Medications/Treatments
What is the mechanism of action of a beta blocker?
Give one example for full points
"lols"
Define preload and afterload
preload: the pressure generated at the end of diastole (resting filling pressure)
afterload: Resistance heart must overcome to pump blood
What is the optimal point the heart muscle can be stretched?
120%
A CK-MB level greater than ____ is indicative of cardiac muscle damage
6%
Which signs indicate possible increased afterload for the left ventricle?
Cool, clammy extremities, may indicate peripheral arteries are constricted, thick brittle nails, and non-healing wounds indicate chronic poor perfusion.
Explain the difference between a loop diuretic and a thiazide diuretic
example of loop diuretic: furosomide
example of thiazide diuretic: metolazone
define hypervolemia and/or hypovolemia and how they can affect preload/afterload
hypervolemia: increase in intravascular volume, excess of extracellular fluid and it increases both preload and afterload
hypovolemia: decrease in intravascular volume, deficit of extracellular fluid, and it decreases both preload and afterload
The hemodynamic goal is to:
optimize ________ & minimize _________
optimize Preload & minimize Afterload
This lab is a hallmark marker for congestive heart failure
BNP
normal: <100
The nurse is caring for a patient who has increased afterload, what findings is the patient exhibiting?
Decreased stroke volume and hypertension
How do angiotensin-converting enzyme (ACE) inhibitors work to reduce HF? Name 2 ways.
1) prevent the conversion of angiotensin I to angiotensin II
2) cause systemic vasodilation because it inhibits angiotensin II
3) reduce preload and afterload
Explain the difference between systole and diastole of the heart
Systole: the contraction of the heart
Diastole: the relaxation of the heart
What does the mnemonic 'MONA B' stand for and when is it used?
M- Morphine
O- Oxygen
N- Nitroglycerin
A- Aspirin
B- Beta Blocker
Used for patients experiencing chest pain
Breakdown of muscle tissue releases this damaging protein in the blood
Lactic Acid
normal (0.5-2.2)
The nurse is caring for a patient with left sided heart failure, what may the patient be exhibiting?
crackles, cough, dyspnea, fatigue, weakness, oliguria during the day, tachycardia, S3 & S4 gallop
What are the parameters for giving nitroglycerin?
One sublingual then wait 5 minutes, if the patient is still having chest pain, take one more sublingual and wait 5 minutes, repeat one more time. If chest pain still persists, call 911 or notify physician.
What are the three major categories for valvular dysfunction and give an example of one
1) Stenosis- aortic or mitral valve stenosis
2) Regurgitation- aortic or mitral valve regurgitation
3) Prolapse- valvular prolapse
If afterload increases, cardiac workload ______.
Increases
How do they measure ejection fraction and what is the normal range?
ECHO and/or cardiac catheter
normal range: greater than 60%
The nurse is caring for a patient with right-sided heart failure, what may the patient exhibit?
What are the pulse parameters for digoxin administration and why are they important?
<60 bpm adult
<70 bpm child
<90 bpm infant
Important because bradycardia is one of the first signs of digoxin toxicity along with vomiting, abdominal pain, anorexia, nausea, and arrhythmias.
Name one compensatory mechanism for arterial blood pressure regulation and explain
1) RAAS: blood flow/ blood pressure is decreased, Renin is produced, angiotensinongen converted to Angiotensin I, which converts to angiotensin II, aldosterone is secreted which increases absorption of sodium and water and excretion of potassium and hydrogen.
2) The kidneys: GFR decreases when blood pressure decreases, therefore urine output is decreased, therefore the body retains water, which increases the blood volume.
3) Autonomic Nervous System: the sympathetic increases CO by causing vasoconstriction, speeding up the heart rate, and increasing cardiac contractility. The parasympathetic nervous system decreases cardiac output by slowing the heart rate and decreasing cardiac contractility and vasodilation.
Starlings Law states:
As stretch increases (more preload), contraction increases which increases cardiac output
Strength of contraction varies with length of muscle fiber
When is the onset of troponin after a MI
6 hours
normal range: <0.3 ng/ml
What are the two most common valvular dysfunctions that occur as a result of infective endocarditis?
Mitral Regurgitation
Aortic Stenosis