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160 Cards in this Set
- Front
- Back
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What is the pace set by the SA node?
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60-100 bpm
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What is the pace set by the AV node?
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40-60 bpm
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What is the pace set by the Purkinje fibers?
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30-40 bpm
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part of the EKG that shows atrial contraction/depolarization
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P wave
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time from the firing of the SA node until the electrical impulse reaches the AV node (on an EKG)
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PR interval
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How long does the PR interval last?
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0.12 - 0.20 seconds
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part of the EKG that shows ventricular depolarization/contraction
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QRS complex
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How long does the QRS complex last?
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0.06 - 0.10 seconds
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part of the EKG that shows ventricular repolarization
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T wave
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length of time from ventricular depolarization to ventricular repolarization; varies with the patient's heart rate (usually about 0.4 seconds)
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QT interval
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the characteristic of being able to contract and relax without outside stimulus
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automaticity
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the regular generation of an action potential
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rhythmicity
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P rate is 60 or less
There is a QRS for each P. |
sinus bradycardia
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P rate is 100-150
There is a QRS for each P. |
simple sinus tachycardia
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P rate is between 251 and 300.
Many P waves and then a QRS. |
atrial flutter
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P rate is greater than 300.
Many P waves and then a QRS. |
Atrial fibrillation
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P wave is absent.
QRS > 0.11 and rate is 100 or more |
Ventricular tachycardia
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P wave is absent.
QRS > 300 |
Ventricular fibrillation
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What 4 things affect cardiac performance?
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preload
afterload heart rate contractility |
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The volume of blood in the heart at the end of diastole is directly related to the force of contraction during the next systole.
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Frank-Starling Law
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The amount of tension generated in the wall of the ventricle to produce a given intraventricular pressure depends on the size (radius and wall thickness) of the ventricle.
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Laplace's Law
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Resistance to fluid flow through a tube takes into account the length of the tube, the viscosity of the fluid, and the radius of the tube's lumen.
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Poiseuille's Formula
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amount of blood ejected each time the heart beats
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stroke volume
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amount of blood in liters ejected from the ventricle every minute
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cardiac output
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What is the average cardiac output in liters?
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4-6 liters per minute
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heart sound that signifies closure of the AV valves
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S1
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heart sound that signifies closure of the semilunar valves
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S2
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vibration of the ventricular walls from the blood rushing in
increased filling of the ventricles normal up to age 30, then abnormal thereafter |
S3
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heart sound caused by blood rushing into a stiffened, noncompliant ventricle
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S4
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heart sound caused by turbulent blood flowing through an abnormal valve
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murmur
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heart sound caused an inflammed pericardium rubbing up against the chest wall
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rub
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the sound a stiff stenotic AV valve makes when it opens
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snap
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the sound a stiff stenotic semilunar valve makes when it opens
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click
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the sound of turbulent blood flow at low pressure
usually venous in nature |
hum
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Name some different causes of chest pain.
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Coronary artery disease
Hypertension Pulmonary (pneumonia) GI (acid reflux) Cancer/tumor Pericarditis/Effusion Trauma Aneurysm Infection |
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What are the clinical manifestations of atherosclerosis/ coronary artery diseae/ myocardial infarction?
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angina
silent ischemia prinzmetal angina myocardial infarction |
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recurrent predictable chest pain (occurs with exercise)
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stable angina
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unpredictable chest pain caused by the abnormal vasospasm of coronary vessels with or without associated atherosclerosis
pain often occurs at night during REM sleep |
prinzmetal anginal
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presents as new-onset angina, angina that is occurring at rest, or agina that is increasing in severity or frequency
signals that atherosclerotic plaque has become complicated and infarction may soon follow should be treated as a medical emergency |
unstable angina
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If you have this, you are predisposed to cardiovascular disease.
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C-reactive protein
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test that shows a picture of the heart to see if it's the right size
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echocardiogram
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test that shoots dye through the groin into the coronary circulation to see if there is any damage
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cardiac catheterization
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What are the nursing implications for atherosclerosis/CAD/MI?
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1. Risk factor modification
2. Assess for allergies to iodine-based dye |
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a consistent elevation of systemic blood pressure
consistent increase in blood pressure |
hypertension
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What causes hypertension?
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an increase in cardiac output
an increase in peripheral resistance both of these things |
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What is a normal blood pressure?
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systolic <120
diastolic <80 |
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What is the range for prehypertension?
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systolic 120-139
diastolic 80-89 |
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What is the range for Stage 1 hypertension?
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systolic 140-159
diastolic 90-99 |
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What is the range for Stage 2 hypertension?
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systolic >/= 160
diastolic >/= 100 |
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Name the risk factors for primary hypertension.
