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112 Cards in this Set
- Front
- Back
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• Myocardial Infarction tissue damage
-tissue damage is caused by: -tissue that is damaged is the.... |
-oxygen deprevation
-necrosis of myocardial tissue -subendocardial layer of cardiac muscle -zone of injury & ischemia are in the subendocardial layer -can affect all three layers of cardiac muscle= transmural |
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• Mitrial Valve
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blood flows from L.Atrium thru Mitral valve to L.Ventricle during ventricle diastole. blood flow backs up into L. atrium during narrowing with mitral valve disease
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• SA node
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primary pacemaker that sends signal to AV node. spontaneous and repetitive.
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• BP effects of Medications that cause vasoconstriction
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-vasocontriction causes an incr. HR, & BP.
-this increases CO -incr. oxygen demand -can worsen HF if poorly perfused b/c of arteriosclerosis |
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• Risk factors for peripheral vascular disease
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-hypertention -African Americans
-hyperlipidemia -DM -smoking -obesity -genetics -age |
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• Clinical manifestations of arterial insufficiency
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-arterial foot ulcers at end of toe, b/t toes,
-cool, cold feet -decreased or absent pedal pulse -prevent trauma and infection - stress foot care. |
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• Review Vital sign norms
Bp= Temp: oral- armpit- rectum- ox sat: Pulse- Respiration- |
Bp= <120/89
Temp: oral- 98.6 armpit- 98.1 rectum-99.5 ox sat: >95% Pulse-60-100 Respiration-16-21 |
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• Bruits
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swishing sounds from turbulant blood flow thru narrowed or atherosclerotic arteries.
asses by listening to carotid artery while patient holds breath. |
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• Orthostatic hypotension
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dizziness when moved from lying to sitting or standing.
BP checks taken while lying, sitting and then standing. Transient and pass quickly. may be due to postural hypertension |
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• Heart murmur is....
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turbulant blood flow thru normal or abnormal valves.
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• Pacemaker
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1
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• Pathophysiologic process of Increase in preload:
Can Cause: how to decrease: |
heart failure due to the heart being overworked. We can decrease preload by:
nutrition- low sodium, low water retention. drug therapy- diuretics, morphine (pre & after) |
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• Nursing diagnosis for heart failure (3)
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1- impaired gas exchange
2-decreased cardiac output 3- activity intolerance |
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•Arteriosclerosis is the....
Atherosclerosis is the..... |
Arterio- hardening of arterial wall.
Atheros- placque build up ( a type of arterio) |
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• Lovastatin potential risk factors
Should not be used by whom? Discontinue if pts has..... |
-muscle myopathy
-decreased liver function -not for liver disease pts -not while pregnant -discont. if pt has muscle cramps or elevated liver enzymes. |
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• Peripheral arterial disease (PVD)
-What is it. - it is a result of. |
-Change in blood flow through arteries and veins
-can block the flow of blood to the lower extremeties -Atherosclerosis |
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• Anticoagulant treatment for pt with DVT
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-IV heparin
-warfarin -LMWH (lovenox) |
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• Capillary refill
how to do it. what does it indicate |
-squeeze finger or toenail to blanch
-should refill <2 minutes -if it does not = arterial insuficiency |
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• S/S of petechiae
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-pinpoint hemorrhagic lesions on skin
-may only be visible on palms of hands or soles of feet |
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• Pts. At risk for hematological problems
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-elderly= bone marrow function decrease
-mentrating women -drug use -diet -radiation therapy -chemical exposure (house location) -long antibiotic therapy |
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• Medication administration – oral, eyes, ear, injections
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1
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• Dosage
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1
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cyanosis is the....
Caused by..... |
bluish, darkened colour of skin and mucous membrane.
Caused by deoxygenated hemoglobin |
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Rubor is the.....
Caused by.... Indicates..... |
Dusky redness of dependent foot.
Caused by decreased blood flow of peripheral extremity from peripheral cyanosis. indicates arterial insufficiency |
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orthostatic hypertention
how to detect |
supine 3 min. change position to sit then stand checking bp.
