples) |
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Definition
| HR, arrhythmias, BP, blood volume, myocardial contractility, etc. |
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Term
| Pathophysiology of decreased CO (how are the brain, heart, lungs, skin, kidneys, pulses affected)? |
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Definition
Brain: decreased LOC
Heart: client complains of chest pain
Lungs: SOB, lungs sound "wet"
Skin: cool and clammy
Kidneys: UO goes down (eventually fail)
Peripheral Pulses: weak/thready |
|
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Term
Arrhthymias are no big deal UNTIL they affect your CO.
Which arrhythmias are always a big deal? |
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Definition
Pulseless Ventricular Tachycardia
Ventricular Fibrillation
Asystole (duh) |
|
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Term
| What is coronary artery disease (CAD)? |
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Definition
| Most common CV disease. Broad term that includes chronic stable angina and acute coronary syndrome. |
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Term
What is chronic stable angina?
What brings this type of pain on?
What relieves it? |
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Definition
Decreased blood flow -> ischemia -> pain
Low O2 causes pain; often r/t exertion
Rest and/or NTG sublingual relieves this pain. |
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Term
| How does (NTG) help treat/prevent chronic stable angina? |
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Definition
| Causes vasodilation that will decrease preload and afterload; will also dilate coronary arteries increasing blood flow to the myocardium. |
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Term
| How often do you take NTG? |
|
Definition
1 every 5 minutes and up to 3 times if not relieved.
AHA says call 911 if not relieved by first NTG. |
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Term
| Is it okay to swallow NTG? |
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Definition
|
|
Term
|
Definition
| Keep NTG in a dark, glass bottle; keep it dry and cool. |
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Term
| Something you should warn client who may be using NTG? |
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Definition
| It may or may not burn/fizz and this is normal. |
|
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Term
| How often do you need to renew your NTG? |
|
Definition
An average of every 3-5 months.
The spray is renewed every 2 years. |
|
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Term
| After client receives NTG, what do you expect their BP to do? |
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Definition
| Decrease r/t systemic vasodilation of venous and arterial systems. |
|
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Term
| How do beta blockers help treat/prevent chronic stable angina (pathophys)? |
|
Definition
Beta blockers block the beta cells, which are the receptor sites for catecholamines (epi & norepi).
Beta block -> decreased contractility -> decreased CO -> decreased workload -> decreased oxygen demand |
|
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Term
| What do beta blockers do to BP, HR, and myocardial contractility? What is the resultant effect? |
|
Definition
| Beta blockers decrease BP, HR, and myocardial contractility resulting in a decrease in the workload of heart. |
|
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Term
| How do calcium channel blockers (CCBs) help treat/prevent chronic stable angina? |
|
Definition
Blood pressure is determined by CO and peripheral resistance and CCBs decrease BP.
Low pressure -> decreased afterload -> decreased workload -> oxygen demand |
|
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Term
| Benefits of CCBs are they _____? |
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Definition
| Decrease afterload and increase blood flow (oxygen) to heart muscle. They also do not block catecholamines like beta blockers do. |
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Term
| Why do we give Acetylsalicylic Acid (Aspirin) for chronic stable angina? |
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Definition
Keep the blood flowing by preventing platelet aggregation.
Usually 81-325 mg dosages. |
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Term
| Client education for chronic stable angina? |
|
Definition
| Frequent rest, don't overeat, no excess caffeine (or similar drugs), dress warmly in cold weather (any temp extreme can precipitate an attack), take NTG prophylactically, smoking cessation, weight loss, avoid isometric exercises (they increase workload), and decrease stress. |
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Term
| Why would we do cardiac catheterization for chronic stable angina? |
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Definition
| The most definitive (and most invasive) way to find out what's going on. |
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Term
Pre-procedure for cardiac catheterization:
What are we asking, assessing, and explaining? |
|
Definition
Cardiac catheterization has an iodine dye so we want to ask about allergies (shellfish) and assess kidney function!
Base assessment for comparison post-procedure.
We are going to explain that the "hot shot" is when they are injecting the dye and we also want to let client know that heart palpitations are normal. |
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Term
Post-procedure for cardiac catheterization:
What are we watching for and how are we caring for patient? |
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Definition
Watch puncture site for bleeding and hematoma formation.
Assess distal extremity to puncture site for the "Five Ps" and compare with base assessment.
