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Study Guide 2024/
What is stroke volume - ansAmount of blood ejected with each heart beat What is cardiac output - ansAmount of blood pumped by each ventricle in 1 minute Normal 4-8 L/min Cardiac index - ansCO divided by body surface area Normal 2.8-4.2 L/min/m What regulates the cardiovascular ssytem - ansAutonomic nervous system, Baroreceptors, chemoreceptors What are the Gerontological Consideration - ansRisk for cardiovascular disease (CVD) increases with age. CVD leading cause of death in adults > 85 What are some age related changes - ansIncreased collagen, decreased elastin Decreased response to stress Heart valves become thick and stiff. Number of pacemaker cells decrease. Decreased number and function of β-adrenergic receptors Blood vessels thicken and less elastic Increase in SBP and decrease or no change in DBP Incompetent venous valves Orthostatic hypotension Postprandial hypotension What are some subjective data for cardiovascular system - ansHistory of present illness Past health history Past and current medications Surgery or other treatments What are some objective data for cardiovascular system - ansVital signs Peripheral vascular system Inspection Palpation Auscultation When taking orthrostatic BP you should never - anshave a difference of > 20 mm Example ( laying 120/80, sitting 160/100 ) What is BMP - ans( B-type natriuretic peptide) will be increased in there is heart failure What are the cholesterol level - ansTotal cholesterol < LDL- (bad) < HDL-( happy ) > What are the nursing responsibility for cardiac cath - anscheck site, lay flat, log roll, check pulses, Bed rest for 2 hours How much sodium should a cardio patient get in 24 hours - ans2300 grams What are the cardiac biomarkers ( troponin) - ansTroponin T (cTnT) Troponin I (cTnI) Rises within 4-6 hours, peaks 10-24 hours, detected for up to 10-14 days What are the cardiac biomarkers ( creatine kinase ( CK) - ansThree isoenzymes CK-MB cardiac specific
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Rises in 3-6 hours, peaks in 12-24 hours, returns to baseline within 12-48 hours Cardiac catheterization - ansRight-sided to measure pressures Left-sided to evaluate coronary arteries How do the Baroreceptors Factors Influencing BP - ansSensitive to stretching Send impulses to sympathetic vasomotor center Blood pressure (BP) - ansthe force exerted by the blood against the walls of the blood vessel, is primarily a function of cardiac output (CO) and systemic vascular resistance. What is the Systolic BP - ansthe force exerted by the blood against the walls of the blood vessel What is the Diastolic BP - anspressure in the arterial system during ventricular filling What is a normal BP - ans<120 /< What is prehypertension - ans120/139/80- What is hypertension stage 1 - ans140-149/90- What is hypertension stage 2 - ans>160/> What are the sign and symptoms of Hypertension - ans"Silent killer", Often asymptomatic S/S reflect effects on target organs/tissues Fatigue , Activity intolerance, Dizziness, Palpitations, Angina Dyspnea What kind of studies are done for hypertension - ansUrinalysis, BUN and serum creatinine, Creatinine clearance Serum electrolytes, glucose, Serum lipid profile, Uric acid levels, ECG, Echocardiogram What does MAP mean - ansit is the average pressure in the arterial system if the mean < 60mm HG for adequate tissue prefusion Primary (essential or idiopathic) hypertension - anselevated BP without an identified cause, and it accounts for 90% to 95% of all cases of hypertension. Secondary hypertension - anselevated BP with a specific cause that often can be identified and corrected. relates to a underlying cause What is Coronary artery disease - ansa type of blood vessel disorder that is included in the general category of atherosclerosis What are the clinical manifestation of a hypertension crisis - ansHypertensive encephalopathy, Headache, n/v, seizures, confusion, coma, Renal insufficiency Cardiac decompensation, MI, HF, pulmonary edema Aortic dissection What are the nursing /collaborative management for hypertension crisis - ansHospitalization, IV drug therapy: titrated to MAP Monitor cardiac and renal function, Neurologic checks Determine cause, Education to avoid future crisis What is a Hypertensive crisis - ansterm used to indicate either a hypertensive urgency or emergency, develops over hours or days and BP is severely elevated > 220- What is a Hypertensive urgency - ansdevelops over days to weeks. This is a situation in which a patient's BP is severely elevated (usually above 180/110 mm Hg) but there is no clinical evidence of target organ disease.
