NUR 114 > Perfusion A > Flashcards

Perfusion A Flashcards

(47 cards)

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1
Q

Preload

A

volume of blood entering the ventricles at the end of diastolic

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2
Q

Afterload

A

resistance left ventricles must overcome to circulate blood (systolic) and eject the contents

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3
Q

Cardiac output

A

Heart Rate*Stroke Volume

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4
Q

Normal cardiac output

A

4-8 L/min

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5
Q

Ejection Fraction

A

if low, heart is failing
amount of blood pumped out of the ventricle/total amount of blood in the ventricle=EF
Normal 55-70%

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6
Q

MAP

Mean Arterial Pressure

A

SBP+2(DBP)/
3
Normal 60-70

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7
Q

Angina

A

“heart attack”

pain caused by insufficient coronary blood flow resulting in lack of oxygen

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8
Q

Chronic stable angina

A

pt needs rest; deep breaths

-deep chest pain 
pain radiates to neck jaw shoulders back and arms 
-pain radiates L side normally 
-n/v; indigestion
-dyspnea, diaphoresis, lightheadness
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9
Q

Atypical Angina

A

Women

indigestion, aching jaw, fatigue, sleep disturbances, shob

may not have “chest pain”

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10
Q

Atypical Angina

A

Elderly

no chest pain
shob, disorientation/confusion

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11
Q

Unstable Angina

A

Acute Coronary Syndrome

Pre-infarction
pain, WILL FEEL LIKE AN EMERGENCY
-Usually lasts longer than 15 minutes
-Causes severe activity limitations
-Is not relieved by rest and nitroglycerin

people have this before a heart attack

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12
Q

Variant (Prinzmetal’s) angina

A

Due to coronary artery spasms
Similar to stable angina
Lasts for a longer period of time

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13
Q

Labs for Angina

A

Lipid profile
(triglyceride 35-160,
<200 cholesterol)

Na 135-145
K 3.5-5.3
Ca 8.5-10.5
Mg 1.5-2.5
BUN 6-20
CRT 0.7-1.7
Glucose 65-99
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14
Q

C-Reactive Protein

A
  • shows inflammation in the body; not specific to the heart

- can have a role in the development and progression of atherosclerosis

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15
Q

Coagulation studies

want this to be high for blood to be thinner

A

PT 11-`13.5 seconds
PTT 20-35 seconds (Heparin)
INR 0.9-1.9 (Coumadin)

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16
Q

Troponins T and 1

A

found only in patients with myocardial muscle ischemia or necrosis, so any rise in value indicates possible MI (levels rise within 3-6 hours)

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17
Q

Creatinine Kinase MB(CK-MB)

A

most specific for MI (rises 2-3 hours after cardiac cells are injured and remains elevated for 12 hours)

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18
Q

Myoglobin

A

is a small oxygen-binding protein found in heart and skeletal muscled which is released when heart or skeletal muscles are injured

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19
Q

ECG

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A

The electrocardiogram provides a graphic record of the heart’s electrical activity.

  • dysrhythmias
  • electrolyte imbalances
  • conduction abnormalities
  • enlarged heart
  • effects of drugs
20
Q

Exercise ECG (Stress Test)

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A
  • Non-invasive
  • Patient should rest, avoid smoking and use of alcohol
  • No food 2 hours before test
21
Q

Pharmacological ECG (Stress Test)

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A
  • Invasive (used when patient cannot tolerate exercise)
  • Must have IV access
  • -Dobutamine- strengthen heart muscles
  • -Dipyridamole- anticoagulant
22
Q

Contraindications for CST

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A
  • Severe HTN
  • HF
  • Unstable angina
  • Acute myocarditis
23
Q

Goals for Cardiac Stress Test (CST)

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A
  • Target heart rate: 80-90% of maximum predicted heart rate

- Discontinue stress test if significant changes noted in the ECG especially changes in ST segment

24
Q

Trans-Esophageal Echocardiography (TEE)