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family history
advancing age cigarette smoking obesity heavy alcohol consumption gender (men<50, women>50) black race high dietary sodium intake low intake of K+, Ca++, Mg++ glucose intolerance |
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most prevalent form of hypertension
hypertension in systolic and diastolic values no known cause |
primary hypertension
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hypertension that is caused by a systemic disease process that raises peripheral resistance or cardiac output (Ex. renal disease, adrenocortical tumors, adrenomedullary tumors, drugs)
affects less than 10% of those with hypertension If you control the disease, you can control the hypertension. |
secondary hypertension
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hypertension where the systolic BP is above 140 and the diastolic BP is below 90
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isolated systolic hypertension
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What population does isolated systolic hypertension typically occur in?
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individuals over 65 years old
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What is the chief vascular cause of isolated systolic hypertension?
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rigidity of the aorta
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sustained primary hypertension that involves organ damage
has pathologic effects on the structure/function of the heart, aorta, kidneys, eyes, brain, and lower extremities associated with CHF, MI, and angina |
complicated hypertension
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rapidly progressive hypertension in which the diastolic pressure is usually above 140 mm Hg
causes major kidney damage, cerebral dysfunction and stroke is a life-threatening situation |
malignant hypertension
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If hypertension is sustained, what are its clinical manifestations?
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headache
chest pain dizziness shortness of breath palpitations (symptoms are related to the organs that are damaged - kidneys and heart) |
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What are the nursing implications for hypertension?
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Diagnose it early!
Teach people about risk factors. Treat the top number (systolic). If the systolic is 115 or higher, begin risk factor modification. |
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a decrease in systolic and diastolic BP upon standing
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orthostatic (postural) hypotension
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What are the signs and symptoms of orthostatic hypotension?
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dizziness
blurred vision syncope (loss of consciousness) fainting |
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What can cause orthostatic hypotension?
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medicine
starvation old age fluid volume deficit lying down flat for a long time |
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localized dilation or outpouching of a vessel wall or cardiac chamber
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aneurysm
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What is the treatment for an aneurysm?
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depends on size and location:
If <5 cm, reduce BP If >5 cm, surgery |
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obstruction of a vessel by an embolus
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embolism
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a thrombus (blood clot), air bubble, fat, bacteria, or foreign substance that travels through the bloodstream, stopping and occluding a vessel
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embolus
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an inflammatory disease of the peripheral arteries accompanied by thrombi, inflammation, and vasopasm of arterial segments
can occlude portions of small to medium sized arteries in the feet and sometimes hands to where the person may lose a limb or digit clot development in the extremities decreases circulation |
thromboangiitis obliterans (Buerger disease)
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Who is typically affected by thromboangiitis obliterans (Buerger disease)?
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young male smokers
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What is the chief symptom of thromboangiitis obliterans?
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pain and tenderness of the affected part
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How is thromboangiitis obliterans treated?
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cessation of smoking
once the person stops smoking, signs and symptoms will go away |
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disease that is characterized by attacks of vasospasm in the small arteries and arteries of the fingers and sometimes the toes
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Raynaud disease
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Who does Raynaud disease tend to affect?
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young women
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What triggers the vasospastic attacks of Raynaud disease?
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brief exposure to cold or emotional stress
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What are the nursing implications for Raynaud disease?
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Teach the patient warming techniques (wear gloves, get out of cold)
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distended veins usually in the lower extremities
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varicose veins
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What causes varicose veins?
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increased pressure
prolonged standing |
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What can help prevent varicose veins?
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compression stockings
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inadequate venous return over a long period of time
causes pathologic changes as a result of ischemia in the vasculature, skin, and supporting tissues |
chronic venous insufficiency
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What are the symptoms of chronic venous insufficiency?
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chronic pooling of blood in the veins of the lower extremities (edema)
hyperpigmentation of the skin of the feet and ankles |
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What can chronic venous insufficency cause?
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venous stasis ulcers (necrosis of the tissue in the lower extremities)
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clots form in the deep veins of the legs
occur most often in people with conditions that predisponse them to venous stasis (prolonged bedrest), endothelial injury (IV meds, trauma, previous clot), or hypercoagulability (BCP, HRT) |
deep venous thrombosis (DVT)
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What is the major danger associated with a DVT?
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that it will break off and go to the lungs (pulmonary embolism)
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What happens in the area where the thrombus forms in a DVT?
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the inflammatory response causes extreme tenderness/pain, swelling, heat, and redness
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What are the nursing implications for a DVT?
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Know that compression hose pump the legs to get blood flowing.
