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124 Cards in this Set
- Front
- Back
The RCA is located between the ------------ AND --------------
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RA
RV |
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The RCA extends to the posterior of the heart (is dominant) in ______of the population
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90%
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The RCA supplies blood to the ____, ___, ______________ &_________of__________
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RA
RV most of the conduction system inferior &posterior walls the LV |
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Occlusion of the RCA may result in __________, ________or _________infarction
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inferior
posterior RV |
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A frequent complication is ________
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heartblocks
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The LAD is located _______.
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btn RV and LV
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The LAD is the main supply to ______,, _______, and ________.
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LV
septum anterior wall |
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Occlusion of the LAD results in __________MI, associated with _________ _________
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anterior wall
pump failure |
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The circumflex curves between the _____ and _____; it also wraps around _____________
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LA
LV the back of the heart |
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Occlusions of the circumflex result in ____ or ________ MI
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lateral
posterior |
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Cardiac output is defined as
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volume of blood ejected from LV over one minute (4-6 L)
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Determinants of CO are ____ and ______
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HR
SV |
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SV is affected by _____, ___ and _____
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preload
afterload contractility |
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The volume of blood in the ventricle at the end of diastole is _________ and is the most important component of _____
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preload
SV |
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The tension or resistance in the systemic circulation is _____.
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afterload
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The SNS has the greatest effect on the _____ and ______ ________
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R & L ventricles
blood vessels |
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The PNS cardiac effects are______, ______ and ____
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decreases HR
decr spd of cond thru AV node slight depress of contractility |
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Baroreceptors respond to
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Pressure changes --BP changes
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Chemoreceptors respond to changes in ________, ________
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blood chemistry: O2, CO2, H ion concentration (acidosis, alkalosis_
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The RAAS is a compensatory mechanism that plays an important role in auto regulation by ___________________
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detecting decr in BP,vasoconstriciton, decr renal perf, incr aldosterone wh incr BP
.....look at RAAS chartq |
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Aortic dissection pain is described as _____.
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ripping and tearing, radiates to back; sometimes causes laryngitis. Not relieved by rest
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Anginal chest pain may last ______ and can radiate to the ______
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20-30 min
substernal chest, arm, jaw, shldr and back. May/may not be rel'd c nitro or rest |
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Pericarditis pain is described as ___, __________ or ______, oppressive pain that is exacerbated by _______
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sharp
pleuritic dull inspiration |
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ST elevations on the 12 lead for pericarditis are _____, with out _________
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global
reciprocal changes |
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Gastric refulx pain may mimic ___ and is described as _____ or _____, but is relieved by _____. ______ show up on ECG
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MI
burning squeezing antacids; Will not |
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6 symptoms assoc with cardiac origin of pain include:
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diaphoretic, cool/clammy skin, dizziness, sob, palpitations and anxiety
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Dyspnea may develop ____, d/t_______
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slowly
forward (LV) pump failure |
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Pulm edema can occur _____d/t
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rapidly
anesthesia, or a strong acute ischemic event |
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____ or ____-______ sputum is r/t ____ ____ ____ secondary to __________
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Frothy
pink acute pulmonary edema L heart failure |
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System assessment questions and considerations for cardiac pt and why: UO, fatigue, syncope, leg edema, leg pain
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UO-should be >30 cc/hr
fatigue-worse at PM than AM syncope-not perfusing well chest pain-d/t ischemia dizzyness and palpitations leg edema-symetrical, look for venous ulcers leg pain-arterial-stops if dangle over bed; venous-pain relief if elevate legs |
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The apical pulse (PMI) is normally seen _____
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5th ICS, midclavicular line
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CV palpation assessment is done with_____of hand
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side/palm
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normal apical pulse should not be seen or felt in more then ___ intercostal space
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one
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Sustatined movement of the apex is due to _____ ______ and are called ___ and _____
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ventricular enlargement
lifts heaves |
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Cardiac thrills are best felt with the _________, lifts and heaves are best felt with the ______
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heel of the hand
fingertips |
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S1/S2 heart sounds are ___ ____ and best heard with the ______ of stethoscop
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high freq
diaphragm |
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S3/S4 are ___ ____and best heard with the ____
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low frequency
bell |
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5 cardiac auscultation landmarks.
All Physicians Take Money Eagerly |
Aortic area
Pulmonic area Tricuspid area Mitral area Erbs point |
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S1 occurs at the end of _____. S2 at the end of _____.
