Cardiovascular, Cvd, Cad

Front 1

Electrocardiogram (ECG)

Back 1

Monitors PQRST & U waves of heart

Front 2

Why is ECG used?

Back 2

Dx dysrythmias, myocardial ischemia, injury, infarction & monitor electrolyte imbalance or med admin

Front 3

P Wave represents?

Back 3

Firing of SA node, atrial depolarization

Front 4

QRS represents?

Back 4

AV depolarization through ventricles

Front 5

T wave represents?

Back 5

Repolarization of ventricles

Front 6

U wave represents?

Back 6

Repolarization of purkinje fibers or associated w/ hypokalemia

Front 7

Systole

Back 7

Contraction, ventricles eject blood

Front 8

Diastole

Back 8

Relaxation, blood flow into ventricles

Front 9

Stroke Volume (SV)

Back 9

Amount of blood ejected per beat

Front 10

Cardiac output (CO)

Back 10

Amount of blood pumped by each ventricle per min.

Front 11

CO formula

Back 11

CO=SV×HR

Front 12

Norm. CO

Back 12

4-8 L/min

Front 13

Cardiac index formula?

Back 13

CO÷BSA

Front 14

Cardiac index norm.

Back 14

2.8-4.2 L/min/m^2

Front 15

CVD inc. With?

Back 15

age

Front 16

Leading cause of death in adults >65yo

Back 16

CVD

Front 17

CAD most common cardiovascular problem due to?

Back 17

Atherosclerosis

Front 18

Cardiovascular change result of

Back 18

Aging, disease, environmental factors, lifetime behaviors

Front 19

Age related changes include

Back 19

Dec. Stress response, inc. SBP and dec./no change in DBP, ortho hypotension, postprandial hypotension, inc. collagen, dec. Elastin

Front 20

Subjective CVD Qs

Back 20

Hx present illness, past health Hx, past/current meds, past surg.

Front 21

CVD risks factors

Back 21

HTN, Sedentarty life, DM, obesity, genetics, tobacco, abn. Lipids

Front 22

CVD objective data (vitals)

Back 22

Vitals BP bilateral SBP should not dec. More than 20 mmHg from supine to standing

Front 23

CVD objective data inspect, palate, auscultate

Back 23

Inspect: edema, neck vein distention, stasis ulcers, nail clubbing.

Palpate: extremity moisture, temp, pulse, cap. Refill, edema

Auscultate: major arteries, bruit

Front 24

Bruit is

Back 24

Abn. Flow causing humming or buzzing

Front 25

Cardiac biomarkers/enzymes

Back 25

Released into blood when heart suffers ischemia

Front 26

Troponin levels help Dx?

Back 26

Acute coronary failure

Front 27

Troponin specific to heart?

Back 27

Troponin T (cTnT)/ Troponin I (cTnI)

Front 28

Troponin rise, peak, detected for?

Back 28

Rise: 4-6hr

Peak: 10-24hr

Detected: 10-14 days

Front 29

Creatine kinase (CK)

Back 29

Found in heart (specific CK-MB)

Front 30

CK-MB rise, peak, baseline return?

Back 30

Rise: 3-6hr

Peak: 12-24hr

Baseline return: 12-48hr

Front 31

Myoglobin is

Back 31

Heme protein found in heart, sensity to early myocardial injury, limited in MI Dx

Front 32

C-reactive protein

Back 32

Produced by liver during acute inflammation, inc. Lvl linked to presence of atherosclerosis/1st occurance of heart attack.

Front 33

Serum lipids consist of

Back 33

Triglycerides, cholesterol, phospholipids

Front 34

Total cholesterol lvls

Back 34

<200 mg/dL

Front 35

LDL (Bad cholesterol) lvl

Back 35

Transport cholesterol to cells from liver

<130mg/dL

Front 36

Triglyceride lvls

Back 36

M: 40-160 mg/dL

F: 35-135 mg/dL

Front 37

HDL (good cholesterol) lvls

Back 37

Protect coronary arteries by transporting cholesterol to liver

M: >45 mg/dL

F: >55 mg/dL

Front 38

Chest X-ray Dx

Back 38

Show heart shape, size, anatomical changes. Records enlargement of heart, pericardial effusion, pulmonary congestion.

