Cardiac Output And Tissue Perfusion

Front 1

What is cardiac output (CO)?

Back 1

hearts ability to pump blood systemically is measured by CO

Front 2

CO=?

Back 2

heart rate (HR) x stroke volume (SV)

Front 3

What is stroke volume?

Back 3

amount of blood pumped out of the ventricle with each contraction

Front 4

What are modifiable risk factors?

Back 4

weight, social activities (smoking, drinking), diet, exercise

Front 5

What are non-modifiable risk factors?

Back 5

age, gender, family hx, race

Front 6

What are the clinical manifestations of adults with alterations in cardiac output and tissue perfusion?

Back 6

chest pain, dyspnea, peripheral edema, wt gain, fatigue, dizziness, syncope, changes in LOC

Front 7

What is diastole?

Back 7

relaxation phase, simultaneous

Front 8

What is systole?

Back 8

contraction of the atria and ventricles, not simultaneous

Front 9

What is the primary pacemaker of the heart?

Back 9

sinoatrial (SA) node

Front 10

What is preload?

Back 10

degree of stretch of the ventricular cardiac muscle fibers at the end of diastole

Front 11

What is afterload?

Back 11

resitance to ejection of blood from the ventricle

Front 12

What is contractility?

Back 12

force generated by the contracting myocardium

Front 13

What are the priority nursing actions for a pt with an alteration in cardiac output and tissue perfusion?

Back 13

monitor VS, auscultate heart for sounds and rhythm, monitor ECG for dysrhythmias, watch for trends in VS/hemodynamics, assess labs and cardiac biomarker, measure UO, observe and monitor for changes in skin color and temp, nail beds, lips, ears, extremities and buccal mucosa, administer prescribed meds, record pain, consult with nutrition

Front 14

What is coronary artery disease?

Back 14

atherosclerosis of the inner lining of the blood vessels that supply blood to the heart

Front 15

Medications for CAD

Back 15

HMG-CoA or statins, nicotinic acids, fibric acids, bile acids, cholesterol absorption inhibitor

Front 16

What is prescribed with every chest pain?

Back 16

MONA-morphine, O2, Nitro, ASA

Front 17

What is the difference between angina and a heat attack?

Back 17

angina will be relieved by rest and nitroglycerin

Front 18

What is angina?

Back 18

syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest by insufficient coronary blood flow

Front 19

What are the types of angina?

Back 19

Stable angina, unstable angina, intractable or refractory angina, variant angina, and silent ischemia

Front 20

What are the clinical manifestations of angina?

Back 20

chest pain, radiation to neck, jaw, shoulders or inner arm, weakness or fatigue, parasthesia in arms, wrists and hands, anxiety, SOB, pallor, dizziness, NV

Front 21

What are the education/safety needs for the angina patient?

Back 21

educate on nitrate admin, side effects and contraindications, teach when to report pain, teach when to call MD, educate on activities to avoid and rest periods, educate on risk of antiplatelet/anticoagulant medications

Front 22

Medications for angina:

Back 22

Nitrates, beta blockers, calcium channel blockers, antiplatelet, ASA, Plavix, Ticlid, Reopro, anticoagulant, heparin, Lovenox

Front 23

Time=

Back 23

muscle

Front 24

What is an MI

Back 24

acute onset of angina caused by an interruption in coronary artery blood flow which causes prolonged oxygen deprivation and permanent myocardial tissue death

Front 25

What are the education/safety needs for the MI patient?

Back 25

obtain 12 lead ECG, assess pain, administer meds, reassure patient on task performing and fears, teach what will be done next, keep family informed

Front 26

Medications for MI

Back 26

ASA (keeps platelets from sticking), nitroglycerin (vasodilation), morphine (IV), IV beta blocker or ACE inhibitor, platelet-inhibitors/thrombolytics, analgesic, supplemental O2

Front 27

What is HF (heart failure)

Back 27

inability of the heart to pump enough blood to meet the needs of the tissues for oxygen and nutrients supplied by the blood. AKA CHF

Front 28

systolic heart failure

Back 28

inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract

Front 29

diastolic heart failure

Back 29

inability of the heart to pump sufficiently because of an alteration in the ability of the heart to fill

Front 30

Congestive heart failure

Back 30

ineffective heart pump, fluid overload, inadequate tissue perfusion, reversible, progressive, lifelong, systolic or diastolic

Front 31

Right sided HF

Back 31

RV cannot eject sufficient amounts of blood and blood backs up in the venous system/peripheral tissues and viscera

Front 32

What does right sided heart failure result in?

