cardaic

if heart isnt compensating for HF give what drugs

IV inotropes (dobutamine) vasodilators (nitrropressuide)

diuretic causes _____ and ________ which traps more blood out in the arms and legs and reduces ______

diuresis vasodilation preload

medications to decrease preload

diuretics nitrates

s/s of dig toxicity early late

early: anorexia, N/V late: arrythmias and vision changes

most common complications post op pace maker

electrode displacemnt

the left coronary artery supplies

entire left ventricle

pt education for stable angina - low _____ and high _____ diet -avoid caffiene of drugs that ______ _____ -wait -___ hours after eating to exercise -temp extremes can

fat, fiber -increase HR -2 hours -increase chest pain

nesiritide should not be given .... what does it do

for more than 48 hours -vasofilates the veins and arteries and has a diuretic effect

women usually present with what when having an MI

gi symptoms or chocking sensation

worry about the STEMI pt bc

having a heart attack and the goal is to get them to the cath lab in less than 90 min

fluid retention think

heart problems

tx of pulm edema

high flow o2

side effect of amiodarone

hypotension

what should we have the pt do to help not displace the electrodes

immbolize arm passive ROM keep pt from raising arm higher than shoulder

ACE results in

increase in arterial dilation and increase stroke vol

triad MI for women s/s

indigestion of feeling of fullness unusual fatigue inability to catch ones breath

drugs that improve contractility

inotropes (dopamine, dobutomine)

systolic think

contract

what do beta blockers do

decrease BP P and myocardial contractility

cardiac diet

decrease fat, salt, cholesterol

decreased contractility=

decreased CO

why do we want the pt head up

decreases workload on the heart and increases CO

how to tx vfib if that doesnt work then we

defiburlate and CPR give epi

any electrolyte imbalance can lead to =

dig toxicity

A 70 year old female client reports an occasional choking sensation over the past 12 hours. What additional symptoms reported by the client would indicate to the nurse that the client may be having a myocardial infarction? Correct! Select All That Apply1. Unusual fatigue.2. Indigestion.3. Aching jaw.4. Feeling faint5. Pain between the shoulder blades.6. Left arm paresthesia.

1., 2., 3., 4., & 5. Correct: Look at the hints - elderly, female, choking sensation. Women often present with GI signs and symptoms, epigastric complaints, or pain between the shoulders, aching jaw, or choking sensation. The triad of symptoms: feeling of fullness in the abdomen, unusual fatigue, and an inability to "catch one's breath". Remember that the elderly may just faint or only have SOB. 6. Incorrect: Left arm paresthesia sounds more like a stroke rather than an MI.

digitalizing dose

loading dose-give more than they will go home on

left sided heart failure think

lungs

safest time to have sex

morning 8-9AM, when pt is well rested

troponin has a high specificity to

myocardial damage

unstable angina=decreased blood flow to ______ which will lead to both ____ and _______

myocardium ischemia necrosis

unstable angina does anyhting bring this pain on?

no, can happen when coming out of REM sleep

what are things that can cause pacemaker malfunction

not programmed correctly electrodes dislodged battery may be dead

arrythmias are not big deal unless what

they affect cardiac output- check for perfusion problems

hypok+ + dig=

toxicity

best cardiac biomarker

troponin

if pt is on nesiritide do what before drawing a BNP

turn it off 2hr b4

pulm edema positioning

upright position legs down due to promoting pulling of blood in lower extremities

2mg of morphine can

vasodialte to decrease preload and afterload decrease aggitation to not being able to breath

right sided heart failure think

venous

BNP is secreted when

ventricular tissues in the heart when the volumes adn pressures increased

beta blockers relax _____ and decrease _____ _____

vessels bP

amiodarone is given when

vfib and pulseless VT are resistant to tx

class 4 HF is the

worst

is diuresis a good thing in HF pt

yes! good perfusiojn

drugs that help prevent angina

beta blockers calcium channel aspirin

rate control drugs

beta blockers calcium channel blockers digoxin

beta blockers block

beta cells which are the receptor sites for catecholamines epi and norepi

CPK-MB elevates within peaks within

cardiac specific isoenzyme increases with damage to cardiac cells. elevates in 3 to 6 hours and peaks in 12 -24 hours.

