Cardiovascular Chapt 3 NPTE

clingenhoel
Flashcards by clingenhoel, updated more than 1 year ago
clingenhoel
Created by clingenhoel over 5 years ago
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Flashcards on Cardiovascular Chapt 3 NPTE, created by clingenhoel on 12/15/2015.

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Question Answer
Heart cycle Right Atrium receives blood from superior and inferior vena cava--tricuspid>Right ventricle-->lungs via pulmonary artery-->Left atrium--bicuspid>Left ventricle -->aorta to the body
Conduction of the heart SA node impulse spreads throughout atria which contact together-->impulse stimulates AV node, transmitted down bundle of His to Purkinje fibers; impulse spreads to ventricles which contract together
Cardiac output Q= SV x HR normally 4-5 L/min
Ejection fraction % of blood emptied from ventricle during systole; clinical measure of LV function EF=SV/ left ventricular end diastolic volume(LVEDV)
Lymphatic system Drains lymph from bodily tissues and returns it to venous circulation. All travel to left subclavian vein. Contributes to immune system fx: lymph nodes collect cellular debris and bacteria; remove excess fluid, blood waste and protein, and produce antibodies
Parasympathetic stimulation (cholinergic) Control in medulla oblongata Via vagus nerve (CN X), cardiac plexus; innervates all myocardium; releases acetylcholine. causes artery vasoconstriction
Sympathetic stimulation (adrenergic) Control in medulla oblongata Via cord seg T1-T4 Releases epinephrine and norepinephrine. Fight or flight
Baroreceptors (pressoreceptors) Main mechanism controlling HR
Circulatory reflex Respond to changes in BP 1) Increased BP results in parasympathetic stim, dec rate and force ; sympathetic inhibition, decreased peripheral resistance 2) Decreased BP results in sympathetic stimulation, inc HR and BP and vasoconstriction of peripheral blood vessels
Chemoreceptors Sensitive to O2. CO2, lactic acid. Inc CO2, lowers pH, inc HR Inc O2, decreased HR (less needed cycle of O2/min)
Hyperkalemia Inc K+ ions widen PR interval and QRS, tall T waves
Hypokalemia dec K+ ions flattened T waves, prolonged PR and QT intervals-->ventricular fibrillation
Normal HR Adult: 60-100 Children: 60-140 Newborns: 90-164
Heart sounds (normal) Lub: normal closure of mitral and tricuspid valves (beginning of systole) Dub: normal closure of aortic and pulmonary valves (end of systole)
Normal RR Adult: 12-20 b/m Child: 20-30 b/m Newborn: 30-40 b/m
Ankle brachial index (ABI) The ratio of LE pressure / UE pressure 1.00-1.40- normal <0.90 = 2-4 fold increased risk for cardiovascular event/death < 0.50 =inc risk for limb ischemia in 1 yr Clinically significant change = > 0.10-0.15 in patient with symptoms
STEMI Tissue death full thickness of myocardium ST elevated MI (STEMI) or Q wave
Heart failure: heart is unable to maintain circulation of the blood to meet needs of the body Left sided (CHF): pulmonary congestion, edema and low Q due to backup of blood from left ventricle to left atrium and lungs. (From excessive workload from the heart, hypertension) Right sided: Increased pressure load on R ventricle with heir pulmonary vascular pressures. Jugular vein distention and peripheral edema *Can have biventricular
REDUCE BP ACE inhibitors Angiotension II receptor blockers ACE: Decreases Na retention and peripheral vasoconstriciton to decrease BP*- lisinopril Angiotension 2: blocks binder of angio 2 at muscle level, decrease BP*-losartan
CONTROL ANGINA Nitrates (nitroglycerin) Dec preload through peripheral vasodilation, reduce myocardial oxygen demand, reduce angina*, dilate coronary arteries to improve BF
Beta-adrenergic blocking agents reduce myocardial demand by reducing HR and contractility; control arrhythmias, chest pain; reduce BP*-lopressor, toprol XL, propranolol
Calcium channel blocking agents (Cardizem, pericardia, norvasc) Inhibit flow of Ca+, decrease HR, decrease contractility, dilate coronary arteries, reduce BP, control arrythmias, chest pain
Diuretics decrease myocardial work, control hypertension
Activity restriction Acute MI/ Acute heart failure activity increased after acute MI has stopped Activity should be limited to 5 METs or 70% of HR max for 4-6 wks -No increase in oxygen demand for patients in acute or decompensated heart failure*
