Test Four = Cardiac

Front 1

What is Perfusion?

Back 1

Is the process of forcing blood or other fluid to flow through a vessel and into the vascular bed of a tissue to provide oxygen and other nutrients.

Front 2

Tissue perfusion

Back 2

Is the flow of blood through the body tissue. Vital organs require continuous perfusion for their optimal function – brain, heart, lungs, kidneys and GI tract.

Front 3

Systole

Back 3

Contraction - Blood is pumped from the ventricles and fills the pulmonary and systemic arteries.

Front 4

Diastole

Back 4

Relaxation- the ventricles relax and fill with blood. Takes up two thirds of the cardiac cycle.

Front 5

What is the conduction of the heart

Back 5

• SA pacemaker of the heart 60-100
• AV secondary pacemaker 40-60
• Bundle of His
• Left and right bundle branches
• Purkingie Fibers

Front 6

What is preload

Back 6

amount of blood going in- it’s the blood sitting in the heart before contraction this is seen at the end of diastole when the heart relaxes how much blood flows into the heart.

Front 7

What is afterload

Back 7

the pressure the blood must overcome to eject the blood to the rest of the body.

Front 8

What are Baroreceptors?

Back 8

They are a type of mechanoreceptor that detects the pressure of blood flowing through them, and can send messages to the central nervous system to increase or decrease total peripheral resistance and cardiac output. They are an example of a short-term blood pressure regulation mechanism

Front 9

What are chemorecptors

Back 9

Chemoreceptors in the medulla oblongata, carotid arteries, and aortic arch detect the levels of carbon dioxide in the blood,

Front 10

S3

Back 10

Murmurs = heart failure “Kentucky”

Front 11

S4

Back 11

heard in children and the elderly “Tennessee” heard on the left side and you use your bell

Front 12

EKG

Back 12

Electrocardiography – measures the electrical impulses of the heart. Test can also detect electrolyte imbalances such as Potassium if up arrhythmias (diuretics) also Magnesium will affect the muscles ability to pump. T wave is affected by potassium

Front 13

BUN

Back 13

10-20 fluid status – if in heart failure volume will be decreased and everything becomes diluted.

Front 14

Total cholesterol should be less than?

Back 14

200

Front 15

LDL should be less than

Back 15

100

Front 16

HDL should be

Back 16

greater than 60

Front 17

Triglycerides should be

Back 17

less than 150

Front 18

Blood glucose

Back 18

There has been a strong correlation between cardiac and diabetes.

Front 19

C Reactive Protein

Back 19

if elevated can be signs of atherosclerosis (plaque and cholesterol) This has now been added to the markers for heart disease.

Front 20

Homocysteine

Back 20

when elevated related to atherosclerosis and clot formation. Nutritional deficiencies can add to this also folic acid deficiency.

Front 21

Cardiac Tamponade

Back 21

fluid in the pericardium which compresses the heart chambers and leads to decrease cardiac output.

Front 22

what is heart failure

Back 22

lost its contractibility and left ventricular doesn’t work anymore.

Front 23

Hypertension what is it?

Back 23

Narrowing of your pipes.
An intermittent or sustained elevation of diastolic BP

Front 24

What is MI

Back 24

blockage of one or more coronary arteries which leads to prolonged myocardial ischemia resulting in irreversible cell death and muscle death – 15 min = heart death.

Front 25

What is atherosclerosis?

Back 25

decrease blood flow
*narrowing of the lumen
*increased resistance=decreased flow
*plaques build along the vessel wall so the vessels can’t stretch and you will have and increase in your afterload.
*group of risk factors include high cholesterol
* Abdominal obesity
*insulin resistant – hyperlipodomia.
*lipid deposits develop within the vessel and form a fatty streak.
*eventually a fibrous plaque develops impeding blood flow thru the artery.
*Marked deficit in hearts blood and O2 supply in proportion to myocardial demand.

Front 26

What else can elevate your LDL's

Back 26

estrogen

Front 27

Statins are?

Back 27

1st line of defense for lowering cholesterol

Should be administered at night “when head hits the pillow”
Erectile dysfunction in males
First manifestation of rapicomylsis is muscle ache.
Monitor liver function test and check for muscle aches.

Front 28

Nicotinic Acid is?

Back 28

Given with meals
If patient states a flushing feeling this is normal and tell them to take an aspirin.

Front 29

Fibric Acids are?

Back 29

Works on lowering the LDL levels and is given 30 min before am and pm meals
Monitor liver function test if abnormal after 3 months med is DC. Also monitor H&H and WBS’s as the med can decrease these levels

Front 30

Bile Acid Sequestrants

Back 30

Powder you mix with 4-6oz of juice and is very constipating so you increase your fluids.

Front 31

What is Angina?

Back 31

Angina is temporary or reversible myocardial infraction is not reversible
Insufficient coronary blood flow resulting in inadequate O2 supply to myocardium
Don’t have enough oxygen, convert to anaerobic (without air) produces lactic acid, this irritates nerve endings and they send pain impulses to the brain
Within 10 seconds myocardial cells experience ischemia

Usually occurs with activity
All about supply and demand It’s a decrease in blood flow

Front 32

Unstable Angina is?