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A
  • Examines cardiac structure and function
  • May be done with pharmacologic stress test
  • NPO 4 to 6 hours before and 4 hours after procedure (avoid aspiration)
  • IV access, moderate sedation
  • Monitor for:
  • –Bleeding
  • –Sore throat
  • –Aspiration
  • –Vocal cord paralysis
  • –Pain (could indicate perforation)
  • monitor airway and swallow test
25
What questions to ask before a CT?
- assess for die allergy (iodine and seafood) | - assess for Metformen (for DM) do not take 48H before
26
MONA for pt with heart attack
- Morphine - Oxygen - Nitrates - Aspirin
27
Nitroglycerin
- Short acting sublingual - given to reduce cardiac muscle oxygen demand through vasodilation which decreases ischemia, relaxes blood vessels and relieves pain - Prevents pain in patients with angina when climbing stairs, having sexual relations, or going outside in cold weather - Decreases afterload, creating a more favorable balance between oxygen supply and demand
28
PT education with Nitro
- Keep nitroglycerin in original dark capped bottle and renew supply every 3-5 months - Do not eat, drink or smoke while nitroglycerine is dissolving - Lie down when taking sublingual nitroglycerin to prevent falls resulting from sudden hypotension
29
Long Acting Nitrates - Isosorbide dinitrate - Isosorbide mononitrate - Nitroglycerin patch or paste
- Used to reduce the incidence of angina attacks - Apply to clean, dry, hairless area - Remove after 12-14hours - Rotate application sites
30
Beta-Blockers (LOL)
Metoprolol Carvedilol - block cardiac stimulating hormones - reduces HR, BP, O2 - wheezing, crackles, cough, edema, weight gain (HF)
31
Calcium Channel Blockers (PINES)
Amlodipine Verapamil (no grapefruit juice) - Action of drugs: - -Decreases afterload (resistance in vascular) - -Decreases HR - -Decreases peripheral vascular resistance - -Promotes vasodilation, thus lowering BP - -Improves myocardial perfusion - Check BP and pulse prior to administration
32
Anti-Platelet Agents(GREL)
Prevent platelet aggregation Aspirin (bleeding) - 81-325mg - no herbal remedies - ringing in the ears; ototoxicity Clopidrogrel - Take with food - Report s/s bleeding - avoid grapefruit juice Prasugrel - Do not give to patients with history of stroke - Watch for s/s bleeding
33
Clopidrogrel
- Take with food - Report s/s bleeding - Anti-Platelet Agents
34
Prasugrel
- Do not give to patients with history of stroke - Watch for s/s bleeding - Anti-Platelet Agents
35
Peripheral Vascular Diseases (PVD)
- lower and upper extremities - Arteries and arterioles transport oxygenated blood from the heart to the body tissues - Veins and venules return unoxygenated blood back to the heart
36
S/S of Peripheral Artery Disease (PAD)
- intermittent claudication (too little blood flow to legs and arms) - rest pain - paresthesias (numbness) - diminished peripheral pulses - pallor w/ extremity elevation - rubor w/ extremities
37
Peripheral Artery Disease (PAD)
result of systemic atherosclerosis -can cause gangrene, extremity amputation, rupture of aneurysms, infection/sepsis
38
Stage I: Asymptomatic PAD
- No claudication is present - Bruit or aneurysm may be present - Pedal pulses diminished
39
***Stage II: Claudication PAD
- Muscle pain, cramping or burning with exercise relieved by rest - Symptoms return with exercise
40
Stage III: Rest pain PAD
- Pain while resting(often awakens patient at night) - Numbness, burning or toothache like - Pain relieved by placing the extremity in dependent position
41
StageIV:Necrosis/ Gangrene PAD
- Ulcers and blackened tissue occur on the toes | - Gangrenous odor
42
best way to manage PAD?
EXCERCISE
43
Stains
-lower cholesterol -monitor liver enzymes AST 10-40 ALT 7-57 -avoid grapefruit juice -take with food (GI disturbances)
44
Arterial thrombosis/embolism
``` 6Ps -pain -pallor -paresthia (numbness/tingling) -pulselessness -paralysis poikilothermia (coldness) ```
45
Chronic Venous Insufficiency
Chronic Venous insufficiency is inadequate venous return for a period of time, resulting in stagnation most commonly in the lower leg
46
Virchow’s triad:
Blood stasis (pooling) Vessel wall injury Hyper coagulation
47
Diagnosis of DVT
-D-dimer test (fibrin coagulation activation) Helps determine risk -Compression ultrasonography Allows rapid and clear visualization of thrombi -DVT risk classification (page 742 Iggy)
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