Keeping the client on bed rest, flat, with leg straight for 4-6 hours. |
|
|
Term
| What is the major complication post heart catheterization? |
|
Definition
|
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Term
| If the client reports pain following a heart catheterization what are we assuming and what are we doing? |
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Definition
| Assume hematoma/hemorrhage and report the pain immediately to the physician. |
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Term
| What do we do if the client scheduled for a heart cath is on Glucophage (Metformin)? |
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Definition
| HOLD this medication for 48 hours post procedure. (worried about kidneys) |
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Term
CAD: ACS
What is acute coronary syndrome (ACS)? |
|
Definition
| Refers to any group of symptoms attributed to the obstruction of the coronary arteries. (MI & unstable angina) |
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Term
| (ACS) Does the client have to be doing anything to bring this pain on? |
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Definition
|
|
Term
| (ACS) Will rest or NTG relieve this pain? |
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Definition
|
|
Term
| What exactly is going on in a client with ACS? (pathophysiology) |
|
Definition
| Decreased blood flow to myocardium -> ischemia and necrosis |
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Term
|
Definition
Pain: "crushing", "elephant sitting on chest", pressure that radiates to the left arm and jaw, N/V, and/or pain between the shoulder blades.
Decreased BP, cold and clammy skin, or vomiting (r/t to pain). |
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Term
| What is the #1 sign of an MI (ACS) in the elderly? |
|
Definition
SOB! The older you are, the less pain you experience.
Elderly are also the most likely to have behavior/LOC changes. |
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Term
Diagnostic lab work for ACS associated issues:
CPK-MB
Troponin
Myoglobin |
|
Definition
CPK-MB: Cardiac specific isoenzyme; increased with damage to cardiac cells.
Troponin: Cardiac biomarkers with high specificity to myocardial damage.
Myoglobin: Look at these to RULE OUT an MI (negative = no MI). |
|
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Term
| When do CPK-MB, troponin, & myoglobin elevated and peak? |
|
Definition
CPK-MB: Elevates in 3-12hrs; peaks in 24hrs.
Troponin: Elevates within 3-4 hours; Remains elevated for up to 3 weeks.
Myoglobin: Elevates within 1 hour; peaks in 12 hours. |
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Term
| What are the normal troponin isomer (I & T) lab values? |
|
Definition
I-troponin: <0.03
T-troponin: <0.20 |
|
|
Term
| Which cardiac biomarker is the most sensitive indicator for an MI? |
|
Definition
|
|
Term
| Which enzymes or markers are most helpful when the client delays seeking care? |
|
Definition
|
|
Term
| What untreated arrhythmias will put the client at risk for sudden death (ACS)? |
|
Definition
Pulseless Ventricular Tachycardia
Ventricular Fibrillation
Asystole
Bradycardia |
|
|
Term
| What is the priority treatment for ventricular fibrillation? |
|
Definition
|
|
Term
| If the first shock doesn't work and client remains in V-fib, what is the first vasopressor we give? |
|
Definition
|
|
Term
| What is Amiodarone and what is it usually used for in relation to ACS? |
|
Definition
| An anti-arrhythmic that is used for fast arrhythmias and also when V-fib and pulseless VT are resistant to treatment with vasopressors. |
|
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Term
| What anti-arrhythmic drugs are commonly given to prevent a second episode of V-fib? |
|
Definition
|
|
Term
| What are the s/s of lidocaine toxicity? |
|
Definition
Any neuro changes or change in LOC!
Lidocaine numbs you and decreases irritability in the heart. |
|
|
Term
| What is the first anti-arrhythmic of choice and what is an important side effect of it? |
|
Definition
Amiodarone.
An important side effect to watch out for is hypotension, which can lead to further arrhythmias. |
|
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Term
| What drugs are used for chest pain when a client gets to the ED? (remember the mnemonic) |
|
Definition
M-O-N-A
Oxygen
Aspirin
Nitroglycerin
Morphine |
|
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Term
| What position should an ACS client be placed in? |
|
Definition
| Head up position to decrease workload on the heart and increase CO. |
|
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Term
| What is the door to drug time on fibrinolytics and why is it important? |
|
Definition
30 minutes! (Hurst also says within 6-8 hours on same page, so idk)
Dissolve clot -> decrease size of infarction |
|
|
Term
| What are the fibrinolytics? What is the major complication a/w their use? |
|
Definition
The -ase's.
