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What is the blood flow path?
LV->aorta->arteries->arterioles->capillaries->venules->veins->vena cava->RA
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Blood vessels have?
- 1. smooth endothelial lining
- 2. ANS innervation of smooth muscle
- 3. elastic tissue
- 4. alpha-adrenergic receptors
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When alpha-adrenergic receptor s are stimulated by epinephrine, what happens?
arteriole vasoconstriction
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What is the formula for cardiac output?
Cardiac output (ml/min)=heart rate (per min)X stroke volume (RV&LV output in ml per contraction)
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Changes occur in cardiac output when?
HEART BEGINS TO FAIL
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The heart has beta adrenergic receptors that, when stimulated by epinephrine cause?
- 1. increase in pulse
- 2. increase in force of contraction
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What are the 3 waves of a ECG?
- 1. p wave
- 2. qrs wave
- 3. t wave
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what is p wave?
contraction (depolarization) of atria
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what is qrs wave?
contraction (depolarization) of ventricles
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what is t wave?
relaxation (repolarization) of ventricles
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What are ECG waves affected by?
- 1. drugs
- 2. electrolyte imbalances
- 3. heart disease
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What are the common drugs used for heart disease?
- 1. diuretics
- 2. ACE inhibitors
- 3. Calcium channel blockers
- 4. beta-adrengeric blockers
- 5. nitrates
- 6. digitalis
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What are diuretics?
- 1. increase sodium excretion
- 2. increase K loss
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What is the most common treatment for heart disease?
diuretics
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What is the path for ACE inhibitors?
blacks formation of Angiotensin II->decrease in aldosterone secretion->decreased sodium retention-> decreased BP
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What are calcium channel blocker's path?
decrease in P, causes vasodilation->decreased BP
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What are beta-adrenergic blockers?
- 1. decrease P
- 2. decrease force of contraction
- THUS:
- 3. easing stress on heart
- 4. decreasing BP
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What are nitrates?
vasodilate coronary arteries (EX:Nitroglycerin)
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What is digitalis?
- 1. increases force of contraction
- 2. decreases P
- LEADS TO:
- making beats more efficient
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What are the different heart diseases?
- 1. angina pectoris
- 2. myocardial infarct
- 3. atherosclerosis
- 4. arteriosclerosis
- 5. cardiac rhythm disorders (bradycardia, tachycardia, asystole, fibrillation, PVC)
- 6. pericarditis
- 7. congestive heart failure
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What is another name for myocardial infarct? (MI)
Anterior MI
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What is MI?
total occlusion of coronary artery->cardiac tissue death
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What are the S&S of MI?
- 1. chestpain (may feel like heartburn)
- 2. sweating
- 3. nausea
- 4. pain may radiate to jaw, arm, or back
- 5. insomnia prior to MI
- 6. ECG shows changes
- 7. blood tests show increase cardiac enzyme levels due to muscle damage
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(MI) when may pain be minimal?
- If you are:
- 1. female
- 2. elderly
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What helps with MI if taken early on?
ASA
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What is the tx for MI?
- 1. extensive array
- 2. thrombolytics if caught early on
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What is angina pectoris?
chest pain due to lack of sufficient coronary blood flow (only PARTIAL artery occlusion).
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What is the tx for angina pectoris?
nitroglycerin (NTG)
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What are atheromas?
patches of cholesterol deposits
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What is atherosclerosis?
blood vessels lined with artheromas
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What is arteriosclerosis?
blood vessels lose their elasticity
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arteriosclerosis is usually due to?
old age
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arteriosclerosis is also called?
"hardening of the arteries"
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Diuretics cause increased excretion of sodium and water leading to?
decreased blood volume
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What are the adverse effects of diuretics?
- 1. nausea
- 2. vomiting
- 3. orthostatic hypotension
- 4. dizziness
- 5. xerostomia
- 6. hypokalemia
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Ace inhibitors prevent decreased blood vessels size, in other words?
prevents vasoconstriction
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What are the adverse effects of ace inhibitors?
- 1. headache
- 2. orthostatic hypotension
- 3. dizziness
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Calcium channel blockers decrease?
myocardial conduction & contractabilty
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What are the adverse effects for calcium channel blockers?
- 1. dizziness
- 2. fainting
- 3. headache
- 4. othostatic hypotension
- 5. constipation
- 6. gingival hypertension
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beta-adrenergic blockers prevent increased heart rate in response to?
sympathetic nervous system & cholamines
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what are the adverse effects for beta-adrenergic blockers?
