Med-Surg 1 Exam 3: Cardiovascular/Endocrine (mce11)
pt has cushing's disease. states "i just don't know what to do, i feel so confused & down in the dumps" what should the nurse ask?
"have you noticed if your mood goes quickly from happy to sad?" because "mood swings" are a symptom of cushing's disease
when should patients contact their doctor (in context to heart failure)
-HR remaining below 50 after arising -wheezing or difficulty breathing -weight gain of 3lbs in 1wk or 1-2lbs over night -persistent increase in NTG use -dizziness, faintness, or SOB with activity
candidates for a CABG surgery
-angina with greater than 50% occlusion of the left main artery -unstable angina with severe two-vessel disease, moderate 3 vessel disease -ischemia with heart failure -acute MI with cardiogenic shock -signs of ischemia or impending MI after angiography -valvular disease
nursing actions preprocedure angiography:
-client maintains NPO for at least 8 hours -ensure consent form is signed -assess for iodine/shellfish allergy
physical manifestations of a pt with moderate mitral valve stenosis
-dyspnea on exertion -orthopnea -palpitations -neck vein distention
complications of CABG
-fluid/electrolyte imbalance -hypotension -hypothermia -hypertension -bleeding -cardiac tamponade -decreased LOC -anginal pain
define mitral valve prolapse
-leaflets enlarge and fall back into left atrium during systole -most patients are asymptomatic -patients have normal heart rate and blood pressure
nursing actions postprocedure angiography
-maintain bed rest in supine position with extremity straight for a prescribed time -monitor urine output
physical assessment findings of an MI
-pallor, and cool, clammy skin -tachycardia & palpitations -tachypnea & SOB -diaphoresis -vomiting -decreased LOC
what sensations might the patient feel during a cardiac cath that are considered normal?
-palpitations (as the catheter is passed up to the left ventricle) -hot flash (as the medium is injected -desire to cough (as the medium is injected)
normal range of CK-MG?
0% of total CK
how much fluid does 1 kg indicate?
1kg = 1 liter of fluid
how is morphine sulfate usually dosed?
2 to 10mg IV every 5 to 15 minutes
peak of regular insulin?
2-4 hours
target range of A1c for diabetic patients?
4-6%
normal range for total lipids
400-1000 mg/dL
A cardiac nurse educator is reviewing the use of the fixed rate mode pacemaker with a group of newly hired nurses. Which of the following statements by a newly hired nurse indicates understanding of the review? A. "This means the pacemaker fires in an asynchronous pattern." B. "This means the pacemaker fires only when the heart rate is below a certain rate." C."The pacemaker can automatically adjust to a client's increased activity level." D."The pacemaker activity is triggered by heart muscle activity."
A
A nurse is admitting a client who has a suspected MI and a history of angina. Which of the following findings will help the nurse distinguish angina from an MI? A. angina can be relieved with rest and nitroglycerin B. the pain of an MI resolves in less than 15 minutes C. the type of activity that cause an MI can be identified D. angina can occur for longer than 30 minutes
A
A nurse is caring for a client who asks why her provider prescribed a daily aspirin. Which of the following is an appropriate response by the nurse? A. "Aspirin reduces the formation of blood clots that could cause a heart attack." B. "Aspirin relieves the pain due to myocardial ischemia." C."Aspirin dissolves clots that are forming in your coronary arteries." D."Aspirin relieves headaches that are caused by other medications."
A
A nurse is completing discharge teaching with a client who has a permanent pacemaker. Which of the following statements by the client indicates understanding of the teaching? A. "I will notify the airport screeners about my pacemaker." B. "I will expect to have occasional hiccups." C."I will have to disconnect my garage door opener." D."I will take my pulse every 2 to 3 days."
A
a client has splinter hemorrhages in her nail beds and reports a fever. which disorder are these manifestations associated with? a. infective endocarditis b. pericarditis c. myocarditis d. rheumatic endocarditis
A
which test is the best tool for diagnosing heart failure? a. echocardiography b. pulmonary artery catheter c. radionuclide studies d. MUGA scan
A
A nurse educator is reviewing the use of cardiopulmonary bypass during surgery for coronary artery bypass grafting with a group of nurses. Which of the following statements should the nurse include in the discussion? (Select all that apply.) A. "The client's demand for oxygen is lowered." B. "Motion of the heart ceases." C."Rewarming of the client takes place." D."The client's metabolic rate is increased." E. "Blood flow to the heart is stopped."