Front 39

Electrocardiogram (ECG) is used to

Back 39

Asses heart activity, monitor resting/ambulatory ECG, stress testing

Front 40

Echocardiogram is

Back 40

Ultrasound of heart, with/without contrast, provide info regarding structure/motion of heart, measure ejection fraction

Front 41

Ejection fraction

Back 41

65-70% percentage of end diastolic blood volume ejected,can also measure during systole. Provide info on left ventricle during systole

Front 42

Cardiac catheterization

Back 42

R Side: measure pressures

L Side: evaluate coronary arteries

Front 43

Cardiac catheterization edu, consideration, actions

Back 43

NPO 8hrs, consent form, client understand procedure, iodine/shellfish allergy, renal function

Front 44

Coronary angiography is for

Back 44

Identifying coronary blockage using contrast medium

Front 45

One of the most modifiable risk factors that lead to CVD is

Back 45

HTN

Front 46

Inc. BP inc. Risk for

Back 46

MI, Heart attack, Stroke, Renal disease

Front 47

Systemic vascular resistance

Back 47

Force opposing the movement of blood within vessels

Front 48

Normal BP range

Back 48

SBP: <120 mmHg

DBP: <80 mmHg

Front 49

Prehypertension range

Back 49

SBP: 120-130 mmHg

Or

DBP: 80-89 mmHg

Front 50

Stage 1 HTN range

Back 50

SBP: 140-159mmHg

Or

DBP: 90-99 mmHg

Front 51

Stage 2 HTN range

Back 51

SBP: > OR = 160 mmHg

Or

DBP: >OR= 100mmHg

Front 52

Primary HTN is

Back 52

AKA essential/idiopathic HTN

Inc. Without identified cause

Exact cause unknown, several contributing factors

Front 53

Secondary HTN

Back 53

inc.BP with specific cause (med, kidney disease), Tx aimed at removing or Tx cause.

Front 54

HTN risk factors

Back 54

Age, DM, Obesity, Stress, Excess sodium, ETOH, inc. Serum lipids.

Front 55

HTN clinical manifestations are

Back 55

Monitor: Headaches, facial flushing, fatigue, dizziness/fainting, palpation, angina, renal change, dyspnea, visual disturbance

Front 56

HTN target organs are

Back 56

Heart, brain, PVD, kidney, eyes

Front 57

Overall HTN goals are

Back 57

Control BP, dec. CVD risk factors/target organ disease, lifestyle modifications(weight loss #1)

Front 58

2 main action of drug therapy for HTN

Back 58

Dec. Volume circulating blood

Reduce SVR

Front 59

Diuretics for HTN

Back 59

Dec. Volume, promote Na/H2O excretion, reduce plasma volume/vascular response to dopamine, nor-epinephrine

Monitor for hypokalemia: muscle weakness, irregular pulse, dehydration

Front 60

Ace inhibitors function by

Back 60

Prevent conversion of angiotensin 1 to angiotensin 2 (BP enzyme) preventing vasoconstriction.

Front 61

Captopril Rx

Back 61

Monitor BP, Hypotension (fatigue, dizziness, nausea, blurry vision, lightheadedness) monitor edema (evidence of heart failure)

Can cause renal/heart complications

Report cough/angioedema severe adverse effect

Front 62

Calcium channel blocker

Back 62

Blocks Ca access to cells causing vasodilation, dec. BP/HR

Front 63

Nifedipine Rx (Ca blocker)

Back 63

Monitor BP, hypotension, use with caution in pts with heart failure.

Educate pt how to take pulse, call HCP if irregular or lower that norm.

Avoid grapefruit juice, potentates med, inc. Hypotensive effects.

Front 64

What is atherosclerosis?

Back 64

Hardening of arteries

Front 65

What are arthromas?