Back 32

More severe and there is no known cause it’s unpredictable.

Front 33

Stable Angina is?

Back 33

is a predictable pattern. Stop the activity and take nitro. Take one Nitro every 5 min and the max is three “15 mins”

Front 34

What is Variant Angina?

Back 34

occurs spontaneously with no relationship to activity
Usually happens a night. And it is thought to be caused by artery spasm. Risk for MI is high.

Front 35

Nitroglycerin is what?

Back 35

the drug of choice for treating angina.
Dilates both veins and arteries causes venous pooling therefore less blood return to the heart (decreases preload)
Dilates arteries resulting in decreased peripheral vascular resistance (<BP) therefore (decreases afterload)

Front 36

What would you teach to patients given Nitroglycerin?

Back 36

: Carry nitro at all times, take drug in anticipation of any activity that may produce pain or exertion (prior to exercise, stair climbing, sexual activity)

Front 37

what is Nitrobid?

Back 37

Isordil – (patch) lasts up to 12 hours. It’s especially useful when pt experiences nocturnal angina.
Take BP before, rotate the site. Remove old ointment before applying new one. Nitrobid another name

Front 38

Beta Blockers are?

Back 38

Action – (protects the heart muscles) decrease myocardial oxygen consumption by blocking sympathetic impulses to heart, smooth muscle of bronchi and blood vessels.
Result - Decreases heart rate and blood pressure and myocardial contractility creating a more favorable balance between 02 need and supply. Need to check HR and BP before you give it.

Front 39

Propranolol is what?

Back 39

is the drug of choice can be administered with sublingual nitro. Nursing consideration – should not be used for pt with COPD, may cause impotence in men, and do not stop taking meds.

Front 40

What should I know about Loressor?

Back 40

These beta blockers block beta 1 (found in the smooth muscles of the heart) and it will then decrease HR, cardiac output and contractility. Lopressor, Tenoromin – induce cardiac Beta blockage without causing wheezing

Front 41

What are calcium channel blocker

Back 41

Calcium influences cardiac contraction and electrical stimulation. Action – dilates smooth muscle of coronary arteries thus, increasing oxygen supply, decreases systemic arterial pressure and workload. (Vasodilatation)
Channel blockers block the flow of Ca ions across myocardial cell membranes, resulting in relaxation of smooth muscles of myocardium.

Front 42

Nifedipine is used for?

Back 42

Prinzmetals or Resting Angina due to vasospasm. Most common used are Nifedipine S/E headache , flushing and dizziness. Male’s hypertension and pines hard to conceive also pines are very constipating.

Front 43

What is the first thing you would give for angina

Back 43

aspirin

Front 44

what is PTCA

Back 44

when symptoms can not be controlled with drugs than this invasive procedure is done to improve circulation. Balloon is inflated into the artery.

Pt receives large amounts of heparin during procedure, monitor closely for bleeding, after procedure continue to receive IV heparin and nitroglycerin to prevent vasospasm.
Nursing Interventions:
Use moderation in all activities of life, rest between activities, stop smoking, do not over eat, and avoid caffeine and healthy coping mechanism.

Front 45

When are you diagnosed with Hypertension?

Back 45

Three or more different dates of Systolic BP over 140 or Diastolic BP above 90.

Front 46

What is hypertension

Back 46

Alteration in tissue perfusion. Increase afterload and increased preload = heart failure
Leads to Angina, MI, CHF and arrhythmias (which is an interruption of electrical impulses in heart and will affect the electrolytes and low calcium levels
You are continuing to add volume and the heart will stretch and keeps contracting it will get weak. Ventricle can’t contract and decrease output and now Angie and Al come out

Front 47

What is effected by hypertension

Back 47

Most patient don’t have symptoms however check for epistaxis, and headaches they are the first symptoms and obtain an eye evaluation
Eyes – blurred vision or failing vision have them checked. Brain – strokes, Kidneys – renal failure

Front 48

What is the goal for hypertension?

Back 48

Ultimate goal is to lower BP Use Step Therapy 1st lifestyle modifications (three months) 2nd Introduce meds – thiazide (diuretic) may add beta blocker

Front 49

What meds would you give for HTN

Back 49

DIURETICS – Thiazide –used more often to treat HTN, first degree to decrease fluid load and promote K excretion. You need to monitor K. Works well with African and the elderly = low doses. Loop Diuretics (Lasix) – these meds lost K and excessively especially dangerous to those on digoxin Order K supplement. Potassium Sparing Diuretics- Retains K need to assess for hyperkalemia
ACE Inhibitors (prils) – decreases BP in 4 out of 5 pt who have mild HTN. Combine with diuretics can control severe HTN. Capoten, Vasotec and Zestril. More Chance of compliance due to less risk of S/E. Can experience hacking cough. ACE inhibitors are beneficial to those who have HTN from diabetic nephropathy and chronic renal failure.

Front 50

What patient teaching would you do for HTN

Back 50

Patient Teaching – Orthostatic hypotension worse in am, K depletion, sexual dysfunction, avoid hot baths and showers and med at HS if “first dose”