A, B, C
A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure? (Select all that apply.) A. Follow‐up ECG B. Energy settings used C. IV fluid intake D. Urinary output E. Skin condition under electrodes
A, B, E
Which of the following are expected findings for pulmonary edema? select all that apply a. tachypnea b. persistent cough c. increase urinary output d. thick, yellow sputum e. orthopnea
A, B, E
a nurse educator is reviewing expected findings in a client who has right-sided valvular heart disease. which of the following findings should the nurse include in the discussion? select all that apply a. dyspnea b. fatigue c. bradycardia d. pleural friction rub e. peripheral edema
A, B, E
5. A nurse is admitting a client to the coronary care unit following placement of a temporary pacemaker. Which of the following nursing actions should the nurse use to promote client safety? (Select all that apply.) A. Wear gloves when handling pacemaker leads. B. Ensure electronic equipment has three‐pronged grounding plugs. C. Minimize the client's shoulder movements. D. Hold the lead wires taut when turning the client. E. Keep extra pacemaker batteries at least 300 ft away from the client.
A, C
A nurse at a provider's office is reviewing the laboratory test results for a group of clients. The nurse should identify that which of the following results indicates the client is at risk for heart disease? (Select all that apply.) A. Cholesterol (total) 245 mg/dL B. HDL 90 mg/dL C. LDL 140 mg/dL D. Triglycerides 125 mg/dL E. Troponin I 0.02 ng/mL
A, C
A nurse is caring for a client following the insertion of a temporary venous pacemaker via the femoral artery that is set as a VVI pacemaker rate of 70/min. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Cool and clammy foot with capillary refill of 5 seconds B. Observed pacing spike followed by a QRS complex C. Persistent hiccups D. Heart rate 84/min E. Blood pressure 104/62 mm Hg
A, C
a nurse is teaching a client who has heart failure about the need to limit sodium in their diet. which of the following foods should the nurse recommend? select all that apply a. 1 slice cheddar cheese b. 1 medium beef hot dog c. 3 oz atlantic salmon d. 3 oz roasted chicken breast e. 3 oz lean baked ham
A, C, D
A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? (Select all that apply.) A. A client who has metabolic alkalosis B. A client who has a serum potassium level of 4.3 mEq/L C. A client who has an SaO2 of 96% D. A client who has COPD E. A client who underwent stent placement in a coronary artery
A, D, E
A nurse is caring for a client who asks why the provider bases his medication regimen on his HbA1c instead of his log of morning fasting blood glucose results. Which of the following responses should the nurse make? A. "HbA1c measures how well insulin is regulating your blood glucose between meals." B. "HbA1c indicates how well your have regulated your blood glucose over the past 120 days." C."HbA1c is the first test your doctor prescribed to determine that you have diabetes." D."HbA1c determines if the your doctor should adjust your insulin dosage."
B
A nurse is caring for a client who is 4 hr postoperative following coronary artery bypass grafting (CABG) surgery. He is able to inspire 200 mL with the incentive spirometer, then refuses to cough because he is tired and it hurts too much. Which of the following actions should the nurse take? A. Allow the client to rest, and return in 1 hr. B. Administer IV bolus analgesic, and return in 15 min. C. Document the 200 mL as an appropriate inspired volume. D. Tell the client that he must try to cough if he does not want to get pneumonia.
B
A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. The nurse should anticipate that which of the following management strategies will be used for this client? A. Defibrillation B. Pacemaker insertion C. Synchronized cardioversion D. Administration of IV lidocaine
B
Which of the following foods has the highest source of potassium? a. 1 medium apple b. 1 medium baked potato c. 1 slice toast with 1 tsp peanut butter d. 1 large scrambled egg
B
a nurse is caring for a client who has heart failure and reports increase SOB. the nurse increases the client's oxygen. which actions should the nurse take first? a. obtain the client's weight b. assist the client to the high-fowler's position c. auscultate lung sounds d. check oxygen saturation
B
which of the following clients should the nurse identify as being at risk of acquiring rheumatic endocarditis? a. older adult who has COPD b. child who has streptococcal pharyngitis c. middle-age adult who has lupus d. young adult who recently got a new tattoo
B
which of the following lab findings would the nurse expect for a client with diabetes insipidus? a. absence of glucose b. decreased specific gravity c. presence of ketones d. presence of RBC
B
which diagnostic lab test differentiates HF from lung dysfunction?