Back 65

Fatty deposits that prefer coronary arteries

Front 66

Stages of atherosclerosis development are

Back 66

1. Chronic endothelial injury

2. Fatty streak

3. Fuberous plaque

4. Complicated lesion

Front 67

Non modifiable risk factors for CAD are

Back 67

Inc. Age, genetics, ethnicity (more common in white men), gender (more common in men than women until 75yo)

Front 68

Modifiable risk factors of CAD are

Back 68

Obesity, DM, physical act., serum lipids, BP <140/90 mmHg, tobacco, psychosocial (stress, anger, depression)

Front 69

What should a CAD assessment include?

Back 69

Health/Family/psychosocial Hx, diet, activity, presence of cardio symptoms.

Front 70

What type of nutritional therapy should be considered in CAD pts?

Back 70

Lower LDL cholesterol

Front 71

Low LDL cholesterol meals include...

Back 71

Dec. Saturated fats and cholesterol (vegetable oil, shellfish, nuts, seeds margarine)

Front 72

What foods are major sources of saturated fats and cholesterol?

Back 72

Red meat, egg yolks, whole milk products (butter, sour cream, cream cheese)

Front 73

Initiate lipid lowering drug therapy if...

Back 73

Diet and exercise are ineffective

Front 74

The type of med most commonly used that functions by inhibiting synthesis of cholesterol in liver, dec. LDL, and inc. HDL?

Back 74

Statins

Front 75

When on statins, why are liver enzymes monitored?

Back 75

Liver damage/myopathy

Front 76

A serious side effect of Simvastatin (zocor) and Gemfibrozil (lopid) is...

Back 76

Liver failure, rhabdomyolysis (muscle pain, weakness)

Front 77

Antiplatelet therapy functions by

Back 77

Dec. Platelet aggregation, inhibit thrombus formation.

Front 78

Some anticoagulants include...

Back 78

Aspirin (ASA), Clopidrogrel (plavix)

Front 79

Some considerations before starting AC therapy?

Back 79

Hx of bleeding, teach pt of inc. Bleeding and bruising, have blood monitored to check bleeding times (PT, aPTT, INR, CBC)

Front 80

High o2 demand greater than o2 supply can lead to...

Back 80

Myocardial ischemia

Front 81

Clinical manifestation of angina is

Back 81

Chest pain

Front 82

The most common reason for angina to develop is

Back 82

Atherosclerosis (70% or more blockage)

Front 83

Chronic stable angina is...

Back 83

Chest pain that occurs intermittently over a long period of time. Usually in similar pattern.

Front 84

What can cause an episode of Chronic stable angina?

Back 84

Exercise or emotional stress

Front 85

What can relieve an episode of Chronic stable angina?

Back 85

Rest or nitroglycerin

Front 86

Some pt descriptions of Chronic stable angina are...

Back 86

Pressure, heaviness, tight suffocating sensation, difficulty breathing, fatigue

Front 87

Overall goal to treat Chronic stable angina?

Back 87

Dec. O2 demand and/or inc. O2 supply

Front 88

Shirt acting nitrates work by...

Back 88

Dilate peripheral and coronary blood vessels

Front 89

Shirt acting nitrate administration are by

Back 89

Sublingual or spray

Front 90

Short acting nitrates in an emergency steps are

Back 90

Administer, no relief of pain call 911;if some relief repeat q5 mins for a max of 3 doses. *WE NEED COMPLETE RELIEF NOT SOME*

Front 91

What could be included in pt teaching when giving shirt acting nitrates?

Back 91

Headache is the most common side effect, can be take prophylactically before activity know to cause angina

Front 92

Beta blockers work by...

Back 92

Blocking receptors on heart by causing dec. HR and force of contraction.

Front 93

Some beta blockers are...

Back 93

Atenolol and metoprolol ( end in -lol)

Front 94

Unstable angina....

Back 94

Occurs at rest, pain last >/= 10 min, need immediate Tx

Front 95

What are S/S of unstable angina

Back 95

SOB, fatigue (most prominent), anxiety, indigestion

Front 96

Some interventions for Angina are....

Back 96

Upright position, supplemental o2, vitals, 12 lead ECG, a assess heart/lungs. Pt will most likely be anxious have cool, pale, clammy skin.