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orthostatic hypotention
what happens to bp |
systolic drops slightly or unchanged.
siastolic rises slightly |
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postural hypotention
bp changes are: Causes are: |
systolic decr. of more than 20
diastolic decr of more than 10 Causes: Cardio drugs, BV decrease. age, prolonged bedrest. ANS disorders. |
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Heart murmur assessment. we listen for...
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systolic murmur
=aortic stenosis or mitral regurg. between s1 and s2. diastolic murmur = mitral stenosis & aortic reg. b/t s1 & s2. |
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Apart from the SA node can anything else cause an electrical impulse.
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yes, myocardial ischemia, electrolyte imbalance, hypoxia etc. can generate electrical impulses independently and cause dysrythmias.
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SA node is part of what cardiac electrophysiology?
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Automaticity.
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Excitability is the....
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ability of non-pacemaker heart cells to respond to an electrical impulse.
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SA node, what path does it take for signals.
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SA node top of R.Atrium signal to AV node and bundle of his. signal to perkinje cells which does contraction.
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Pwave is the.....
QRS wave is the... T wave is the.... |
P=atrial depolarization from SA
QRS=Ventricle depolarization. bundle of his, perkinje T=ventricle repolarization |
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preload is....
determined by......... |
stretch of myocard fiber.
by: amount of blood returning to the heart from venous and pulmon. |
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Preload. (starlings law)
Increase in ventricular volume.... |
... incr. muscle length & tension which enhances contraction & stroke volume.
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Heart failure nursing diag #1
1- impared gas exchange: we want to maintain adequate_________ tissue perfusion. |
HF: imparied gas exch.
maintain adequate pulmonary tissue perfusion. |
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Heart failure nursing diag #1
1- impared gas exchange: intervention would be to _____ levels in blood. |
maintain oxygen levels
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Heart failure nursing diag #1
1- impared gas exchange: We promote oxygen levels by implementing _____ ______ in the means of...... |
ventilation assistance. oxygen therapy. monitor RR. HR.& rhythm q 4hrs. Auscul.q1-4hrs. high fowlers. pillows under arms. deep breathing & coughing excer. q2hrs to help oxyg & prevent atelectasis.
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ace inhibitors used for:
brands are: |
heart failure
enalapril, fosinopril, ramipril |
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What do Ace inhibitors do?
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-prevent conversion of angiotensin.
-arterial resistance, dilation, and incr. SV. |
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Ace inhibitors are less effective in whom.
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African americans.
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Ace inhibitors:
Monitor: at risk for low bp are: |
-hyper K in renal pts.
- 1st dose can low BP -elders, start bp of <100. -sodium level of <137 |
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Ace inhibitor education
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-take 1hr b/f or 2 hrs after meals
-do not take with food -do not stop abruptly |
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Ace inhibitor side affects:
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-tach
-angina -Rash -GI upset -renal failure -cough |
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Digoxin is used for what disease process?
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Heart failure
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Digoxin for HF does what?
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-decr. dyspnea
-incr. contractility -reduces HR -slows conduction thru AV node -inhibits sympathetic activity -enhances parasympathetic activity. |
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Digoxin side affects are:
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-dig toxicity(death)
-esp. in elders. (lower dose) -interacts w antacids. -anorexia, fatigue, mental -dysrhythmias. -incr. mortality in women w hf |
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How does a dig tox show up on an ecg?
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-bradychardia
-loss of P wave |
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Digoxin we monitor:
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-apical pulse & rhythm.
-serum dig levels -K levels -angina |
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Diuretics do what in the heart?
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-decrease preload.
-excrete Na & water -decr circulating blood volume. -reducing systemic & pulmonary congestion. |
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Diuretics can be used for?
Some diuretics are: |
-heart failure.
-furosemide(lasix), hydrochlorthiazide |
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Some risk factors for pts taking diuretics are:
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-dehydration
-hypo K. (neuro, muscle weakness, irreg. HR |
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Atherosclerosis is the leading risk factor in what disease?
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cardiovascular disease.
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Atherosclerosis occurs from...
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-blood vessel damage that causes inflammatory response.
