Beg Med Surg Cardiac And Heart Failure

Front 1

Is CO2 acidotic or alkalinic?

Back 1

acidotic

Front 2

If the lungs cannot get rid of CO2 very well, what would happen to body pH?

Back 2

It would go down

Front 3

What is the biggest artery in the body?

Back 3

Aorta

Front 4

What could cause the heart to shift/move?

Back 4

obesity, ascites, pregnancy

Front 5

ascites

Back 5

excess fluid in the space between the membranes lining the abdomen and abdominal organs (the peritoneal cavity). This is typically caused by liver disease.

Front 6

lubb sound

Back 6

S1
systole

Front 7

What are you hearing during the first, lubb sound?

Back 7

Mitral and tricuspid valves

Front 8

dubb sound

Back 8

S2
diastole

Front 9

What are you hearing during the second, dubb sound?

Back 9

Aortic valve and the pulmonic valve

Front 10

Landmarks for aortic valve?

Back 10

2nd intercostal space, Right sternal boarder

Front 11

Landmarks for pulmonic valve?

Back 11

2nd intercostal space Left sternal boarder

Front 12

Landmarks for tricuspid valve?

Back 12

4th intercostal space Left sternal boarder

Front 13

Landmarks for mitral valve?

Back 13

5th intercostal space, left mid clavicular line

Front 14

Diastolic time is _/_ as long as systolic time

Back 14

2/3

Front 15

S3 sounds like?

Back 15

kentucky/gallup

Front 16

S4 sounds like?

Back 16

mississippi

Front 17

What electrolyte is needed for good heart contraction?

Back 17

calcium

Front 18

That hormone is needed for calcium?

Back 18

Parathyroid hormone

Front 19

What is a cells excitability?

Back 19

more excitable if it can conduct things easier

Front 20

Cells in ___ have the ability to stimulate themselves

Back 20

atrium

Front 21

What is a-fib?

Back 21

atrium cells are all firing

Front 22

hyperthyroidism causes HR to do what?

Back 22

Goes up

Front 23

Hypothyroidism causes HR to do what?

Back 23

Go down

Front 24

Cardiac output

Back 24

How much blood is leaving the heart

Front 25

Heart rate

Back 25

How many times a minute the heart is pumping

Front 26

Stroke volume

Back 26

amount of blood is coming out of the Left ventricle with each contraction

Front 27

Preload

Back 27

Volume of blood in the ventricles at the end of diastole

Front 28

Impedance

Back 28

amount of pressure- blood viscosity

Front 29

Myocardial contractility

Back 29

how well the heart muscle can contract

Front 30

How to calculate cardiac output?

Back 30

HR X Stroke volume

Front 31

Normal resting HR

Back 31

60-100

Front 32

Heart rate is controlled by the...

Back 32

Autonomic nervous system

Front 33

What happens when the vagus nerve in the PSNS is stimulated?

Back 33

It makes the heart go slower

Front 34

What can cause the vagal nerve to be stimulated?

Back 34

valsalva maneuver (bearing down)

Front 35

What will catecholamines, epinephrine, and norepinephrine do to the heart?

Back 35

Increase HR and increase contractility

Front 36

Preload ___ with hypervolemia

Back 36

increases (lots of H2O and IV fluid can increase preload)

Front 37

Starlings Law

Back 37

the more stretch in our heart muscle, the more preload we can have, and the more blood to shoot out

Front 38

What will hypovolemia do to preload amount?

Back 38

decrease the preload amount

Front 39

What will a pt with low preload look like?

Back 39

dehydrated

Front 40

What is the hearts conduction pathway?

Back 40

SA node --> AV node --> Bundle of HIS --> Purkinje Fibers

Front 41

What is the hearts natural pacemaker?

Back 41

SA node

Front 42

what rate does SA node tell heart to beat?

Back 42

60-100

Front 43

what rate does AV node tell heart to beat?

Back 43

40-60

Front 44

what rate does purkinje fibers tell heart to beat?

Back 44

20-40

Front 45

What electrolyte do we worry about losing too much of when on diuretic therapy?

Back 45

Potassium

Front 46

What happens to myocardial contractility during hypoxia?

Back 46

decreases

Front 47

What happens to myocadial contractility during acidosis?

Back 47

decreases

Front 48

What respiratory conditions can cause hypoxia?

Back 48

hyperventilation, COPD, pneumonia

Front 49

What are baroreceptors?

Back 49

receptors that sense if there is low blood volume, they respond to stretch

Front 50

Where are baroreceptors located?

Back 50

in carotid arteries and arch of the aorta

Front 51

What happens if the baroreceptors sense that there is low blood volume?

Back 51

What will increase the Heart rate

Front 52

What type of patients may have problems with baroreceptors not working?

Back 52

pots with arteriosclerosis

Front 53

How does our body help itself if we have low BP?

Back 53

Baroreceptors
Renin angiotensin system
autonomic nervous system
ADH made by pituitary

Front 54

What does ADH do for low BP?

Back 54

It causes the body to decrease the amount of urine produced, leaving more water in the body, and thereby increasing blood pressure

Front 55

What to chemoreceptors do?