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diastole-when Atrio Ventricular valves close.
systole-when pulmonic and aortic valves close |
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An S3 heart sound is considered abnormal after the age of ___
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30
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Differentiating systolic from diastolic murmurs is done by _____ ____ _______ _____
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palpating the carotid artery
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S3 and S4 can be heard distinctly for _____. S3/S4 blend together for _____ and are referred to as _______
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HR < 100
HR > 100 summation gallop |
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Pulses are checked to determine changes in -------- --------
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Heart rate
Rhythm and quality of pulse |
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It is important for -------- ------- to verify lost peripheral pulses with vascular surgery patients
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Two
nurses |
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The 4Ps ---- ---- ---- and ----indicate a -----artery. this is an ----- -------
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Pain pulselessness paralysis pallor
Blocked Immediate intervention |
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You suspect your patient could have peripheral artery disease. you perform an ankle brachial index. this is done by
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ABI=Ankle SBP/brachial SBP
ABI should be .80or greater, or decrease of no more than 15percent from baseline |
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Why is it important to know what the patient's baseline BP is
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It is used to normalize patients BP while hospitalized
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The advantages of using mean arterial pressure clinically are
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Not site dependent.
Not affected by poorly damped invasive line. Approximates perfusion pressure to cerebral and systemic arterial systems |
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Edema from a systemic cause is seen ---- whereas localized edema maybe caused by -----------
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In all dependent areas.
a thrombus or other instructive process. |
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Measurement of edema should be done--------And--------
For Consistent measurement |
Where the edema is greatest
Marked |
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Pitting edema is better assessed by---------Then by a---------
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Describing length of time it takes for tissue to return to baseline
Measurement scale example 1/2 inch pitting edema |
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Myocardial oxygen demand is affected by blank, blank, blank, and blank blank.
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Pre-load
After load Contractility Heart rate |
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How does increased or decreased pre-load affect myocardial oxygen demand
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Increased preload decreases myocardial oxygenation demand.
Decreased pre-load decreases stroke volume, increases compensatory heart rate and increases oxygen demand |
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Contractility consumes blank of myocardial oxygen supply
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70%
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After load is the blank that blank must overcome to eject its blank. It is affected by blank blank blank.
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Force or resistance
Ventricle Preload Systemic vascular resistance |
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Types of angina
Stable angina |
Predictable, does not increase in severity or duration, relieved with rest and or nitro
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Types of angina
Unstable angina |
Previously diagnosed but occurs more frequently and last longer or produces symptoms with less and less exertion
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Types of angina
Prinzmetal angina |
Also called variant angina. Usually occurs at rest and is due to coronary artery spasm
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Types of angina
Anginal equivalent |
Symptoms that do not include chest pain, such as dyspnea, diaphoresis, Jaw, tooth, neck or arm pain.
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Types of angina
Silent ischemia |
Ischemia without symptoms. Detectable only through ECG
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Types of angina
Associated angina |
Associated with an MI. Angina lasting greater than 20 to 30 minutes of onset. MI and/or infarction should be considered
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The labvalues specific to myocardial infarction are blank and blank
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CK/MB
Troponin's. Troponin's are the most reliable marker for cardiac injury. |
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Reinfarction is diagnostic if troponins taken 3 to 6 hours apart show ------
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Elevation of greater than 20 percent
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MRI is suspected with ST elevation is greater than blank on the ECG or if it occurs in blank or blank
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1 mm
In two leads that look at the same area of the heart. Hyper a cute T waves are shown. |
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Supplemental oxygen should be applied for what three reasons.
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1. if arterial oxygen saturation is less than 90%.
2: if patient is exhibiting respiratory distress. 3. If patient is at high risk for hypoxemia. |
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What are the functiosof nitrates?
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Vasodilator, decreased preload, dilates coronary arteries allowing more oxygenated blood to the myocardium.
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What are the functions of morphine given for acute coronary event
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Increases venous capacitance therefore decreases preload in patients with heart failure secondary to ischemia. Decreases heart rate therefore decreases workload
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Standard medications used to treat and MI are
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Oxygen. Nitrates. Anticoagulants. Beta blockers. Ace inhibitors. Calcium channel blockers. Fibrinolytics.
