Respiratory
Enlargement of airspaces and alveolar wall destruction
Emphysema
Fatty streaks cause damage to vessels by secreting:
Inflammatory cytokines
Shortness of breath, frothy sputum, fatigue, orthopnea, reduced exercise tolerance, weight gain
Signs and symptoms of left sided heart failure
You notice your patient's EKG looks like big tombstones with no clear p waves, qrs or t waves (uh oh). You correctly identify this rhythm as:
Ventricular tachycardia
Name 2 major side effects to monitor for a patient taking furosemide (Lasix):
For loop diuretics:
dehydration, hypotension, hypokalemia, hearing loss
When using a beta 2 agonist inhaler and a glucocorticoid inhaler, what is the correct order of administration?
Beta 2 agonist THEN glucocorticoid
A 55-year-old patient died of a myocardial infarction. Autopsy would most likely reveal:
a. Fibrin clot formation within an atherosclerotic coronary artery.
b. Smooth muscle dysplasia in the coronary artery.
c. Embolization of plaque from the aorta.
d. Decreased ventricular diastolic filling time.
Fibrin clot formation within an atherosclerotic coronary artery.
Name 3 symptoms/signs of right sided heart failure
Jugular venous distention, weight gain, peripheral edema, hepatosplenomegaly, dyspnea, ascites, fatigue, rapid/irregular heartbeat, abdominal bloating, etc
Your patient's EKG rhythm looks like a jagged sawtooth with small QRS complexes between every few sawteeth. You correctly identify this dysrhythmia as:
Atrial flutter
Name 3 medications that inhibit steps of the RAAS system:
Aldosterone antagonists (spironolactone)
ACE inhibitors (lisinopril)
ARBs (losartan)
Direct Renin Antagonists (aliskiren)
Productive cough, purulent sputum, dyspnea, adventitious lung sounds, dramatic cyanosis, hypoxemia, hypercapnia
S/s of chronic bronchitis
The progression of atherosclerosis begins with:
a. Endothelial injury and inflammation.
b. High serum cholesterol levels.
c. An increase in antithrombotic substances.
d. Congenital heart disease.
Endothelial injury and inflammation
_______ is the volume of blood stretching the ventricles at the end of diastole, and is determined by venous return to the heart.
Preload
Before administering a beta blocker (metoprolol) you should ALWAYS:
check blood pressure and heart rate
alpha 1 receptors are responsible for increasing ____ and beta 1 receptors are responsible for increasing ___
SVR (vasoconstriction) and heart rate
A patient comes to the ED after evacuating a house fire. On route, they were stable, but they suddenly begin rapidly breathing with retractions. Crackles and bronchi are present. They are rapidly declining. What does the nurse suspect?
ARDS
After walking from his car to the clinic, a patient develops substernal pain and discomfort in his left shoulder and his jaw that lasts for 2 minutes and subsides with rest. He indicates that this has occurred frequently over the past few months with similar exertion. The nurse suspects he is most likely experiencing:
Stable angina
What would you expect to see happening with the heart rate and blood pressure of a shock patient?
Heart rate increased, blood pressure decreased
Name the electrical activity in the heart associated with the P wave, QRS complex, and T wave:
P wave: depolarization of atria
QRS: depolarization of ventricles
T wave: repolarization of ventricles
Calculate the MAP for the blood pressure 120/80
MAP= [(2x80) + 120]/3= 93mmHg
MAP= [(2xD)+S]/3
Name 3 medication that can be used in the long term prophylaxis of asthma:
Leukotriene modifiers
Long-acting anticholinergics
Glucocorticoids
LABAs
What is a major side effect and safety risk when taking nitroglycerin?
Orthostatic hypotension
Name the four types of shock and provide one example of each:
Cardiogenic (HF, MI), distributive (sepsis, anaphylaxis), obstructive (cardiac tamponade, pneumothorax), hypovolemic (blood loss, dehydration, third spacing)
Name two side effects associated with calcium channel blockers (ie verapamil and diltiazem)
• Bradycardia
• Hypotension
• Heart block
• Heart failure
• Peripheral edema
• Constipation
Also: flushing, reflex tachycardia --> nifedipine
BP= a x b
a= c x d
Hint: think about different volumes and pressures impacting preload, afterload, ejection fraction, and distal tissue perfusion!
BP= CO x SVR
CO= HR x SV