calcium channel blockers do what

cause vasodilation of the arterial system

decreased CO will lead to

chest pain wet lungs SOB cold and clammy UO decreased

amniodarone helps with

rhythm

how can cardiac tamponade happen

right venticlar biopsy mi percarditis

Swan-Ganz catheter

soft, flexible catheter that is inserted through a vein into pulmonary artery. used to provide continuous measurements of pulm artery pressure. can exercise with device but patient should avoid activities that increase pressure on injection site

renew nitro spray and pills every

spray 2 years pills 6 months

left coronary artery occlusion think

sudden death or widow maker

cardiac cath pre procedure -ask if they are allergic to.... -check what function -can give what drug to help protect the kidney - hot shot describe -palpitations... normal or not

- shellfish or iodine -kidney -mucomyst -get hot -normal

S/S of right sided heart failure

-distended neck veins -edema -enlarged organs -weight gain -ascites

normal troponin levels

0-0.4 ng/mL

norm dig level

0.5-2ng/mL more than2 is toxic

40mg of lasix push over

1-2min to prevent hypotension and ototoxicity

The nurse performs a rapid assessment on a client who states, "I feel really sick and my heart is beating so fast." What signs and symptoms would indicate to the nurse that the client's cardiac output is inadequate? Select All That Apply1. CVP 5 mm Hg.2. Moist skin.3. Urinary output 150 mL over 4 hours.4. Weak radial pulses.5. BP 90/50, HR 200, RR 22.6. Mild chest discomfort.

2, 4, 5, & 6. Correct: When cardiac output is inadequate, the vital organs are not being perfused properly. Skin will be cool and clammy (moist) because the skin is not being perfused. Radial pulses will be weak and thready, because less blood is pumping through the arteries. Less volume means less pressure, so BP is low. The heart rate is too fast, so blood does not have time to get in the ventricles before it is contracting again which decreases cardiac output. Less blood is being pumped to the body. Chest pain means oxygenated blood is not reaching the heart muscle. 1. Incorrect: Normal CVP is 2-6 mmHg, so this is a normal finding. 3. Incorrect: Normal urinary output (UOP) should be at least 30 mL per hour. This client's UOP was 150 mL over 4 hours (50 mL per hour). So no concern here.

report a weight gain of _____-____lbs

2-3

A client reports dizziness and weakness while walking down the hall. The nurse notes the client's cardiac rhythm displayed on the telemetry monitor. What actions should the nurse take? Exhibit Correct! Select All That Apply1. Assist client in ambulating back to bed.2. Obtain client's blood pressure.3. Auscultate lung sounds.4. Prepare for cardioversion.5. Initiate 100% oxygen per nonrebreather mask.

2. & 3. Correct: The client is dizzy and weak. This client is at risk for falling, so think safety and get the client back in bed. Use a wheelchair to accomplish this. Then obtain the client's BP. It may be low, indicating poor tissue perfusion to the vital organs. One cause of premature ventricular contractions (PVCs) includes heart failure, so assess the lungs for adventitious sounds. 1. Incorrect: This client is dizzy and weak. Having the client ambulate back to the bed is a safety risk. The client could fall or the condition could deteriorate while ambulating. 4. Incorrect: Cardioversion is not indicated with an underlying rhythm that is normal (NSR) with PVCs. Oxygen may decrease the PVCs. If not, medication can be administered to decrease the rate of the PVCs. 5. Incorrect: Oxygen may abate the PVCs; however, it should be initiated at 2 liters/NC rather than at 100% per nonrebreather mask. Start with the least amount of oxygen that could relieve symptoms.

The nurse is providing teaching to a group of clients newly diagnosed with chronic stable angina. What points should the nurse include? Correct! Select All That Apply1. Wait 1/2-1 hour after eating to exercise.2. Attend classes such as guided imagery to reduce stress.3. Temperature extremes can precipitate an angina attack.4. Gradually increase weightlifting training to improve cardiac output.5. Eat a low fat, low fiber diet to lose weight.6. Medications prescribed to prevent angina work by increasing the workload of the heart.