BNP
which diagnostic test bed differentiates between heart failure and lung dysfunction?
BNP
A nurse is caring for a client following an angioplasty that was inserted through the femoral artery. While turning the client, the nurse discovers blood underneath the client's lower back. Which of the following findings should the nurse suspect? A. Retroperitoneal bleeding B. Cardiac tamponade C. Bleeding from the incisional site D. Heart failure
C
A nurse is presenting a community education program on recommended lifestyle changes to prevent angina and myocardial infarction. Which of the following changes should the nurse recommend be made first? A. Diet modification B. Relaxation exercises C. Smoking cessation D. Taking omega‐3 capsules
C
A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of MI and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the MI occurred 14 days ago? A. CK-MB B. Troponin I C. Troponin T D. Myoglobin
C
A student nurse is observing a cardioversion procedure and hears the team leader call out, "Stand clear." The student should recognize the purpose of this action is to alert personnel that A. the cardioverter is being charged to the appropriate setting. B. they should initiate CPR due to pulseless electrical activity. C. they cannot be in contact with equipment connected to the client. D. a time‐out is being called to verify correct protocols.
C
what is the most common type of cardiac surgery and the most common procedure for older adults?
CABG
risk factors for cardiomyopathy
CAD, infection or inflammation of the heart muscle, various cancer treatments, prolonged alcohol use & heredity
over secretion of ACTH from the anterior pituitary gland results in what?
Cushing's Disease
A nurse is admitting a client who has complete heart block as demonstrated by ECG. The client's heart rate is 34/min and blood pressure is 83/48 mm Hg. The client is lethargic and unable to complete sentences. Which of the following actions should the nurse perform first? A. Transport the client to the cardiovascular laboratory. B. Prepare the client for insertion of a permanent pacemaker. C. Obtain a signed informed consent form for a pacemaker. D. Apply transcutaneous pacemaker pads.
D
A nurse is providing teaching to a client who has a new diagnosis of diabetes insipidus. Which of the following client statements indicates an understanding of the teaching? A. "I can drink up to 2 quarts of fluid a day." B. "I will need to use insulin to control my blood glucose levels." C."I should expect to gain weight during this illness." D."Muscle weakness is a symptom of diabetes insipidus."
D
A nurse is teaching a client who has angina about a new prescription for metoprolol. Which of the following statements by the client indicates understanding of the teaching? A. "I should place the tablet under my tongue." B. "I should have my clotting time checked weekly." C."I will report any ringing in my ears." D."I will call my doctor if my pulse rate is less than 60."
D
A nurse is teaching a client who is scheduled for an angiography. Which of the following statements should the nurse include in the teaching? A. "you should have nothing to eat or drink for 4 hours prior to the procedure." B. "you will be given general anesthesia during the procedure." C."you should not have this procedure done if you are allergic to eggs." D."you will need to keep your affected leg straight following the procedure."
D
a nurse is caring for a client who has pericarditis. which of the findings does the nurse expect? a. petechiae b. murmur c. rash d. friction rub
D
which lab test helps confirm the diagnosis of rheumatic endocarditis? a. ABG b. serum albumin c. liver enzymes d. throat culture
D
which disorder is associated with kussmaul's respirations?
DKA
acute diabetic emergencies:
DKA, HHNS, hypoglycemia
define defibrillation
Defibrillation stops all electrical activity of the heart, allowing the SA node to take over and reestablish a perfusing rhythm.
how is an ECG used in patients with an inflammatory heart disorder?
ECG can detect a heart block, which is associated with rheumatic fever - which can lead to pericarditis
risk factors for left-sided heart failure
HTN, CAD, angina, MI, valvular disease
patients with which chronic conditions should be screened annually for microalbuminuria?
HTN, metabolic syndrome or diabetes mellitus
what are the risk factors for afib?
HTN, previous ischemia stroke, transient ischemia attack TIA, or other throboembolic event, CAD, DM, HF and mitral valve disease
which patients are at greatest risk for developing infective endocarditis?