Peripheral arterial disease (PAD) Chronic, occlusive arterial disease of medium/large vessels, the result of peripheral atherosclerosis -Diminished BF to affected extremities -Early: intermittent claudication, pain burning aching cramping. Late: trophic changes (hair loss, skin and nail changes), muscle atrophy
Thromboangiitis obliterates (Buerger's disease) Chronic, inflammatory vascular occlusive disease of small vessels Common in young adults, smokers Progresses distal to proximal in UE/LE Symp: paresthesia or pain, cyanotic cold extremity, dec temp sensation, risk of ulceration/gangrene
Diabetic Angiopathy An inappropriate elevation of blood glucose levels and accelerated atherosclerosis -Neuropathy Neurotrophic ulcers, may lead to gangrene/amputation
Superficial vein thrombophlebitis Clot formation and acute inflammation in superficial vein -usually saphenous vein
Deep vein thrombophlebitis (DVT) Clot formation and acute inflammation in deep vein. May precipitate PE: chest pain, SOB, cough, diaphoresis *ambulation and mobility encouraged after 1 dose of heparin
Venous Valvular insufficiency Fibroelastic degeneration of vale tissue, venous dilation Grade 1: mild aching, minimal edema, dilated superficial Grade 2: increased edema, multiple dilated, changes in shin pigmentation Grade 3: Venous claudication, severe edema, cutaneous ulceration
Lymphedema Mechanical insufficiency of lymph system Primary: congenital condition with abnormal lymph node or vessel Secondary: acquired
max/target HR calculation 208-0.7 x age HR range 60-80%(HR max-RHR) + RHR = target HR
ECG Changes with exercise Tachycardia Rare-related shortening of QT interval ST segment depression, upsloping, less than 1 mm Reduced R wave, inc Q wave Exertional arrhythmias: rare, single PVCs
ECG changes with exercise, a pt with MI or CAD 1. Significant tachycardia 2. Exertional arrhythmias: inc frequency of ventricular 3. ST segment depression; horizontal or downslope, greater than 1 mm below baseline
MET 3.5 mL/kg per minute
Relationship between HR max and functional capacity VO2max 70-85% HR max to 60-80% functional capacity VO2max
Absolute indications for terminating exercise 1. drop in systolic BP >10 mmHg 2. Moderate to severe angine 3. Inc nervous system symptoms 4. Signs of poor perfusion 5. Technical difficulties 6. Subjects desire to stop 7. Sustained VT 8. ST elevation >1.0
Relative Indications for terminating exercise 1. ST or QRS changes 2. Arrhythmias other than sustained VT 3. Fatigue, SO, leg cramps, claudication 4. Bundle branch block 5. Increasing angina 6. Hypertensive response (>250/>115 mmHg)
Cardiac rehab: Phase 1 ADLs, selected arm and leg exercises, ambulation. low intensity 2-3 METs, >5 by discharge Post MI: limited to 70% HR max Short sessions 2-3x/day Restrictions for lifting with sternal incision Goals: Ambulation 20-30 min, 1-2x/day 4-6days/week
Cardiac Rehab: Phase 2 Progress to full ADLs, occupational activities 2-3x/week, 30-60 min Continuous, circuit training, strength training 9 MET functional capacity Strength training: after Phase 1, 5 wks post MI, 8 weeks post CABG
Cardiac rehab: Phase 3 Usually Home 50-85% functional capacity, 3-4x/week, 45+ min/session Entry level criteria: functional capacity of 5 METs, stable angina, controlled arrhythmias
Rehab for arterial disease Interval training: ambulation and rest when claudication gets moderate (2) Can do non-weight bearing activity Improve BF with PF/DF with resistance (Modified Buerger-Allen exercises)
Rehab for Venous DIsease DVT: Activity limited until dose of heparin Chronic venous insufficiency: Positioning- UE/LE elevation Compression Red clad: consider consequences of compression therapy to a limb with ABI < 0.8* or with active cellulitis or infection - Exercise: active ankle exercises, cycle ergometry, early ambulation
Guidelines for Lymphatic Disease Short-stretch compression bandages (worn 24 hrs/day) excessively high pressures will occlude superficial lymph capillaries and restrict fluid absorption Manual lymph drainage (MLD)* Functional activities Red Flag: Strenuous activities exacerbate Meticulous skin care: hygiene, nail care Compression pumps: pressures >45 mm Hg CONTRAINDICATED* Contraindications to modalities: heat/ice cause vasodilation and inc lymphatic load of water, no electrotherapy >30 Hz.
CPR 100 compressions/min 30:2 single rescuer 15:2 with 2 rescuers (children)
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