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COTAC Exam 2 - Cardiovascular System - Exam Review + Key Concepts

Terms in this set (94)

Pink frothy sputum is an indication of what complication?
Pulmonary Edema
What's the difference between unstable and stable angina?
Stable Angina - chest pain relieved with rest or nitroglycerin
Unsteady - chest pain not relieved by rest or nitrolgycerin
Unstable angina is a precurser to what?
Myocardial Infarction (Heart attack; NSTEMI or STEMI) which can lead to heart failure
What disorders are caused by hardening and thickening of the valve leaves?
Stenosis

Think that STenosis STiffens
What is the only cause of rheumatic endocarditis?
Group A Beta Hemolytic Strep

(Causes strep throat)
What type of heart catheterization can be left in for hemodynamic monitoring?
Right heart catheter
What are the differences between a right and left heart catheter?
Right -
-In a vein
-Can be left in
-Biopsy

Left -
-In an artery
-Cannot left in
-Biospy is possible
-Looks at coronary vessels
What is normal venous pressure?
2-6
If venous pressure is too high (over 6), what's the problem?
hypervolemia - we see this with heart failure
If venous pressure is too low (under 2), what's the problem?
Hypovolemia
What would you expect to see with hypervolemia?
-Weight Gain
-Edema
-Crackles in the lungs
-JVD (jugular vein distension)
What are interventions to help with hypervolemia (fluid overload)?
-Fluid restrictions
-Low sodium diet
-Monitor Is/Os
-Diuretics
What can Coronary Artery Disease cause?
Angina (ischemic chest pain), Myocardial Infaction (Heart Attack), Cardiac Arrest
What is often caused by mitral valve prolapse?
Mitral valve regurgitation
What is mitral valve regurgitation?
Mitral valve does not close completely- blood backs up into L atrium. The atrium stretches as a result.
What's the pathway of the heart?
1. Superior Vena Cava 2. Pulmonary Artery 3. Right Atrium 4. Right Ventricle 5. Pulmonary arteries 6. Pulmonary Veins 7. Left Atrium 8. Left Ventricle 9. Aorta
All valve issues if left untreated will lead to what?
Heart failure
What are the risk factors for infective endocarditis?
-Structural malformities (any congenital heart defect)
-Implanted cardiac devices
-Prosthetic heart valves
-IV drug use
-Immunosuppression (always at risk for infection)
-Dental procedures (over 30 minutes)
-Copper IUD


(Anything implanted, especially metal increases the risk of infective endocarditis)
What's another name for Cor Pulmonale?
Right-sided heart failure
JVD (jugular venous distension), dependant edema, ascites (excess abdominal fluid), and fatigue are all signs of what?
Right-sided heart failure (also known as Cor Pulmonale)
Clinical manifestations of what condition include hypotension, muffled heart sounds, JVD, and paradoxical pulse?
Pericardial Tamponade
What's a parodoxial pulse?
Drop in systolic pressure when holding breath or inhaling

This can only be measured with an arterial line
Pharmalogical management of valve disorders may include which classes of medications?
-Diuretics
-Afterload reducing agents (BP meds)
-Positive Inotropic Agents (Digoxin)
-Anticoagulants
-Antiarrythmics
What diagnostics would be ordered to help diagnose infectious and inflammatory disorders of the heart?
-Blood cultures
-Blood count
-Cardiac Enzymes
-ESR/CRP (inflammatory markers, but can't tell you where the inflammation is)
-EKG
-Echo
-Strep
-Chest Xray
Why would you do cardiac enzymes?
After an MI, we commonly see pericarditis
Troponin tells us what?
Damage to the cardiac tissue

Onset: 3-4 hours
Peak: 1 day
Duration: 7-10 days
What's the onset, peak, and duration of troponin?
Onset: 3-4 hours
Peak: 1 day
Duration: 7-10 days
We check troponin levels every _____ hours
4

This is done to see what the trend is, we want the levels to trend down to know the cardiac event has passed
What would be a concerning troponin level?
Troponin over 0.03
Elevated troponin indicates what?
Heart damage (most likely from a Myocardial infarction/ heart attack)
What is the lab used to diagnose a Myocaridal Infarction (heart attack)?
Troponin
What are the 3 types of percutaneous coronary interventions?
Stent
Arthectomy - Removal of plaque
Perc. Transluminal Coronary Angioplasty - put balloon in, squish plaque against the walls, and insert a stent

Remember SAP!
What is used to evaluate coronary patency?
Left Heart Catheter
One of the primary functions of this test is to evaluate cardiac structures.
Echocardiogram

Helps us see how the pump (heart) is working as a whole
When occluded, what is known as "the window maker"?
Left anterior descending artery

The most commonly occluded coronary vessel and one of the most dangerous
What are the frequently seen clincial manifestions of a MI (heart attack)?
-Chest pain
-Left arm pain
-Shortness of breathe
-Nausea/Indigestion
-Cool pale moist skin
-Increased RR + HR
-Anxiety
Initially, mitral valve problems cause disturbances on what cardiac structure?
Mitrial-atrial

Hypertrophy and dysrhythmias
Initially, aortic valve problems cause disturbances on what cardiac structure?
Aortic-ventricular

Hypertrophy + dysrhythmias
Cough, crackles, restlessness, and dyspnea on excertion are what?
Symptoms of left-sided heart failure
What are 5 modifiable risk factors for CAD?
-Smoking
-Hypertension
-Cholesterol (LDL)
-Diabetes Mellitus
-Obesity
-Activity
What are nursing interventions for a patient with heart failure?
-Low sodium diet
-Fluid restrictions
-Monitoring vital signs
-Bed rest + energy conservation
-Lung assessments
-Is + Os
-Monitor Labs
What education would you give to a patient with heart failure?
Low sodium
Low fat
Know about which diuretic they're on to determine potassium intake
What diuretics spare potassium, and which ones hold onto them?
Furosemide - dumps potassium
Spironalactone - potassium sparing
What's the difference between a mechanical and biological valves?
Mechanical valves last a lifetime but lifelong INR