IV drug user, pt with prosthetic valve, pt with mitral stenosis who recently had an abscessed tooth removed, pt with UTI and valve damage
ANGINA vs MI: which one is associated with nausea, epigastric distress, dyspnea, anxiety & diaphoresis
MI
complications of left-sided heart catheterization
MI, stroke, arterial bleeding or thromboembolism, dysrhythmias
serious complications of cardiac catheterization
MI, stroke, arterial bleeding, thromboembolism, letal dysrhythmias, arterial dissection, death
what test would be scheduled for a pt with a suspected pituitary tumor?
MRI of the head
which MI classification should avoid thrombolytics?
NSTEMI
which lab test are monitored with patients on warfarin?
PT and INR
patients taking warfarin will undergo which anticoagulant studies?
PT/INR
patients taking heparin will undergo which anticoagulant studies?
PTT partial thromboplastin time
RBC compensations associated with heart disease
RBC is increased as needed to compensate for decreased available oxygen
angina ECG changes
ST depression and/or T wave inversion indicates presence of ischemia
STEMI vs NSTEMI??
STEMI has ST elevation in two contiguous leads - indicating infarction/necrosis NSTEMI have ST & T-wave changes - indicating necrosis
MI ECG changes
T-wave inversion; ST-segment elevation indicates injury; abnormal Q-wave indicates necrosis
which class of diabetic meds in used as a last resort?
TZD - glitazone sisters
what is the most common problem with a patient with valvular heart disease? a. reduced cardiac output b. difficulty coping c. shortness of breath d. altered body image
a
how is afib detected on an ECG?
a chaotic rhythm with no clear P waves, no atrial contractions, loss of atrial kick and an irregular ventricular response
what is chronic stable angina associated with?
a fixed atherosclerotic plaque
what is the classic auscultatory finding in aortic regurgitation?
a high-pitched, blowing - MURMUR
secondary diabetes insipidus
a lack of AHD production - caused by infection, tumors in or near the hypothalamus or pituitary gland, head trauma or brain surgery
what is a ventricular assist device?
a mechanical pump that assists a heart that is too weak to pump blood through the body
clinical manifestations of valvular disease?
a murmur, orthopnea, PND, & fatigue
what is troponin?
a myocardial muscle protein released into the bloodstream with injury to myocardial muscle
what is the most common cause of cushing's disease?
a pituitary tumor called an adenoma
besides cigarette smoke, what is a major risk factor for CAD?
a positive family history in a first-degree relative (parent, sibling, child)
what is pulmonary edema?
a severe, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure
what is S3 called
a ventricular gallop
a patient is treated for acute pulmonary edema. which medications does the nurse prepare to administer to this pt? *select all that apply a. SL nitro b. IV lasix c. IV morphine sulfate d. IV beta blocker e. IV nitro
a, b, c, e
the nurse is assessing a patient with left-sided heart failure. which assessment finding does the nurse expect? *select all that apply a. displacement of the apical pulse to the left b. s3 heart sound c. paroxysmal nocturnal dyspnea d. jugular venous distention e. oliguria during the day f. wheezes or crackles
a, b, c, e, f
the nurse is assessing a patient with right-sided heart failure. which assessment findings does the nurse expect to see in this patient? *select all that apply a. dependent edema b. weight loss c. polyuria at night d. hypotension e. hepatomegaly f. angina
a, c, e
what is paradoxical splitting?
abnormal splitting of the second heard sound
risk factors for pulmonary edema
acute MI, fluid volume overload, HTN, valvular heart disease, postpneumonectoly, post evacuation of pleural effusion, acute respiratory failure, left-sided heart failure, high altitude exposure or deep-sea diving, trauma, sepsis, drug overdose
complications of angina or MI
acute MI, heart failure/cardiogenic shock, ischemia mitral regurgitation, ventricular aneurysms/rupture, dysrhythmias
a pt is admitted with substernal pain that radiates to the left shoulder. the pain is grating, and is worse with inspiration and coughing. what likely is the cause of the pt's symptoms?
acute pericarditis
decreased production of cortisol and aldosterone is known as:
addison's disease
nursing actions for onset of heart failure
administer oxygen, IV morphine, diuretics, and/pr nitroglycerin (to decrease preload)
which patients have a greater risk of forming thrombi?
afib, prosthetic valves, or infective endocarditis
when are levels of Troponin T no longer evident?