Get people up and walking around. Put them on anticoagulant therapy (Cumadin). After DVT has developed, put them on Heparin or Cumadin. |
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a progressive occlusion of the superior vena cava that leads to venous distention and swelling in the upper extremities and head
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Superior vena cava syndrome
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What causes superior vena cava syndrome?
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lung cancer, lymphomas, and metastasis of other cancers
the growth compresses and occludes the SVC |
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How is superior vena cava syndrome treated?
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radiation and medications, as necessary
surgical treatment includes stent or graft placement |
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What causes coronary artery disease?
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atherosclerosis
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What causes acute coronary syndrome?
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persistent ischemia that causes irreversible damage
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type of acute coronary syndrome that occurs if a thrombus occludes the coronary vessel for more than 20 minutes, resulting in sustained ischemia
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myocardial infarction
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What are the clinical manifestations of an MI?
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crushing chest pain
pain in the left arm and jaw shortness of breath sweating nausea vomiting dizziness ST elevation on an EKG |
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acute inflammation of the pericardium caused by infection (virus or bacteria), uremia, neoplasm, MI, surgery, or trauma
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acute pericarditis
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What are the symptoms of acute pericarditis?
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sudden onset of severe chest pain that worsens with respiratory movements and with lying down
dysphagia restlessness irritability anxiety weakness malaise *may hear a friction rub at he cardiac apex and left sternal border as a diagnosis |
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What is the treatment for acute pericarditis?
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relieve symptoms
explore the underlying cause usually self-limiting, but can give antibiotics |
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the accumulation of fluid in the pericardial cavity
can occur in all forms of pericarditis most often, the fluid is an exudate, which reflects pericardial injury and inflammation |
pericardial effusion
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condition in which fluid in the pericardial cavity creates enough pressure to cause cardiac compression
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tamponade
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What can tamponade cause?
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pulsus paradoxus
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aterial blood pressure during expiration exceeds arterial blood pressure during inspiration by more than 10 mm Hg
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pulsis paradoxus
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What are the clinical manifestations of pericardial effusion?
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muffled heart sounds
dyspnea on exertion dull chest pain |
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What is the treatment for pericardial effusion?
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pericardiocentesis - drain the fluid out
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occurs when acute pericarditis is not treated (becomes chronic)
form of pericardial disease that is either idiopathic or associated with radiation exposure, rheumatoid arthritis, uremia, or coronary artery bypass graft |
constrictive/restrictive pericarditis
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What is the pathophysiology of constrictive/restrictive pericarditis?
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Fibrous scarring with occasional calcification of the pericardium causes the visceral and parietal layers to adhere, obliterating the pericardial cavity
the fibrotic lesions encase the heart in a rigid shell this compresses the heart and eventually reduces cardiac output, like tamponade does |
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What is the difference between tamponade and constrictive pericarditis?
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constrictive pericarditis always develops gradually
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What are the symptoms of constrictive pericarditis?
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exercise intolerance
dyspnea on exertion fatigue anorexia |
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What is the treatment for constrictive pericarditis?
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diuretics
sodium restriction surgical excision of the pericardium |
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the heart muscle is inflamed and does not work as well
can be a response to ischemic hearta disease and hypertension or a secondary response to infectious disease most causes are idiopathic, however |
cardiomyopathy
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What are the 3 types of cardiomyopathy?
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dilated
hypertrophic restrictive |
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type of cardiomyopathy in which the blood flows slower because the heart is enlarged and stretched
most common type of cardiomyopathy |
dilated
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What are the symptoms of dilated cardiomyopathy?
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fatigue
weakness palpitations |
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What does dilated cardiomyopathy eventually lead to?
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left heart failure
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type of cardiomyopathy in which the left ventricle muscle mass enlarges
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hypertrophic
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What are the symptoms of hypertrophic cardiomyopathy?
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dyspnea
angina pectoris fatigue dizziness (syncope) palpitations |
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What does hypertrophic cardiomyopathy eventually lead to?
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left heart failure
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type of cardiomyopathy in which the heart muscle becomes rigid and restricts the movement of the heart
least common type |
restrictive
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What are the major symptoms of restrictive cardiomyopathy?
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dyspnea
fatigue |
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What does restrictive cardiomyopathy eventually lead to?
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right heart failure
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condition in which the heart cannot pump enough blood, causing the extremities, kidneys, and brain to suffer
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congestive heart failure
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What can cause CHF?
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coronary artery disease
past history of MI untreated hypertension valvular disease cardiomyopathy infection heart defect |
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What causes right heart failure?
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an increase in pulmonary artery pressure or some sort of lung disease
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the inability of the heart to adequately supply the body with bood-borne nutrients, despite adequate blood volume and normal/elevated contractility
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high output failure
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What causes high output failure?