- 1. bradycardia
- 2. dizziness
- 3. fatigue
- 4. orthostatic hypotension
- 5. sexual dysfunction
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What are the warning signs of a heart attack?
- 1. feeling of pressure, heaviness, or burning in the chest, especially with increased activity
- 2. sudden SOB, sweating, weakness, fatigue
- 3. nausea, indigestion
- 4. anxiety/fear
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What is the normal pulse at rest?
60-80
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What is bradycardia?
decreased P
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What are the effects of bradycardia?
- 1. stroke volume increased
- 2. possibly reduced cardiac output
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What is tachycardia?
increased P
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What are the effects of tachycardia?
1. possibly reduced cardiac output
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What is fibrillation?
weak contactions, irregular beats
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What are the effects of fibrillation?
no filling, no output-cardiac standstill
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What is aystole?
cardiac standstill
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What is Premature Ventricular Contraction (PVC)?
additional ectopic beats
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What are the effects of PVC?
may induce fibrillation
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What is pericarditis?
inflammation of the pericardial membrane
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What is pericarditis due to?
- 1. trauma
- 2. infection
- 3. MI
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Pericarditis has S&S similar to MI except?
- 1. pain may increase with deep breath
- 2. murmur(friction rub) often aucsculated
- 3. fluid/scar tissue may form around the heart
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In pericarditis, fluid/scar tissue may for around the heart, what is needed then?
needle aspiration, may lead to congestive heart failure
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What is endocarditis?
inflammation/infection of valves of heart
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What heart disease often follows other heart diseases?
CHF
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What is CHF?
weakened heart->inefficient pumping->blood backflows to lungs/rest of body
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What are the S&S of CHF?
- 1. cough (first sign)
- 2. weight gain of over 2 lbs per night
- 3. increase in BP, then decrease as the heart fails
- 4. increased P, but weak and thready
- 5. oliguria
- 6. cardiogenic shock->death if untreated
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All shocks except neurogenic shock results in?
- 1. decreased BP
- 2. increased P
- 3. decrease urine output
- 4. organ failure->death if untreated
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What is ventilation?
exchange of air between atmosphere and lungs
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What is tidal volume?
amt of air inhaled and exhaled with normal breath (500ml)
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what is expiratory reserve volume?
amt of air exhhaled after forced expiration, after a normal exhalation (1500 ml)
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What is residual volume?
amt of air left in lungs between breaths...needed to keep aveoli open
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Respiratory rate is controlled by?
- 1. neurons in brainstem which connect to diaphragm and accessory muscles
- 2. chemoreceptors in carotid arteries and aorta which respond to changing levels of O2 and CO2
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what is hypercapnea?
increased CO2 in blood
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What is hypoxemia?
decrease in O2 in blood
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what is hypoxia?
decreased O2 in tissues
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CO2 acts as a vasodilator and acid so it leads to?
decrease pH of blood
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What are arterial blood gases? (ABG)
measurement of oxygen/carbon dioxide and pH in blood by drawing a sample of blood from an artery
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What are the interventions to help with respiratory disorders?
- 1. chest physiotherapy (remove thick secretions&reduce infections)
- 2. oxygen
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What are the drugs to help with respiratory disorders?
- 1. decongestants (vasoconstriction in nasal mucosa)
- 2. expectorants (thin respiratory secretions for easy removal)
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What are the surgeries that help with respiratory disorders?
- 1. thoracentesis (removal of excess fluid from pleural cavity)
- 2. tracheotomy
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What is IRDS?
lack of surfactant is aveoli
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what is IRDS usually due to?
premature birth
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What are the tx for IRDS?
- 1. treat mother with steroids prior to delivery
- 2. neonate put in ICU and given surfactant in lungs
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What is laryngotracheobronchitis? (LTB)
- "Croup"
- spasms of bronchial smooth muscles
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What is bronchiolitis usually due to?
Respiratory Syncytial Virus (RSV)
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What is asthma?
obstruction of airway with allergic reaction (bronchioconstriction)
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What was TB called in the older days?
"Consumption"
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What are the S&S of TB?
- 1. hemoptysis (blood in sputum)
- 2. night sweats
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what is pneumonia?
viral or bacterial infection of the lungs
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what are the S&S of pneumonia?
- 1. fever
- 2. cough
- 3. decreased breath sounds
- 4. increased WBC if bacterial
- 5. fatigue
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When are people at higher risk of getting pneumonia?
- AFTER:
- 1. stroke
- 2. post-op
- 3. immune suppressed
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What is important to note about COLD/COPD?
do not give them to much oxygen as it stops their stimulus to breathe
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