after 10 to 14 days
when are levels of Troponin I no longer evident?
after 7 to 10 days
what is the most important factor in developing CAD in women?
age
purpose of coronary artery bypass grafts
aims to restore vascularization of the myocardium - performed to bypass an obstruction - does not alter the atherosclerotic process
what is the nurse's priority when a pt comes to the ER with DKA?
airway assessment
causes of dilated cardiomyopathy?
alcohol abuse, infection, chemotherapy, poor nutrition
which class of meds alters carb absorption?
alpha glucosidase inhibitors
which heart sound often indicates heart failure?
an S3 gallop
what is creatine kinase-MG?
an enzyme specific to cells of the brain, myocardium & skeletal muscle - appearance of CK in the blood indicates tissue necrosis or injury
significance of WBC in heart disease
an increased WBC has been implicated as strong risk factor for stroke and heart disease - esp. postmenopausal women
what is an echocardiogram?
an ultrasound of the heart
ANGINA vs MI: which one can be relieved by nitroglycerin or rest?
angina
what is a warning sign of an impending acute MI?
angina pectoris
rubor suggests:
arterial insufficiency
what is the rise and fall for myoglobin?
as early as 2 hours and rapid decline after 7 hours
if you have difficulty auscultation heart sounds, what should you do?
ask the patient to lie on his or her left side
what is included in the nutrition history for heart disease?
ask the pt to recall what they've eaten in the past 24 hours, dietary restrictions or supplements and the amount/type of alcohol consumption
what is primary factor in CAD development?
atherosclerosis
how does acute coronary syndrome occur?
atherosclerotic plaque in the coronary artery ruptures, resulting in platelet aggregation, thrombus formation and vasoconstriction
what is S4 called?
atrial gallop
client education for PAD
avoid crossing legs at all times
the male with diabetes asks the nurse for advice about alcohol consumption. what is the nurses's best response?
avoid more than 2 drinks a day & have them with or shortly after a meal
a pt comes to the ER - anxious, tachycardic, struggling for air, and with a moist cough productive of frothy, blood-tinged sputum. what is the priority nursing intervention? a. apply a pulse ox and cardiac monitor b. administer high-flow oxygen via facemask c. prepare for continuous positive airway pressure ventilation d. prepare for intubation and mechanical ventilation
b
which findings does the nurse expect to see in a patient with endocarditis? *select all that apply a. pericardial friction rub b. osler's nodes c. petechiae d. a new regurgitant murmur e. grating pain that is aggravated by breathing
b, c, d
which characteristics describe mitral valve stenosis? *select all that apply a. classic signs of dyspnea, angina, & syncope b. rumbling apical diastolic murmur c. s3 often present due to severe regurgitation d. right sided failure results in neck vein distention e. pt may experience palpitations while lying on the left side
b, d
how are MI's classified?
based on location of the heart (anterior, lateral, inferior or posterior); ECG changes (STEMI vs NSTEMI); time frame within the progression (acute, evolving, old)
how are cardiomyopathies classified?
based on the abnormalities in the structure and function of the heart
why is myoglobin more useful than troponin?
because myoglobin is not cardiac specific
why does urine output require monitoring after a heart cath?
because the contrast medium acts as an osmotic diuretic
which class of medications block glucose release from the liver?
biguanides
what are splinter hemorrhages ?
black longitudinal lines or small red streaks located on the fingernails - indicating endocarditis
common complication of valvuloplasty
bleeding and emboli
how does metformin work?
blocks glucose release from the liver & decreases cellular insulin resistance
what test does the nurse anticipate will be performed to confirm a positive diagnosis of infective endocarditis?
blood cultures
what to monitor for when a patient is taking a beta blocker?
bradycardia, hypotension, decreased LOC, chest discomfort
define atherectomy
break up and remove plaques within cardiac vessels
define syncope
brief loss of consciousness - most commonly caused by decreased perfusion to the brain
how do alpha glucosidase inhibitors work?
by slowing intestinal digestion and altering absorption of carbs
how is the severity of orthopnea measured?
by the number of pillows or the amount of head elevation needed to provide a restful sleep
a patient with a history of valvular heart disease requires a routine colonscopy. the nurse expects a prescription for: a. anticoagulant b. antihypertensives c. antibiotic d. antianginals
c
what is the most definitive diagnostic test for heart disease?