Streptokinase (Streptase)
Alteplase (t-PA)
Tenecteplase (TNKase)
Reteplase (Retavase)
Hemorrhage. Duh. |
|
|
Term
| What kind of things do we want to know about client history (in regards to fibrinolytics)? |
|
Definition
Good bleeding history!
Recent surgeries, strokes, pregnancy, or ulcers. |
|
|
Term
| What are the absolute contraindications for fibrinolytics? |
|
Definition
| Intracranial neoplasm, intracranial bleed, suspected aortic dissection, or internal bleeding. |
|
|
Term
| What are the bleeding precautions (a/w clients on fibrinolytics)? |
|
Definition
Watch for bleeding gums, dark stools, or hematuria.
Use soft toothbrushes, electric razors, and NO intramuscular injections allowed. |
|
|
Term
| What kind of medical interventions are available for clients with ACS? |
|
Definition
Percutaneous Coronary Intervention (PCI)
Coronary Artery Bypass Graft (CABG) |
|
|
Term
|
Definition
| It's a procedure to restore blood flow to the heart vessel. Includes all interventions such as PTCA (angioplasty) and stents. |
|
|
Term
| Major complication of an angioplasty? |
|
Definition
|
|
Term
| If any problem occurs following an angioplasty, what do we do? What if the patient reports chest pain? |
|
Definition
Go to surgery and call physician immediately.
Chest pain following an angio could mean re-occluding and we will want to call physician immediately. |
|
|
Term
| What are the anti-platelet medication? |
|
Definition
Aspirin
Clopidogrel (Plavix)
Abciximab (ReoPro IV)
Eptifibatide (Integrilin IV) |
|
|
Term
| What does the left main coronary artery supply? |
|
Definition
| The entire left ventricle. Left main coronary artery occlusion = think sudden death or "widow maker" |
|
|
Term
| Cardiac Rehabilitation (ACS) |
|
Definition
Smoking cessation
Stepped-care plan (gradual activity increase)
Diet changes: low fat, low salt, low cholesterol
No isometric exercises
No valsalva (client on stool soft)
No straining and no suppository |
|
|
Term
| When can sex be resumed following an MI? |
|
Definition
| When client can walk around the block or up a flight of stairs without discomfort |
|
|
Term
| What is the safest time of the day for sex following an MI? |
|
Definition
| Morning, when well rested. |
|
|
Term
| Best exercise for MI client? |
|
Definition
|
|
Term
| An MI client should be taught s/s of HF, which are? |
|
Definition
| Weight gain, ankle edema, SOB, & confusion to name a few. |
|
|
Term
|
Definition
| Complication that results from cardiomyopathy, valvular heart disease, endocarditis, acute MI, or, the most common, HTN. |
|
|
Term
|
Definition
| Blood not moving forward into the aora and out to the body. If it's not moving forward it will go backward into the lungs. |
|
|
Term
| What are s/s of left sided HF? |
|
Definition
Pulmonary related issues:
Pulm congestion, dyspnea, cough, blood tinged frothy sputum, restlessness, tachycardia, S3 on auscultation, orthopnea, and nocturnal dyspnea. |
|
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Term
|
Definition
| Blood not moving forward into the lungs. If it's not moving forward into the lungs then it goes backwards into the venous system. |
|
|
Term
| What are the s/s of right sided HF? |
|
Definition
| Distended neck veins, edema, enlarged organs, weight gain, and ascites. |
|
|
Term
| What are B-type natriuretic peptides (BNPs)? What do we do if client is on natrecor and we need to draw BNPs? |
|
Definition
Sensitive diagnostic indicators for HF. Can be positive for HF when CXR doesn't indicate a problem. Turn off natrecor 2 hours prior to BNP draw.
Secreted by ventricular tissues in the heart when ventricular volumes and pressure are increased. |
|
|
Term
| What would a CXR show, if positive for HF? |
|
Definition
| Enlarged heart and pulmonary infiltrates (edema/fluid) |
|
|
Term
| What are the standard medication therapies for clients with HF and which is the drug of choice? |
|
Definition
ACE-I & ARBs.