2., & 3. Correct: We want to teach clients who have angina to do whatever they can to decrease the workload of the heart. Stress can increase the workload on the heart, so learning ways to decrease or deal with stess is a positive step. This can be done through guided imagery or music therapy. Temperature extremes can precipitate an attack, so the client should dress warmly in cold weather and be cautious out in extremely hot weather. 1. Incorrect: The client should wait at least 2 hours after eating to exercise. During this time, more blood is going to the digestive system. We don't want the heart to have to compete with the gut. 4. Incorrect: Weightlifting will increase the workload of the heart. We don't want to increase the workload of the heart in a client with a cardiac issue. 5. Incorrect: Losing weight is often beneficial for the cardiac client, so we advise them to decrease calorie consumption and maintain a low fat, high fiber diet. 6. Incorrect: We want to decrease the workload of the heart, not increase it. Medications prescribed to prevent angina work to decrease the workload of the heart.

troponin elevates within how many hours after the onset of pain and remains this way for how many weeks

3-4hours 3 weeks

The nurse is teaching a group of clients in cardiac rehabilitation how blood flows through the heart. What information should the nurse include? Correct! Select All That Apply1. Deoxygenated blood enters the heart through the pulmonary vein.2. Blood flows from the right atrium through the mitral valve to the right ventricle.3. The right ventricle pumps the blood to the lungs via the pulmonary artery where the blood becomes oxygenated.4. From the lungs, oxygenated blood goes to the left atrium via the pulmonary vein, then to the left ventricle.5. The right ventricle pumps the blood out through the aorta to the body.

3., & 4. Correct: These are true statements. The right ventricle pumps the blood to the lungs via the pulmonary artery where the blood becomes oxygenated. From the lungs, oxygenated blood goes to the left atrium via the pulmonary vein, then to the left ventricle. 1. Incorrect: Deoxygenated blood comes from the body to the heart via the superior and inferior vena cava. 2. Incorrect: Blood flows from the right atrium through the tricuspid valve to the right ventricle. 5. Incorrect: The left ventricle pumps the blood out through the aorta to the body.

how long after post cath do pts need to lay flat for

4-6 hours

where to check for an apical pulse

5th intercostal space, 3rd midclavicular line

how long do you hold glucophage after a card cath

48hr

medications to decrease afterload

ACE ARBS hydralazine nitrates

how do you know dig is working

CO will go up

BNP can indicate

HF

CO=

HRxSV

S/S of left sided heart failure

L=Lungs -Pulmonary congestion -dyspnea -cough -blood-tinged frothy sputum!!!! -restlessness -tachycardia -S-3 -Orthopnea -nocturnal dyspnea

mitral valve located betwween

LA and LV

myoglobin is not a good indicator for a ______ it increases within ____ hour and peaks within ______

MI 1 12

new MONA

OANM

loss of capture

Pacing activity occurs but is not captured by the myocardium

tricuspid valve located between

RA and RV

#1 sign of MI in elderly

SOB

pulm edema occurs ____ _____ due to

at night blood pulling in legs

common medications requiring bleeding precautions

abciximab tylenol aspirin apixaban (eliqus) plavix xarelto lovenox coumadin

standard therapy for HF is

ace and arbs

ACE and ARBS both block

aldosterone so you lose NA and H2O and retain K+

preload

amount of blood returning to the right side of the heart

stroke volume

amt of blood pumped out of the ventricles with each beat

percutaneous coronary intervention

angioplasty and stent

how do you take nitro SL

one every 5 min x 3 doses

when can sex be resumed after a CABG

one week to 10 days or walk up a flight of stair w/ no discomfort

what medications does a pt get when coming to the ED with chest pain

oxygen aspirin nitro morphine

failure to sense

pacemaker fires at inappropriate times

nitro with cause decrease _______ and _____

preload afterload

afterload

pressure in the aorta adn peripheral arteries that the left vent has to pump against to get the blood out

3 rhtyhms that are a big deal

pulseless vtach vfib asytole

check 5 p's

pulselssness pallor pain paresthesia paralysis

Echocardiogram can look at

pumping action or ejection fraction

diastolic think

relax/fill

chest pain after a percutaneous coronary intervention means

reocclusion

what releives angina

rest nitro SL

s/s of pulm edema

restlessness anxious serve hypoxia prductive cough that is pink frothy sputum