cardiac catheterization
complications of angiography
cardiac tamponade, hematoma, restenosis o treated vessel, bleeding
complications of right-sided or left-sided heart catheterization
cardiac tamponade, hypovolemia, PE, hematoma or blood loss, reaction to contrast medium
what can echocardiography diagnose?
cardiomyopathy, valvular disorders, pericardial effusion, left ventricular function, ventricle aneurysms, & cardiac tumors
what an cause orthostatic hypotension?
cardiovascular drugs, blood volume decrease, prolonged bedrest, age-related changes, or disorders of the ANS
primary diabetes insipidus
caused by a lack of ADH production - caused by defects in the hypothalamus or pituitary gland
characteristic of dilated cardiomyopathy
causes symptoms of left ventricular failure
dependent foot and ankle edema are a common side effect of:
certain antihypertensive drugs
what would a chest x-ray show on a patient with valvular disease?
chamber enlargement & pulmonary congestion
what would a ECG show on a patient with valvular disease?
chamber hypertrophy
what would a echocardiogram show on a patient with valvular disease?
chamber size, hypertrophy, specific valve dysfunction, ejection function & amount of regurgitant flow
the patient with diabetes has a foot that is warm, swollen, and painful. walking causes the arch of the foot to collapse and gives the foot a "rocker bottom" shape. which food deformity does the nurse recognize?
charcot foot
signs/symptoms of MI (to monitor for after cardioversion)
chest pain & ST segment depression or elevation
what is angina pectoris
chest pain caused by temporary imbalance between the coronary arteries ability to supply oxygen and the cardiac muscle's demand for oxygen -- a warning sign of an impending acute MI
client education regarding aspirin at home for chest pain
chew 325mg (4 "baby aspirins" that are 81mg each) immediately and call 911!
what is included in coronary artery disease?
chronic stable angina & acute coronary syndromes
early symptom of mitral insufficiency
chronic weakness
patients who undergo a heart valve replacement surgery require which LIFETIME treatment?
coagulation therapy to prevent thrombus formation
signs & symptoms of worsening heart failure
cold symptoms (cough) lasting more than 3-5 days, excessive awakening at night to urinate, development of dyspnea or angina at rest or worsening angina, increased swelling in the feet, ankles or hands
what does the skin assessment of heart failure include?
color and temperature
duration and relieving factors of chest pain caused by MI
continus or no chest discomfort; relieved with morphine, cardiac drugs, and oxygen therapy
what are modifiable risk factors?
controllable - personal lifestyle habits, cigarette use, physical inactivity, obesity, and psychological variables
what does the anterior pituitary gland control?
controls growth, metabolic activity & sexual function
manifestations of decreased perfusion
cool, pale, and moist skin
what are some causes of NSTEMI?
coronary vasospasm, spontaneous dissection and sluggish blood flow due to narrowing of the coronary artery
which of the following findings should the nurse expect for a client who has a history of mitral valve insufficiency?
crackles in lung base
excess secretion of cortisol is known as:
cushing's disease
what is an early sign of left sided heart failure? a. nocturia b. weight gain c. swollen legs d. nocturnal coughing
d
which patient is at greatest risk for developing heart failure? a. alzeheimer's pt b. pt with cystitis c. pt with asthma d. pt with HTN
d
how does morphine sulfate work to decrease MI pain?
deceases mycardial oxygen demand, relaxes smooth muscle, and reduces circulating catecholamines
does H & H increase or decrease in heart disease?
decreased - indicate anemia and can lead to angina or aggravate heart failure
what to monitor for patients taking metoprolol?
decreased LOC, crackles in the lungs & chest discomfort
hypotension, syncope, & increased heart rate and signs/symptoms of:
decreased cardiac output
describe left-sided heart failure
decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels
how does coreg work within the body?
decreases the imbalance between myocardial oxygen supply & demand
how does metoprolol work during an MI?
decreases the imbalance between myocardial oxygen supply and demand by reducing after load and slowing heart rate
what is the role of beta blockers during an MI?
decreases the size of the infarct, the occurrence of ventricular dysrhythmias and mortality rates
a deficiency of ADH causes?
diabetes insipidus
nursing interventions for assessment of chest pain
differentiate among the types of chest pain and to identify the source
patients with heart failure and afib will probably be on which medication?