Biological lasts 7-10 years, 3 months anticoagulants
Which kind of valve lasts a lifetime?
Mechanical valve
What medications are commonly used in treatment of infectious and inflammatory diseases of the heart?
-Antibiotics
-Antipyretics
-Anti-inflammatories
-Antifungals
-Antivirals
-Pain medications
What is the pathway of the Electrical Impulse in the Heart?
The electrical impulse originates in the sinoatrial (SA) node, located in the right atrium. It then travels through the atrioventricular (AV) node, then through the bundle of His, and finally through the Purkinje fibers.
What is the pathway of blood through the heart?
superior vena cava, inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary artery, lung capillaries, pulmonary vein, left atrium, mitral valve, left ventricle, aorta
When do troponin levels peak?
24 hours
When is th onset of troponin? (When will you start to see it)
3-4 hours
What's the duration of troponin?
7-10 days
What kind of echocardiograms are there?
TTE - transthoracic

TEE - transesophogeal, remember that TEE goes down your throat
What nursing considerations do you have with a TEE echocardiogram?
Make sure they have a gag reflex and can swallow
When are times you would use an echocardiogram?
If we're concerned about a...
-valve disorder
-heart failure
-hypertrophy
-after an MI
-stress tests
What are the two kinds of stress tests?
Exercise Stress Test - On a treadmill
Pharmacological Stress Test - Regodenosin will make your hard speed up like you're exercising
Who could benefit most from a pharmacological stress test?
-Immobile patients
-Cognitively impaired patients
What will patients be hooked up to during a stress test?
EKG
When do we stop a stress test?
-Chest pain
-Changes in the EKG
-Once target heart rate is achieved
Even if you haven't gotten to your goal with a stress test, it will stop immediately if the client reports what?
Chest pain
What's the difference between an ECG and EKG?
Absolutely nothing
What is a holter monitor?
An ambulatory ECG that monitors patients for 24-48 hours
EKG lead placement
White above green
Brown to the pt. right of sternum
Smoke over fire
A right heart catheter goes through what?
The vein
A left heart catheter goes through what?
The artery
What are indications for a right heart catheter?
Respiratory issues or concerns with pressure (pulmonary hypertension)
How does pulmonary hypertension present?
Exertional dyspnea or right sided heart failure

-Shortness of breathe
-Fatigue
-Chest pain
-Swelling
What's the only way to diagnose pulmonary hypertension?
Right heart catheter
What are some potential complications of a right heart catheter?
-Dysrhythmias
-Infection
-Retroperitoneal bleeding (when it goes through the femoral artery)
Retroperitoneal bleeding only occurs when?
When going through the groin
What are preferred arteries for left heart catheters?
-Right brachial artery
-Right femoral artery
What are indications for a left heart catheter?
-Look at left ventricle
-Look at left side of heart
-Check for proper function
-Contrast dye can be used
This is taken out when it's finished
What are complications for a left heart catheter?
-Bleeding
-Infection
-Puncture
-Bruising
-Dysrhythmias

We always risk trauma at the site with any needle
Right heart catheters can cause a ______ _____, and the left heart catheters can cause a ____________ ______________.
Venous spasm, Myocaridal infarction
A venous spasm is caused from a ________ sided heart catheter.
Right
A myocardial infaraction can happen from a ______ sided heart catheter.
Left
What are nursing considerations for left and right sided heart catheters when going through the wrist?
They'll need to be on bedrest for 2 hours
What are nursing considerations for left and right sided heart catheters when going through the groin?
They'll need to be on bedrest for 2 hours
If a heart catheter is put into the groin, how should the legs be positioned?
Straight
If a heart catheter is inserted in the wrist, what consideration should be made when it comes to sleep and body position?
Don't sleep on that side or arm for 24 hours
What would complications be with hemodynamic monitoring?
-Infection
-Bleeding
What is Central Venous Pressure (CVP)? What's the normal limits?
the pressure of blood in the thoracic vena cava, near the right atrium of the heart; reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system

2-6
What is an EPS?
electrophysiological study; electrode catheters are inserted into veins and threaded into the heart and electrical conduction is measured (tachycardias are provoked and analyzed)

Open chest and only used when going into the chest for another reason
What is CABG? (Coronary Artery Bypass Graft)?
Open Heart Surgery, they take veins from somewhere else and bypass the occluded artery

They'll be put on bypass and is a major surgery
Why does is someone on bypass a high risk for bleeding?
Excessive heparin
After taking Nitroglycerin for the first time, showing no improvement, the patient should do what?
Take one every five minutes (3 total including the first time) and call 911
What's the big side effect of nitro?
Pounding headache, this is normal due to extreme dilation
What should you always wear while administering nitro?
PPE
In terms of lab test with CAD, what do we look at?
LDL
Triglycerides
Total Cholesterol
What is the good type of cholesterol?
HDL (happy cholesterol)
What should total cholesterol be under?
<200 mg/dL
What are risk factors for CAD?
Sedentary lifestyle
Smoking
Poor diet
fatty foods
Chest pain is always considered what until proven otherwise?
heart attack

put them on an ekg ASAP
You have how many minutes to get an EKG reading once there's a complaint of chest pain?
10 minutes
What medications would we expect for myocardial infarctions?
Thrombolytic Drugs
Morphine
Oxygen (only if hypoxic)
Nitro (but doesn't work on a right sided MI)
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