Back 55

Respond to CO2 levels, if there is too much CO2 the receptors tell the arteries to vasoconstrict so that more O2 can get around.

Front 56

What effect do chemoreceptors have on the Cardiac and vascular system?

Back 56

Because it causes vasoconstriction, it increases BP to increase, but it also causes HR to go up to try to get rid of the CO2 faster

Front 57

What does aldosterone do to our fluid level?

Back 57

Helps us retain fluid

Front 58

Diet for cardiac pts

Back 58

low sodium
low fat
avoid excessive fluids

Front 59

How much sodium/day should cardiac diets contain?

Back 59

2 gm

Front 60

How much fat/day should cardiac diets contain?

Back 60

triglycerides about 150

Front 61

How much fluid/day should cardiac diets contain?

Back 61

about 2 Liters/day

Front 62

Teaching tip on how to reduce water intake?

Back 62

consume ice instead of water
2 glasses of ice= 1 glass of water

Front 63

how to calculate lifetime smoker amt?

Back 63

packs per day times years smoked

Front 64

Where in the body is BP the highest?

Back 64

Aortic arch

Front 65

Where in the body is BP the lowest?

Back 65

peripheral capillaries

Front 66

Blood Pressure is the...

Back 66

force exerted against the vessel walls

Front 67

Arteries carry blood from...

Back 67

the heart to the body

Front 68

What is DOE?

Back 68

SOB on exertion

Front 69

orthopnea

Back 69

hard to breathe laying down, need to sit up to breathe

Front 70

How to assess cardiovascular system?

Back 70

general appearance
skin
extremities
blood pressure
heart sounds

Front 71

What BP is considered prehypertension?

Back 71

120-139

Front 72

What BP is considered HTN?

Back 72

140/90- even if it's controlled

Front 73

Any BP over 135/85 makes the ____ ventricle work harder and causes the muscle to ______

Back 73

left

harden

Front 74

Serum Markers of Myocardial Damage (6)

Back 74

Troponin—Troponin T and troponin I
Creatine kinase (CK)
Myoglobin
Serum lipids
Homocysteine
Highly sensitive C-reactive protein

Front 75

Serum lipids should be what number?

Back 75

less than 70

Front 76

Serum triglycerides should be what number?

Back 76

<250

Front 77

Serum HDL should be what number?

Back 77

>40

Front 78

Serum LDL should be what number?

Back 78

<130

Front 79

Labs to test for myocardial damage (7)

Back 79

Microalbuminuria
Blood coagulation studies
ABG
F&E
Erythrocyte count
H&H
Leukocyte count

Front 80

Other diagnostic tests for myocardial damage?

Back 80

catheterization
ECG
EPS
stress test
Echo
Myocardial nuclear perfusion imaging

Front 81

Heart failure AKA

Back 81

Pump failure

Front 82

What is heart failure?

Back 82

the inability of the heart to work effectively as a pump

Front 83

What types of heart failure are there? (3)

Back 83

Left-sided heart failure
Right-sided heart failure
High-output failure

Front 84

Left sided heart failure aka

Back 84

congestive heart failure

Front 85

What are 3 typical causes of left sided heart failure?

Back 85

hypertensive
coronary artery
valvular disease

Front 86

Two types of left-sided heart failure:

Back 86

Systolic heart failure
Diastolic heart failure

Front 87

What is Right-Sided Heart Failure

Back 87

Right ventricle not able to empty completely

Front 88

Typical causes of Right-Sided Heart Failure

Back 88

Typical causes—left ventricular failure, right ventricular MI, pulmonary hypertension

Front 89

What does Right-Sided Heart Failure cause?

Back 89

Increased volume and pressure in the venous system and peripheral edema

Front 90

What is High-Output Failure?

Back 90

Cardiac output remains normal or above normal

Front 91

What is High output failure caused by?

Back 91

Septicemia
Anemia
Hyperthyroidism

Front 92

Heart failure is caused by ______ ________ in 75% of cases.

Back 92

systemic hypertension

Front 93

About one third of patients experiencing ____ _____ also develop heart failure.

Back 93

myocardial infarction

Front 94

Structural heart changes, such as valvular dysfunction, cause _____ or ___ ____ on the heart.

Back 94

pressure
volume overload

Front 95

Left-Sided Heart Failure Manifestations

Back 95

Weakness
Fatigue
Dizziness
Confusion
Pulmonary congestion
Breathlessness
Oliuria
Death

Front 96

Right-Sided Heart Failure Manifestations

Back 96

Distended neck veins, increased abdominal girth
Hepatomegaly (liver engorgement)
Hepatojugular reflux
Ascites
Dependent edema
Weight—the most reliable indicator of fluid gain or loss

Front 97

Ascites

Back 97

accumulation of fluid in the peritoneal cavity.