Back 32

peripheral/dependent edema, hepatomegaly, ascites, JVD, anorexia, nausea, weakness and wt gain

Front 33

Left sided HF

Back 33

LV cannot pump blood effectively to the systemic circulation, pulmonary venous pressures increase

Front 34

What does left sided HF result in?

Back 34

pulmonary congestion with dyspnea, cough, crackles and impaired O2 exchange, extra heart sounds may occur (S3 or ventricular gallop), oliguria/nocturia, pale/ashen skin, cool/clammy, palpitations, weak pulses

Front 35

How does HTN affect afterload, BP and fluid volume?

Back 35

BP increases, afterload increases and fluid volume increases

Front 36

Management of HF includes:

Back 36

eliminate/reduce etiologic or contributory factors, reduce workload of the heart by reducing afterload and preload, optimize pharm and therapeutic regimens, prevent acute exacerbations of HF, supp O2, promote healthy lifestyle

Front 37

What oral meds are used for HF therapy?

Back 37

ACE inhibitors, ARBs, hydralazine and isosorbide dinitrate, beta-blockers, diuretics, digitalis, CCBs

Front 38

What does digitalis do for HF?

Back 38

increases the force of contraction

Front 39

What do CCBs (calcium channel blockers) do for HF?

Back 39

vasodilation and decreases HR

Front 40

What IV meds are used for HF therapy?

Back 40

Nesiritide(Natrecor), Milirinone(Primacor), Dobutamine(Dobutrex), Inotropin(Dopamine)

Front 41

The IV medications Nesiritide(Natrecor), Milirinone(Primacor) and Dobutamine(Dobutrex) are:

Back 41

+ inotropes. These will increase the force of contraction

Front 42

Why is inotropin (Dopamine) prescribed for a patient with HF?

Back 42

at low doses, it will increase renal perfussion

Front 43

As a nurse, what patient teaching will be done for the patient with HF?

Back 43

Take meds as prescribed, low Na diet and fluid restriciton, monitor for signs of excess fluids, hypotension, daily wts and symptoms of disease exacerbations, stress management, avoid ETOH, cease smoking, prevent infection, know when and how to contact HCP, include family in teaching

Front 44

What is pulmonary edema?

Back 44

abnormal build up of fluid in the air sacs of the lungs which leads to shortness of breath

Front 45

Is pulmonary edema chronic or acute?

Back 45

it is an acute event that results from left ventricular failure

Front 46

What are some causes of pulmonary edema?

Back 46

HF, poisonous gas, severe infection/sepsis, med side effects, major trauma, kidney failure, complications of MI, narrowed heart valves, cardiomyopathy

Front 47

What are s/s of pulmonary edema?

Back 47

restlessness, anxiety, sense of suffocation, cyanotic nail beds, ashen skin, cold and moist skin, weak and rapid pulse, confusion, stupor, JVD

Front 48

How is pulmonary edema managed?

Back 48

O2 therapy, morpine, diuretics, IV vasodilators

Front 49

What is the nurses role in education/safety needs for PE?

Back 49

recognize s/s, proper positioning, assist in reducing anxiety and fear, observe for adverse effects of treatment, monitor O2 sats, continually monitor ECG

Front 50

What is PVD?

Back 50

refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain

Front 51

What is PAD?

Back 51

a condition of the blood vessels that leads to narrowing and hardening of the arteries that supply the legs and feet

Front 52

What is the purpose of the continuous-wave Doppler ultrasound?

Back 52

detects blood flow combined with computation of ankle or arm pressures, helps characterize the nature of PVD

Front 53

What are the s/s of PVD/PAD?

Back 53

whooshing sound with stethoscope over artery (arterial bruits), decreased BP in affected limb, loss of hair on legs or feet, weak or absent pulses in limb

Front 54

What is the s/s of PVD/PAD that is severe?