-placque builds up and blocks blood flow. |
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Atherosclerosis is caused by:
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-genetic factors
-chronic diseases (DM) -smoking -eating habits -lack of excercise -African american or hispanic -high LDL, low HDL |
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Atherosclerosis symptoms:
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-high BP
-Bruit in larger arteries -high cholesterol -high triglycerides if >150 |
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Atherosclerosis NI:
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-nutrition (cholesterol no more than 300mg daily)
-incr. fibre to 25-35g daily -Drug therapy |
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Atherosclerosis drug therapy is
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cholesterol reducing statins
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Some statin drugs are:
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-lovastatin, simvistatin, atorvastatin. (lower LDL & triglycerides)
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Normal BP is.....
Prehypertention is.... stage 1 hypertension is..... stage 2 hypertention is..... |
N=120/80
Pre= 120-139/80-89 Stage 1= 140-159/90-99 Stage 2= >160/>100 |
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Hypertention risk factors:
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-African American
-men until age 45 then women -diet, excercise etc. |
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Hypertention drugs are:
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-Diuretics (loop, thiazide, K sparing)
-Blockers (ca channel, Beta, -Ace inhibitors -Arb's -aldosterone receptor antagonists. |
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Thiazide Diuretics:
Drug example. What do they do. |
-hydrochlorothiazide
-prevent Na and water retention -promote K excretion |
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Loop diuretics
Drug example What do they do |
-Furosemide
-slows Na reabsorption -promotes Na & K secretion |
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K sparing diuretics
Drug example What do they do |
-spironolactone
-inhibits Na reabsorption in exchange for K. |
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CAD is a broad term which encompasess which disease process'
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1-Chronic Stable angina
2-Acute coronary syndrome -unstable angina -MI |
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CAD Modifiable & non-modifiable risk factors:
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-Atherosclerosis
-Genetic -lifestyle choice -smoking -obesity -hypertension -Alcohol -DM & stress -large waist size. |
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CAD gender & ethnic risk factors:
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-Age in women
-Postmenopausal women -African Americans & hispanics |
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S&S of angina are:
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-chest discomfort
-radiating to left arm -brought on by exertion or stress -lasts less than 15min |
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S&S of MI
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-substernal chest pain radiating to left arm
-pain in jaw, back, shoulder, -happens without cause -nausea -dyspnea -anxiety -SOB |
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CAD drug classifications used are:
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Nitrates(nitroglycerin)
Beta blockers (metroprolol) Antiplatets (aspirin) |
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Nitro for CAD;
What does it do. |
-incr. blood flow
-dilates coronary arteries -decr. oxygen demand by peripheral dilation. -therefore decr. preload & afterload |
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Nitro transdermal patch:
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-used for chronic stable angina
-rotate sites and educate on headache possibility |
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Beta blocker for CAD:
Name some: What do they do> |
-metroprolol(lopressor)
-slow HR -decrease force of contraction |
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Antiplatets for CAD:
Name some: What do they do: |
Aspirin
-inhibits platelet aggregation -inhibits vasodilation -decreases odds of clots |
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PVD
-inflow obstructions involve the____. -outflow obstruction involves the ______ |
inflow- distal end of the aorta
outrflow- femoral, popliteal, tibeal arteries |
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PVD - assoc with each stage are:
Stage1- Stage 2- Stage 3- Stage4- |
1- asymptomatic
2-claudication 3-rest pain 4-necrosis |
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DVT
What is it: Caused by: |
-blood clot formation
-can lead to Pulmonary embolism -enothelial injury -venous stasis -hypercoagulability |
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DVT
Pts at risk: |
-recent surgery
-age -obesity -hormonal replacement |
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Myocardium infarction
is... |
-myocardium tissue is abruptly and severly deprived of oxygen.
-blood flow is quickly reduced -ischemia = injury or necrosis of myocardial tissue. |
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MI is usually the result of...
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Atherosclerosis of the coronary artery
-rupture of the plaque -thrombosis and blockage of blood flow |
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BP/vasoconstriction meds
Stroke volume improved which stretches_____ Starlings law= |
-myocardial fibers causing dilation.