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Cardio selective beta blockers are safer to use for pations with reactive airway disease and include -------, -------,--------
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Metoprolol -lopressor
atenolol -tenor in Esmolol |
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Standard of care of ST elevation myocardial infarction includes.
Immediate care: |
12 lead ECG within 10 minutes. CBC and cardiac enzymes. Start IV. Chest x-ray. Oxygen and possibly cathlab
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Standard of care of ST elevation myocardial infarction includes.
Medication |
Nitro, morphine, aspirin, Clopidigrel, beta blocker, anti-thrombin, GP IIb IIIa platelet receptor blocker.
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Standard of care ST elevation myocardial infarction includes
Reperfusion |
Fibrynolytic 30 minutes door to needle, emergent PCI 90 minutes door to balloon. Urgent/emergent cabs
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How is an non STEMI differentiated from STEMI
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Non-STEMI=ischemia
STEMI=injury Treatment is predominantly the same except in NonSTEMI no reperfusion therapy and no Fibrinolytics |
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Other significant reasons beta blockers and Ace inhibitors are used in patients with myocardial infarction are
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Beta blockers decrease sympathetic nervous system effects: decrease after load, decrease hypertension, decrease heart rate, and Decrease ventricular remodeling.
Ace inhibitors prevent remodeling, decrease after load, and decrease workload of heart. Both beta blockers and Ace inhibitors are utilized to prevent remodeling in an effort to retain normal myocardial cell functioning. |
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Hypertension is defined
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Systolic blood pressure greater than or equal to 140. Diastolic blood pressure greater than or equal to 90. Taking anti-hypertension medications. Been told twice by Dr. or other health professional that hypertension is present.
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Pathologic consequences for hypertension includes
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CAD. MI. HF. Stroke.
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In adults greater than 50 years old, -------- is a more important indicator for CV risk and is more difficult to control than -----
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SBP>140
DBP |
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-----rises with age. ------- lowers with age
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SBP
DBP |
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Systolic blood pressure greater than 160 with a normal diastolic blood pressure is termed – -- ----
and is common in the -- patient. |
Isolated systolic hypertension
Elderly |
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90% of the population of hypertension has –
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Primary essential hypertension which is defined as hypertension with no known cause.
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Secondary Hypertension
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Hypertension with an identifiable cause that can be corrected
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Resistant hypertension criteria is ---
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Patient is on a full dose therapy including a diuretic.
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Blood pressure levels greater than 250/150 requires emergency treatment with in – and is termed –.
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One hour
Hypertensive crisis |
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Complications due to hypertensive crisis include
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Encephalopathy. Vasospasm. Ischemia. Cerebral edema. Hemorrhage. Brain loses ability to autoregulate
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Signs and symptoms of hypertensive crisis include
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Blood pressure greater than 250/150. Severe headache. Altered level of consciousness. Seizure. Vomiting. Signs and symptoms of heart failure.
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Blood pressure should not be lowered more than – or to a level of – when treating hypertensive crisis.
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25% in first two hours.
160/100. |
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Nitroprusside for hypertensive crisis
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0.25 - 0.5 µg per kilogram per minute. Potent arterial vasodilator
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Heart failure is defined as impaired ventricles to either – or –
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Fill properly
Eject optimally |
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What are two symptoms a patient presents with which manifest heart failure
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Dyspnea or fatigue
Extracellular fluid retention |
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Heart failure is – of hospitalization in the United States in patients older than –.
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Single most common cause
65 |
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Preload is –
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Volume dependent
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After load is dependent on – or – is in the –
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Systemic vascular resistance
How much vasoconstriction Arteries |
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– may be the earliest warning sign of heart failure
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Sinus tachycardia
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Failure of compensatory mechanisms to compensate for the overworked heart and heart failure leads to
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1. Increase preload
2 increased after load 3 decrease contractility 4 decreased ejection fracture due to failure of LVto eject full SV. 5 increased left atrial pressure 5 increased right ventricular pressure |
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Common causes of left heart failure due to left ventricular dysfunction include
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CAD. Hypertension. Dilated cardiomyopathy. Aortic valve disease. Incompetent mitral valve disease. Other causes include myocardial infarct. Congenital mechanical cardiac defects. Chronic tachycardias. PeriPartum, Cardiomyopathy. Cardio toxic agents. Alcohol. Drug abuse. Thyroid and connective tissue disorders. Idiopathic.
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Right ventricular failure may result from ---
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Prolonged left ventricular failure.