Front 97

Peripheral Artery Disease (PAD) is

Back 97

thickening of artery walls

Front 98

What does PAD AND PVD affect

Back 98

Blood flow to (PVD) and from (PAD) heart

Front 99

PVD/PAD is a result of...

Back 99

Atherosclerosis

Front 100

Risk factors for PVD/PAD

Back 100

Tobacco (most important) ,CKD, DM, HTN, females, age, hypercholesterolemia

Front 101

Clinical manifestations of PAD/PVD include...

Back 101

Burning, claudication (pain and/or cramping), numbness in feet.

Front 102

PVD/PAD assessment findings include...

Back 102

*appearance is most important regarding blood flow*

Dec. Cap refill, atrophy, redness, diminished or absent pedial, femoral, popliteal pulses.

Front 103

Complications of PVD/PAD are

Back 103

Atrophy of skin, delayed healing, infection, necrosis, arterial ulcers (occur over boney prominences on toes, legs, feet)

Front 104

What helps promote vasodilation?

Back 104

Warm environment (ex. Warm socks) avoid caffeine, cold, stress and nicotine, avoid crossing legs, elevation to reduce swelling.

Front 105

What type of exercise is recommended?

Back 105

Walking helps build circulation. Walk until pain, stop, rest, walk further

Front 106

Angioplasty is

Back 106

Insertion of catheter through femoral artery

Front 107

Mechanical rotational abrasive artherectomy is

Back 107

Scrap plaque from inside peripheral artery

Front 108

Arterial revascularization surgery is

Back 108

Rerouting circulation around a blockage, can cause potential limb loss

Front 109

What are some nursing considerations for pts who've had therapeutic procedures?

Back 109

Frequent vitals (q15min), observe site for bleeding, monitor VS, peripheral pulse, cap refill, movement and sesation. Bedrest and keep limb straight 2-6hrs

Front 110

How can a nurse provide a pt with PVD/PAD conservative Tx?

Back 110

Trauma protection, dec. Ischemic pain, preventing/control infection, improve perfusion.

Front 111

Venous thromboembolism (VTE) risk factors are

Back 111

Heart failure, immobility, post OP, pregnancy, oral contraceptives, active cancer

Front 112

VTE expected findings are

Back 112

Tenderness,sudden edema, warmth, calf/groin pain, can be asymptomatic

Front 113

What is indicative that a embolism has gone to the lungs from VTE?

Back 113

SOB and chest pain

Front 114

What type of care can be offered to those with DVT and thrombophlebitis?

Back 114

Encourage rest and elevation, warm compress, no massage, anti embolism stockings, IVC filter

Front 115

What are some risk factors for venous insufficiency?

Back 115

Sitting/standing in place for long time, obesity, preg, thrombophlebitis

Front 116

Some of the expected findings in those who may have venous insufficiency are

Back 116

Edema, stasis ulcers, brown discoloration.

Front 117

Risk factors for varicose veins are

Back 117

Female, 30yo older, fam Hx, obesity, preg, standing

Front 118

Finding that may indicate varicose veins are...

Back 118

Distended veins, muscle cramps/spasms, pruritus (itching)

Front 119

Nursing care for venous insufficiency are

Back 119

Evelvate legs 20 min 4-5× day., avoid restrictive clothes/crossing legs, wear compression sock after elevation and when swelling is minimal

Front 120

Therapeutic procedures for venous insufficiency could be...

Back 120

Sclerotherapy, vein stripping, laser Tx

Front 121

What meds are used for DVT/thrombophlebitis?

Back 121

Heparin, enaxoprin, warfarin

Front 122

What med is used to prevent clot formation or enlargement?

Back 122

IV heparin

Front 123

What med uses potanin sulfate as it antidote?

Back 123

Heparin

Front 124

What to monitor when giving heparin

Back 124

PTT, bleeding, platelet count

Front 125

What med uses vitamin K as its antidote?

Back 125

Warfarin

Front 126

What labs are monitored when administering warfarin?

Back 126

PT/INR

Front 127

How long to reach warfarin therapeutic levels?

Back 127

3-4 days

Front 128

What therapy dissolves clots within 5 days of therapy?

Back 128

Thrombolytic therapy