ACE-I are the drug of choice. |
|
|
Term
|
Definition
| Suppress the RAS and result in arterial vasodilation and increased SV. |
|
|
Term
|
Definition
| Block angiotensin II receptors and cause a decrease in arterial resistance and decreased BP. |
|
|
Term
| What do ACE-I and ARBs both do? Why is this important to remember when caring for clients using these medications? |
|
Definition
They both block aldosterone. When we block aldosterone what happens? Na & H20 loss, but potassium retention.
This is important to remember because we need to watch for hyperkalemia in these clients. |
|
|
Term
| What does digitalis (Lanoxin/Digoxin) do and why is it used? |
|
Definition
Increases contractility and decreases HR thereby increasing CO and kidney perfusion.
Used with sinus rhythm or atrial fibrillation and accompanying chronic HF. |
|
|
Term
| What are the normal Digoxin levels? |
|
Definition
|
|
Term
| How do you know that Digoxin is working? |
|
Definition
|
|
Term
| What are s/s of Digoxin toxicity? |
|
Definition
Early: anorexia & N/V
Late: arrhythmias and vision changes |
|
|
Term
| Before giving Digoxin do what? |
|
Definition
|
|
Term
| What electrolyte imbalance can promote Digoxin toxicity? |
|
Definition
ANY electrolyte imbalance can.
Hypokalemia is the most common culprit, though. |
|
|
Term
| When should weight gain be reported (daily)? |
|
Definition
| 2-3lbs in a day should be reported. |
|
|
Term
| If a client has fluid retention, what should you think first? |
|
Definition
|
|
Term
| When should you worry about heart rate changes in regards to pacemakers? |
|
Definition
ALWAYS worry about a decrease in HR, especially if it drops below set point.
It's okay for the rate to increase. |
|
|
Term
| Post-procedure care for clients receiving a pacemaker: |
|
Definition
Immobilize the arm! Most common complication is electrode displacement.
Assisted passive range of motion to prevent frozen shoulder in client.
Do not let client raise arm higher than shoulder height. |
|
|
Term
| What is a loss of capture (pacemaker)? What causes this? |
|
Definition
No contraction following the stimulus.
Electrode displacement, depleted battery, or the pacemaker not programmed properly. |
|
|
Term
| Client education about pacemakers? |
|
Definition
Check pulse daily.
ID card or bracelet all the time.
Avoid electromagnetic fields.
Avoid MRIs
Will set off alarms at airport
Avoid contact sports |
|
|
Term
| Who is at risk for pulmonary edema? |
|
Definition
| Any person: receiving rapid IV fluids, the very young and old, and any person who has a history of CHF or heart disease. |
|
|
Term
| What is happening in pulmonary edema? |
|
Definition
| Fluid is backing up into the lungs because the heart is unable to move the volume forward. |
|
|
Term
| What are the s/s of pulmonary edema? |
|
Definition
| Sudden onset; breathless, restless/anxious, severe hypoxia, and productive cough (pink frothy sputum). |
|
|
Term
| The priority nursing action is to administer _____ to clients with pulmonary edema. |
|
Definition
|
|
Term
| What types of medications are we treating pulmonary edema with? |
|
Definition
Lasix or Bumex to decrease pre/after
Nitroglycerin to decrease afterload
Morphine 2mg IVP to decrease pre/after
Natrecor IV infusion, no longer than 48 hours, for vasodilation & diuretic
Lasix: IVP 40mg over 1-2 minutes.
Bumex: IVP 1-2mg over 1-2 minutes. |
|
|
Term
| How should a patient with pulmonary edema be positioned? |
|
Definition
| Sitting up with legs down to promote pooling in lower extremities. |
|
|
Term
| What is cardiac tamponade (patho)? |
|
Definition
| Blood, fluid, or exudate leak into pericardial sack and compress/squeeze the heart. |
|
|
Term
| What are the s/s of a cardiac tamponade? |
|
Definition
INCREASED cvp and DECREASED BP hallmark
Decreased CO, muffled or distant heart sounds, distended neck veins, all chambers have equal pressure, pulseless paradoxis, or narrowed pulse pressure. |
|
|
Term
| Narrowed pulse pressure we think |
|
Definition
|
|
Term
| Widened pulse pressure we think |
|
Definition
| Increased intracranial pressure |
|
|
Term
| What's a surgical treatment for cardiac tamponade? |
|
Definition
| Pericardiocentesis to drain from around the heart. |
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