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another disease such as anemia
is not common |
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class of CHF in which patients have no limitation of activities; they suffer no symptoms from ordinary activities
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Class I
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class of CHF in which patients have a slight/mild limitation of activity; they are comfortable with rest or mild exertion
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Class II
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class of CHF in which patients have a marked limitation of activity; they are comfortable only at rest
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Class III
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class of CHF in which patients should be at complete rest, confined to the bed or chair; any physical activity brings on discomfort and symptoms occur at rest
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Class IV
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What is the treatment for CHF?
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medication
pacemakers oxygen heart transplant hospice |
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What are the nursing implications for CHF?
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rest
dietary modifications (strict diet) |
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What are the complications of CHF?
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pulmonary edema
renal failure cerebral insufficiency MI cardiac dysrhythmias |
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the valve cusps fail to shut completely, permitting blood flow to continue even when the valve is supposed to be closed
increases the volume of blood the heart must pump and increases the workload of the atria and ventricles |
regurgitation
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What is the most common type of regurgitation problem?
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mitral valve prolapse
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What are the symptoms of mitral valve prolapse?
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many cases are asymptomatic
can cause: palpitations tachycardia light-headedness fatigue dyspnea |
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the valvular opening is narrowed, and blood can't flow forward
increases the workload on the heart |
stenosis
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inflammatory disease caused by a delayed immune response to infection by the group A beta hemolytic steptococcus in genetically predisposed individuals
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rheumatic fever
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What can rheumatic fever cause if left untreated?
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scarring and deformity of cardiac structures, resulting in rheumatic heart disease (inflammation of the heart)
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What are some signs and symptoms of rheumatic heart disease?
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fever
chest pain polyarthritis |
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Who most commonly gets rheumatic fever?
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children
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inflammation of the endocardium, especially the cardiac valves, caused by bacteria, viruses, fungi, parasites, etc. that get into the bloodstream
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infective endocarditis
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What does infective endocarditis usually develop from?
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an invasive dental procedure
a urinary tract infection *Patient should always take antibiotics before having another procedure. |
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oxygen delivery to one or more tissues is below basal requirements and is associated with hypoxic and immunologic injury
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shock
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What are the signs and symptoms of shock?
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tachycardia
very low BP cold and mild skin decreased capillary refill low urine output metabolic acidosis |
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How is shock treated?
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ventilation
drugs to keep BP up give massive amounts of blood/IV fluid |
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type of shock that results from heart failure
most cases follow MI or surgery requiring cardiopulmonary bypass |
cardiogenic shock
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Which type of shock is notoriously unresponsive to treatment?
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cardiogenic
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What are the CM for cardiogenic shock?
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impaired mentation
systemic and pulmonary edema low cardiac output dusky skin color low BP oliguria ileus (intestinal obstruction) dyspnea |
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What is the cause of hypovolemic shock?
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loss of blood, plasma, or interstitial fluid in large amounts
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Hypovolemic shock begins to develop when ________ has decreased by _____%.
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ICF volume
15% |
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What are the CM for hypovolemic shock?
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poor skin turgor
thirst oliguria rapid heart rate |
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type of shock that causes extreme, persistent vasodilation because of an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle
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neurogenic shock
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What are some causes of neurogenic shock?
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trauma to the spinal cord or medulla
depressive drugs anesthetics severe emotional stress pain |
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What are the CM for neurogenic shock?
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very low BP
bradycardia fainting |
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Which type of shock is the most severe and has a sudden onset?
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anaphylactic shock
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type of shock that begins as an allergic reaction to snakebite venom, pollens, insect venom, shellfish, penicillin, etc.
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anaphylactic shock
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What happens in anaphylactic shock?
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vasodilation
peripheral pooling relative hypovolemia decreased tissue perfusion impaired cellular metabolism smooth muscle constriction in the airways death can occur in minutes without emergency treatment |
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What are the first signs of anaphylactic shock?
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anxiety
difficulty breathing edema hives burning or itching skin |
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How is anaphylactic shock treated?
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1. Epinephrine - causes vasoconstriction and reverses airway constriction
2. Volume expanders given by IV 3. Antihistamines/steriods - stop inflammatory reaction |
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type of shock that begins with an infection, progresses to bacteremia (bacteria in the blood) and then to sepsis, etc.
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septic shock
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What is the final result of septic shock?
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multiple organ dysfunction syndrome
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What is the most common cause of septic shock?
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gram negative bacteria
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What are the CM of septic shock?
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low BP
hypoxia tachycardia temperature instability renal dysfunction jaundice clotting problems deterioration of mental status tachypnea |
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How is septic shock treated?
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multiple drug antimicrobial therapy
fluid resuscitation vasoactive medications |