-incr myocardial stretch= forceful contraction = incr SV & CO |
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HF & MI
common causes... |
-hypertension
-cardiac infarctions -CAD -cardiomyopathy -substance abuse -vulvular disease -congenital defects -dysrythmias -DM -smoking -hyperkinetic conditions (thyroid) |
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HF/MI
Client history What to find out.... |
-activity tolerance
-unusual fatigue -Normal ADL's -Chest discomfort -cough -frothy pink sputum -S3/S4 gallop -swollen extremeties -incr. blood pressure |
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Anemia (ethnic)
Sickle cell typically in______ G6PD occurs in ___% of ____ Aplastic anemia is ____ |
-Sickle- African Americans
-G6PD- 10%A.Americans -Aplastic - hereditary |
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Iron deficiency anemia is common in______
Folic acid anemia is caused by: |
-Women, elders, poor diet
-Crohns disease, alcohol abuse |
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Anemia is......
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-reduction of RBC
-amount of hemoglobin -amont of hematocrit |
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Anemia is a ____ ____ not a ____ _______
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-clinical sign
-not a specific disorder |
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G6PD Anemia is.....
caused by: |
- genetic,
-G6PD levels decrease w age -cells break w drug exposure -no symptoms until exposed. -drugs can be toxic to pts. -X-linked recessive enzyme |
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B12 Anemia is.....
starts ____ produces ___symtoms |
-low B12
-rbc's cannot bind to folic acid -which reduces dna synthesis -slow, few symptoms |
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B12 anemia
caused by: patients can present with |
-diet deficiency
-absorption problem -jaundice -glossitis (beefy-red tongue) |
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Aplastic Anemia is....
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-bone marrow is not producing RBC
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Aplastic Anemia
caused by: occurs with.... |
-exposure to toxins
-viral infection -injury to precursor cells -Leukopenia |
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Platelets are the ____ type of ____ _____.
-function |
-3rd type of blood cell
-stick to injured blood vessel walls -stop the flow of blood from injured site -produce clotting agents -stored in the spleen -lifespan of 1-2wks |
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reticulocytes
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-immature RBC
-determine bone marrow function |
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Lab
RBC |
RBC
F: 4.2-5.4 M: 4.7-6.1 D= anemia or hemorrhage I= chronic hypoxia or polycythemia |
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Lab
Hemoglobin (Hgb) |
F: 12-16
M: 14-18 D= same as RBC I= same as RBC |
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Lab
Hematocrit (Hct) |
F: 37-47%
M: 42-52% D=same as RBC I= same as RBC |
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Lab
(MCV) mean corpuscular volume |
80-95
D=iron deficiency I= anemia |
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Lab
(MCH) mean corp. hemoglobin |
27-31
D= same as MCV I= same as MCV |
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Lab
(MCHC) mean corp. hemo. concentration |
32-36
D= iron def. anemia or hemoglobinopathy I=spherocytosis or anemia |
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Lab
WBC |
5,000-10,000
D=long infection or bone marrow suppresion I= infection, inflamation, autoimmune disorder, leukemia |
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Lab
Reticulocyte |
.5-.2%
D=inadequate RBc production I=chronic blood loss |
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Lab
(TIBC) total iron-binding capacity |
250-460
D=anemia, hemorrhage,hemolysis I= iron def. |
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Lab
(FE) iron |
F:60-160
M:80-180 D=iron def. anemia, hemorrhage I=iron excess, liver disorder, megaloblastic anemia |
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Lab
Serrum ferritin |
F:10-150
M:12-300 D:same as iron I:same as iron |
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Lab
Platelet count |
150,000-400,000
D:bone marrow suppression, autoimmune disease, hypersplenism I: polycythemia, malignancy |
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Lab
hemoglobin electrophoresis Hgb A1 Hgb A2 Hgb F Hgb S Hgb C Variations indicate: |
Hgb A1: 95-98%
Hgb A2: 2-3% Hgb F: .8-2% Hgb S: 0% Hgb C: 0% Variations indicate hemoglobinopathies |
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Lab
Direct & indirect coombs |
s/b Negative
positive= antibodies to RBC |
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Lab
(PT) prothrombin time |
11-12.5 sec
D: vitamin K excess I:cloting deficiency of factors V and VII |
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Lab
Bleeding time |
1-9 min
I: inadequate platelet function, clotting factor deficiencies |
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Lab
Fibrin degradation products |
<10
I: intravascular coagulation of fibrinolysis |