Front 98

Impaired Gas Exchange interventions

Back 98

Ventilation assistance
Position
Oxygen

Front 99

Decreased Cardiac Output interventions

Back 99

Improved and increased cardiac pump effectiveness
Hemodynamic regulation
Drugs that reduce afterload—ACE inhibitors, ARB, human B-type natriuretic peptides

Front 100

Drugs that reduce afterload

Back 100

Angiotension-converting Enzyme (ACE Inhibitors)

Angiotensin II receptor blockers (ARBs)

Front 101

What i s afterload?

Back 101

pressure or resistance the heart has to overcome to eject blood.

Front 102

Interventions That Reduce Preload

Back 102

Nutrition therapy
Drug therapy—diuretics and venous vasodilators
Drugs that enhance contractility—digoxin, other inotropic drugs, beta-adrenergic blockers

Front 103

Nutritional interventions for heart failure

Back 103

reduce sodium intake
monitor/restrict fluid intake
lower cholesterol and saturated fats

Front 104

1 liter of fluid retention is equal to ___ kg

Back 104

2.2

Front 105

Drug therapy for heart failure with fluid overload

Back 105

Diuretics- (Loop, Thiazide, Potassium sparing)

Front 106

What are some loop diuretics?

Back 106

Lasix, Bumex

Front 107

What to monitor for with loop diuretics

Back 107

Blood Pressure and K loss

Front 108

Name of a Thiazide diuretic?

Back 108

Hydrochlorothiazide (HCTZ) (diuril)

Front 109

Name of a potassium sparing diuretic

Back 109

Aldactane

Front 110

Drugs for heart failure without or regardless of fluid overload

Back 110

Venous dilators and drugs that enhance contractility positive inotropic

Front 111

Example of venous dilators

Back 111

nitrites
notroglycerin or isosorbide

Front 112

What is a s/e of venous dilators?

Back 112

headache, low bp

Front 113

Example of drugs that enhance contractility

Back 113

digoxin

Front 114

What to monitor with digoxin

Back 114

Apical pulse (decreases HR so may hold at 60)

toxicity- blurred vision, Mental status changes, fatigue

monitor serum dig levels and K levels for toxicity

Front 115

For Heart failure- beta adrenergic blockers... protoype drug?

Back 115

Metoprolol- for chronic HF not acute

Front 116

Important to monitor with metoprolol

Back 116

BP and HR- MUST KEEP BETWEEN 55-60

Front 117

Troponin T & I

Back 117

These troponins are protein components of striated muscle, and are only found in the heart muscle. Elevation of cTnT or TnI is absolutely indicative of cardiac damage,

Front 118

CK- creatinine Kinase

Back 118

CKMB= cardiac tissue
If the value of CK-MB is elevated and the ratio of CK–MB to total CK (relative index) is more than 2.5–3, it is likely that the heart was damaged.

Front 119

Myoglobin- marker for MI

Back 119

Myoglobin is a protein found in muscle, it holds oxygen inside heart muscle. It is continually released into the blood in small amounts due to normal turnover of muscle cells. When muscle is damaged, as in a heart attack, larger amounts of myoglobin are released and blood levels rise rapidly.

Front 120

What does heart failure look like?

Back 120

SOB, increased RR, High BP, orthopnea, crackles at bases of lungs

Front 121

What is tissue perfusion like with heart failure?

Back 121

Inadequate tissue perfusion, heart is not working

Front 122

What is the most common heart failure?

Back 122

Left

Front 123

Reasons for left HF?

Back 123

HTN, Coronary artery disease, valvular disease

Front 124

systolic failure

Back 124

problem contracting

Front 125

diastolic failure

Back 125

problem relaxing

Front 126

If left HF backs up enough...

Back 126

can cause R sided HF

Front 127

2 reasons for Right sided HF?

Back 127

R or L MI or Left HF

Front 128

What does R HF look like?

Back 128

increased volume and pressure in venous system... peripheral edema

Front 129

What is important to know when admin sublingual nitro??

Back 129

Protect from sunlight! also s/e lightheadedness and dizziness

Front 130

What foods are high in k?

Back 130

green, leafy, vegetables - kale, collards, spinach, and turnip greens are the highest.

Front 131

Sublingual nitro O,P,D?

Back 131

O: 1-3 min
P: Unknown
D: 30-60 min

Front 132

Who is at risk for HF?

Back 132

obesity, HTN, diabetes, smokers, >50, male, sedentary lifestyle, poor diet, race

Front 133

Medications used with HF?

Back 133

diuretics (Lasix, beumix)
ACE inhibitors
nitrates
ARB inhibitors
heparin/coumadin/lovenox
aspirin/plavix
digoxin

Front 134

Labs to check with HF

Back 134

Troponin I/T
C reactive protein
F & E
H & H
BNP, BMP

Front 135

s/s HF

Back 135

Inc HR
fatigue, breathlessness, dizziness,
cyanosis, crackles in lung bases
weight gain

Front 136

Nursing care for HF

Back 136

labs, I & Os, assess daily wt, edema, O2 sat, EKG, lung sounds, heart sounds, maintain upright airway, DVT precaution

Front 137

pt teaching for hf

Back 137

diet (low sodium, low fat)
stay as active as possible

Front 138

What is the point of maximal impulse?

Back 138

Apical pulse-