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The incidence of CAD and MI - ansis highest among white, middle-aged men What are the Modifiable risk factors for CAD - ansinclude elevated serum lipids, elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states, and elevated homocysteine level. Elevated Serum Lipids - ansis one of the four most firmly established risk factors for CAD What is the second most modifiable risk factors in CAD - ansHypertension Management of High-Risk Persons - ansRecommend preventive measures for all persons at risk for CAD. Risk factors such as age, gender, ethnicity, and genetic inheritance cannot be modified. Collaborative and Nursing Management: CAD ( nutrition) - ans↓ Saturated fats and cholesterol ↑ Complex carbohydrates and fiber ↓ Red meat, egg yolks, whole milk ↑Omega-3 fatty acids The incidence of cardiac disease is greatly increased - ansin older adults and is the leading cause of death in older persons. myocardial ischemia - ansthe demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen Angina, or chest pain, - ansis the clinical manifestation of reversible myocardial ischemia. Either an increased demand for oxygen or a decreased supply of oxygen can lead to myocardial ischemia. Angina - ansis rarely sharp or stabbing, and it usually does not change with position or breathing. What are the Clinical Manifestations of CAD Angina Pain - ansPressure/ache Indigestion or burning Squeezing, heavy, choking, or suffocating sensation can radiate to shoulder, down the arm , jaw, neck What are the Clinical Manifestations of CAD ( Chronic Stable Angina) - ansrefers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms. only last 5-15 min What is Silent ischemia - ansischemia that occurs in the absence of any subjective symptoms. Patients with diabetes have an increased prevalence of silent ischemia because of nerve damage Nocturnal angina - ansOccurs only at night but not necessarily during sleep Angina decubitus - ansChest pain that occurs only while lying down Relieved by standing or sitting Chronic Stable Angina Collaborative Care - ansGoal: ↓ O2 demand and/or ↑ O2 supply Short-acting nitrates Dilate peripheral and coronary blood vessels Give sublingually (tablet) or by spray If no relief in 5 minutes, call EMS; if some relief ,repeat every 5 minutes for maximum 3 doses Patient teaching Can use prophylactically Long-acting nitrates - ansTo reduce angina incidence Main side effects: headache, orthostatic hypotension
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Methods of administration Oral Nitroglycerin (NTG) ointment Transdermal controlled-release NTG Patient with chronic stable angina with a high or low risk CAD - ansneed to take a ACE inhibitors , These drugs result in vasodilation and reduced blood volume It is recommended that patients with left ventricular dysfunction, elevated BP, or who have had an MI - ansstart and continue β-adrenergic blockers indefinitely, These drugs decrease myocardial contractility, HR, SVR, and BP, all of which reduce the myocardial oxygen demand. What kind of test do you do on a patient with a history of CAD - ansChest x-ray, Laboratory studies, 12-lead ECG, Calcium-score screening heart scan, Echocardiogram , Exercise stress test Pharmacologic nuclear imaging What is a stent - ansis an expandable meshlike structure designed to keep the vessel open by compressing the arterial wall. What is a STEMI - anstotal occlusion of coronary artery What is a non -STEMI - anspartial occlusion of coronary artery- What does ACS mean - ansAcute Coronary Syndrome What is ACS associated with - ansdeterioration of a once stable atherosclerotic plaque. The once stable plaque ruptures, exposing the intima to blood and stimulating platelet aggregation and local vasoconstriction with thrombus formation. This unstable lesion may be partially occluded by a thrombus NSTEMI) or totally occluded by a thrombus STEMI). Unstable angina - ansis chest pain that is new in onset, occurs at rest, or has a worsening pattern. The patient with chronic stable angina may develop UA( unstable angina), or UA may be the first clinical sign of CAD. UA is unpredictable and is an emergency How does a myocardial infarction (MI) occur - ansbecause of sustained ischemia, causing irreversible myocardial cell death (necrosis). Explain how a MI occurs - ansResult of sustained ischemia (>20 minutes), causing irreversible myocardial cell death (necrosis) 80%-90% secondary to thrombus Ischemia starts in subendocardium Necrosis of entire thickness of myocardium takes 4 to 6 hours Loss of contractile function What are the sign and symptoms of ACS - ansSevere, immobilizing chest pain not relieved by rest, position change, or nitrate administration Heaviness, pressure, tightness, burning, constriction, crushing, Substernal, retrosternal, epigastric, Common locations: substernal, retrosternal, or epigastric areas; pain may radiate to neck, jaw, arms, More common in AM, Atypical in women, elderly No pain if cardiac neuropathy (diabetes) What is the initial phase of MI - ansCatecholamine release - stimulation of SNS Release of glycogen, Diaphoresis Vasoconstriction of peripheral blood vessels