Back 54

withering calf muscles, hair loss over toes and feet, painful non-bleeding ulces on feet or toes that are slow to heal, paleness of skin or blue color of toes or foot, shiny tight skin, thick toenails

Front 55

What treatments/medications are used to treat patients with PVD/PAD?

Back 55

antiplatelet agents, Cilostazol, cholesterol lowering medications, pain relievers, surgery

Front 56

As a nurse, what will you teach to a patient with PVD/PAD?

Back 56

modify risk factors, take meds as directed, avoid vasoconstriciton, lower extremities below level of the heart (to increase arterial blood supply), elevate extremities if venous in nature, encourage walking/ROM, discourage standing still or sitting for prolonged periods, maintain warmth, instruct ways to avoid trauma, written instructions on care of extremities and proper fitting of clothes, administer vasodilators and adrenergic blocking agents as prescribed

Front 57

What is Buerger's Disease?

Back 57

AKA Thromboangiitis Obliterans-recurring inflammation of intermediate and small arteries and veins of the lower and upper extremities, autoimmune disorder

Front 58

Progressive occlusion of vessels in Buerger's Disease results in?

Back 58

pain, ischemic changes, ulcerations and gangrene

Front 59

Risk factors for Buerger's Disease:

Back 59

men ages 20-35, tobacco use

Front 60

What is Raynaud's Disease?

Back 60

intermittent arterial vasoocclusion, usually in fingertips and toes

Front 61

What are the s/s of Raynaud's disease?

Back 61

sudden vasoconstriction results in color changes, numbness, tingling and burning pain

Front 62

What is HTN?

Back 62

systolic BP > 140mmHg and diastolic BP > 90mmHg based on average of 2 or more accurate BP taken during 2 or more contacts with HCP

Front 63

What are education/safety needs for adults with HTN?

Back 63

reduce wt, adopt DASH, Na reduction/restriction, increase physical activity, moderation in ETOH and tobacco consumption, teach pt that HTN can increase risk for other cardiovascuar problems

Front 64

What is a hypertensive emergency?

Back 64

BP > 180/120 and must be lowered immediately to prevent damage to target organs

Front 65

What is a hypertensive urgency?

Back 65

BP very high but no evidence of immediate or progressive target organ damage

Front 66

What are the therapeutic goals for a hypertensive emergency?

Back 66

reduce BP 25% in first hour, reduce to 160/100 over 6 hrs, gradual reduction to normal over a period of days, medications such as IV vasodilators, frequent monitoring of BP and cardiovascular status

Front 67

What are the therapeutic goals for a hypertensive urgency?

Back 67

close monitoring of BP and cardiovascular status, assess for potential evidence of target organ damage, fast-acting oral agents (labetalol, captopril, clonidine)

Front 68

What is postural (orthostatic) hypotension?

Back 68

low BP that occurs when the pt assumes an upright posture

Front 69

Postural hypotension can result in:

Back 69

dizziness, lightheadedness, or fainting

Front 70

What are the causes of postural hypotension?

Back 70

dehydration, blood loss, poor autonomic and vascular constriction mechanisms

Front 71

How do we assess for postural hyptoension?

Back 71

position pt supine and flat for 10 min before taking initial BP, position pt sitting on bed with feet dangling and wait 1-3 minutes before taking next BP, have pt stand next to bed, wait 1-3 min before taking next BP

Front 72

What is the normal postural response that occurs when a person stands or sits up from a lying position?

Back 72

HR increases 5-20 bpm above resting HR, unchanged systolic pressure or slight decreas of up to 10mmHg, slight increase of 5mmHg in diastolic pressure

Front 73

What is shock?

Back 73

condition in which a tissue perfusion is inadequate to deliver O2, nutrients to support vital organs, cellular function, affects all body systems

Front 74

What is hypovolemic shock?

Back 74

decrease intravascular volume by 15-30%, loss of 750-1500mL of blood in a 70kg person, caused by fluid losses externally or fluid shifts internally

Front 75

How is hypovolemic shock managed?

Back 75

treat underlying cause, fluid/blood replacement, redistribute fluid, pharm therapy, nurses administer blood/fluid safely, implement other measures