Isolated right ventricular myocardial infarction. Primary pulmonary hypertension. Acute or chronic lung disease. |
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It is important to assess – in the heart failure patient to determine if patient activity has been decreased to compensate for –
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Exercise tolerance
Dyspnea or fatigue |
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Signs of right ventricular backward failure include
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JVD. Abdominal swelling. Peripheral edema. Anorexia. Seizure. Hepatic tenderness.
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Signs of left heart failure include
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Left ventricular hypertrophy. Dyspnea on exertion. Cough.Orthopnea. Paroxysmal nocturnal dyspnea.
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Lab values to monitor in the heart failure patient are:
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Potassium due to diuretics decreasing K levels.
Dig level -digtoxicity BUN and creatinine levels to assess renal function. Hemoglobin and hematocrit |
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When you assess the heart failure patient nursing assessment in the following include:
A. Systolic blood pressure to a goal of – b. heart sounds C. Loans –, –, –, –, or –. D. Hypoxemia signs and symptoms – or – E. ECG findings F. Kidney findings G. Activity intolerance |
A. Greater than 90.
B. s3,s4 C. Crackles wheezes. Cough.Frothy blood tinged sputum. Pulmonary edema. D. Restlessness. Decreased mentation. E. Ventricular arrhythmias or supraventricular arrhythmias F. Heart failure can cause kidney injury and vice versa. Anemia can cause the Ischemiaand worsen heart failure; anemia causes end organ hypoperfusion. G. Decrease SBP>10, decr DBP>5, ^ HR >20beats over resting heart rate, unable to talk with activity, or word dyspnea |
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Hold criteria for medications in heart failure patients may be –
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Lower than in patients without heart failure
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– – Is the worst state of acute decompensation
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Pulmonary edema
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Assessment findings of acute decompensated heart failure include
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Low systolic blood pressure. S3 and S4 sounds. Lung sounds with crackles wheezes cough,blood tinged sputum. Restlessness. Fluid in Lungs. Monitor cardiac rhythm especially ventricular. Kidney function. Anemia resulting in hypoperfusion. Activity intolerance.
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The goal of diuretic therapy for heart failure is to
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Relieve symptoms of congestion while maintaining adequate circulation.
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The most common cardiomyopathy is --
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Dilated cardiomyopathy
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Dilated cardiomyopathy compensatory mechanisms and clinical presentation or the same as – –.
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Heart failure.
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The common diagnostic tool for cardiomyopathy is
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Echocardiogram
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When listening to heart sounds stenosis is heard when the valves are supposed to be –. Regurgitation is heard when the valves are supposed to be –
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Open.
Closed. |
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Beta blockers are – in patients with aortic stenosis and used with caution or avoided with – –.
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Contra indicated
Aortic regurgitation. |
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Medications contraindicated with aortic regurgitation include-- or ---
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Vasoconstrictors or vasoppressors
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Atrial fibrillation commonly occurs with – – and – –. The patient should be assessed for this condition if new on set atrial fibrillation occurs.
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Mitral stenosis
Mitral regurgitation |
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Patients with severe mitral stenosis may have a physical sign called –.
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Mitral facies, which is pinkish purplish discoloration of cheeks
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An ejection fraction less than 60 is considered – in mitral regurgitation.
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Abnormal
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The risk or embolic episodes is greatest with
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Dilated cardiomyopathy
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When administering heparin and nitroglycerin concurrently, the nitroglycerin may block some of the anti-thrombin effects of the heparin
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True
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The goals of treatment for a STEMI are
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Administration of a fibrinlytic agent within 30 minutes of arrival or, if interventional therapy is available, first angioplasty balloon inflation within 90 minutes
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– Is not an indication for temporary cardiac pacing
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General anesthesia in the elderly
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The energy or electricity generated by the pacemaker is called output and is measured in milliamps or mA
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True
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Which ECG leads record the electrical activity on the anterior surface of the left ventricle
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V3, V4
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Which ECG leads record the electrical activity on the lateral surface of the left ventricle
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I, aVl, V5, V6
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When a patient with heart failure is treated with an ace inhibitor the nurse will assess the following laboratory work prior to medication administration
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Serum creatinine and serum potassium
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The goals of therapy for managing heart failure might include
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Improving cardiac output by decreasing preload and afterload with diuretics, and nitroglycerin
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A Homografts valve is
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Tissue valve from human donor
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