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Heart failure is associated with - ansnumerous types of cardiovascular diseases, particularly long-standing hypertension, coronary artery disease (CAD), and myocardial infarction (MI). What are the primary risk factors for Heart Failure - ansHypertension CAD What are the contributing factors in Heart Failure - ansAdvanced age, Diabetes, Tobacco use, Obesity High serum cholesterol What are the primary causes of Heart Failure - ansCoronary artery disease, including myocardial infarction Hypertension, including hypertensive crisis Rheumatic heart disease Congenital heart defects (e.g., ventricular septal defect) Pulmonary hypertension Cardiomyopathy (e.g., viral, postpartum, substance abuse) Hyperthyroidism Valvular disorders (e.g., mitral stenosis) Myocarditis What does cardiac output (CO) depend on - ans1) preload, (2) afterload, (3) myocardial contractility, and (4) heart rate (HR). What are the two classification of Heart Failure - ansSystolic versus diastolic Left-sided versus right-sided Pathophysiology of Systolic HF - ansInability to pump blood forward Caused by Impaired contractile function (MI) Increased after-load ( hypertension) Cardiomyopathy ( Valvular heat disease) Mechanical abnormalities ( Valvular heat disease) Decreased left ventricular ejection fraction (EF, amount of blood ejected from the LV with each contraction) Pathophysiology of Diastolic HF - ansImpaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO Heart failure with normal EF Result of left ventricular hypertrophy from hypertension, (Most common) MI, valve disease, or cardiomyopathy What are the Etiology and Pathophysiology of Coronary Artery Disease - ansAtherosclerosis is the major cause of CAD. It is characterized by deposits of lipids within the intima of the artery. Endothelial injury and inflammation play a central role in the development of atherosclerosis. What are the complication of Coronary Artery Disease
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(Peripheral Vascular Disease (PVD) ) - ansHTN speeds up atherosclerosis,Intermittent claudication Muscle pain during activity, relieved by rest Caused by ischemia What are the complication of Coronary Artery Disease (Nephrolsclerosis) - ansReduced blood flow to kidneys 2° to reduced vessels lumen. Decreased perfusion leading to end-stage renal disease What are the most common complications of hypertension - anstarget organ diseases occurring in the heart (hypertensive heart disease), brain (cerebrovascular disease), peripheral vessels (peripheral vascular disease), kidneys (nephrosclerosis), and eyes (retinal damage). What is collateral circulation - ansWith the gradual increase in the size of lesions the body creates new pathways for the blood Very slow process Physiological response to ischemia Does not fully replace lost volume What are some nonmodifiable CAD risk factors - ansAge, Gender, (Males > females), Ethnicity, (Whites > African Americans), Genetic Predisposition What are some modifiable CAD risk factors - ansHyperlipidemia, HTN, DM, Smoking, Physical inactivity, Obesity What are the manifestation of CAD ( Chronic Stable Angina) - ansChest pain noted on exertion or with any activity that causes myocardial O2 demand. Due to CAD blood vessel cannot meet the demand. Pain that generally lasts less than 5 minutes. Pain resolves when Precipitating factor is removed What are the Diagnostic Tests test that can be done for CAD - ansHistory and Physical examination Bilateral BP measurements Ensure appropriate cuff is used, take minimum of 2 readings Lab studies, UA, creatinine clearance, Electrolytes, BUN, glucose, creatinine,ECG, Echocardiogram What is the Collaborative and Nursing Management: CAD - ansLipid-lowering drug therapy, Fibric acid derivatives (Lopid) Decrease triglycerides and increase HDL, GI side effects Antiplatelet therapy , ASA, Clopidogrel (Plavix) What are the Clinical Manifestations of ACS Unstable Angina - ansNew in onset, Occurs at rest, Worsening pattern, Increase in frequency, Unpredictable, Medical emergency, Symptoms in women may be more vague. UA is unpredictable and is an emergency. What is the immediate treatment of MI - ansM: Morphine O: oxygen N: Nitroglycerin A: ASA or Plavix What is Heart Failure - ansAn abnormal clinical syndrome involving inadequate cardiac pumping/filling