digoxin
purpose of dipyridamole (persantine)
dilates the coronary arteries during a pharm stress test
which does the nurse recognize as a possible outcome for the patient experiencing an age-related decrease in antiduiretic hormone?
diluted urine & dehydration
which symptom does the nurse expect a pt with PAD to report?
discomfort in the lower back, buttocks or thighs after walkin
what medications are used during a pharmacologic stress test?
dobutamine or dipyridamole
what drugs are given for patients with afib?
drugs to slow the ventricular conduction or to convert the afib to NSR - calcium channel blockers, beta blockers, digoxin, anticoagulant therapy
what is the only symptom of heart failure that women may experience?
dyspnea on exertion
what is the leading cause of prehospital death in most patients with acute coronary syndromes?
dysrhythmias
which test is most likely to be ordered for a patient with valvular heart disease?
echocardiography
which lipoprotein is negatively correlated with CAD?
elevated HDL
which lipoprotein is positivity correlated with CAD?
elevated LDL
petechiae on the trunk & mucus membranes are a clinical manifestation for which heart disease?
endocarditis
how do TZD agents work?
enhance insulin action by promoting glucose utilization peripheral cells
what is diabetes insipidus characterized by?
excretion of a large quantity of diluted urine
what are stents?
expandable metal mesh devices that are used to maintain the patent lumen created by angioplasty or atherectomy
client education prior to a stress test
fast 2-4 hours prior, avoid tobacco, alcohol and caffeine, wear comfortable shoes!
what are signs of digoxin toxicity?
fatigue, muscle weakness, confusion, & loss of appetite
manifestations of cardiomyopathy
fatigue, weakness, heart failure, dysrhythmias, s3 gallop, cardiomegaly, angina
normale ranges for triglycerides
females: 35-135 mg/dL males: 40-160 mg/dL
normal range of HDL
females: greater than 55 mg/dL males: greater than 45 mg/dL
when would electric cardioversion be used in an emergency?
for unstable ventricular or supra ventricular tachydysrhythmias
when are AEDs used?
for vfib or pulseless v tach
what complications can result from severe PAD?
gangrene, amputation, ulcer formation
over secretion of growth hormone results in what?
gigantism in children and acromegaly in adults
how will a patient with pericarditis describe his pain?
grating substernal pain that is aggravated by inspiration
description of percarditic pain?
grating substernal pain, aggravated by inspirations
when is paradoxical splitting heard?
has a wider split on expiration - heard in patients with severe myocardial depression (MI, left bundle-branch block, aortic stenosis, aortic regurgitation, & right ventricular pacing)
if the nurse can't hear the S1 sound, what should she do?
have the patient lay on their left side
common side effect of nitroglycerin
headache
where the second heart sound best heard at?
heard best at the base of the heart and the end of ventricular systole
what can cause abdominal edema?
heart disease and cirrhosis of the ier
dyspnea, productive cough, edema and venous distention are signs/symptoms of:
heart failure
what does a BNP over 100 pg/mL suggest?
heart failure
what is a general definition of heart failure?
heart failure occurs when the heart muscle is unable to pup effectively, resulting in inadequate cardiac output, myocardial hypertrophy & pulmonary/systemic congestion. the heart is unable to meet tissue needs.
what can cause bilateral edema of the legs?
heart failure or chronic venous insufficiency
elevated hematocrit is caused by:
hemoconcentraion (hypovolemia shock and excessive diuresis)
what are the common anticoagulants used?
heparin and enoxaparin (lovenox)
is the second heart sound high pitch or low pitch?
high pitch
what psychological factors are increased risk for heart disease?
highly competitive, overly concerned about meeting deadline, often hostile or angry, stress, anger and hostility
why would a pt with DKA be breathing so rapidly and deeply?
his serum pH is low and this is a compensatory mechanism
pt has HTN, fatigue, muscle weakness, bruising on arms, pitting edema on ankles & has gained 15lbs in 6 months. she also has truncal obesity and thin extremities. what does she probably have?
hypercortisolism (cushing's disease)
what is the dawn phenomenon?
hyperglycemia on awakening
what is somogy's phenomenon?
hypoglycemia in the early mornings
After the initial dose of an ARB, what does the nurse monitor for carefully?
hypotension
outcome for beta blockers & mild HF:
improved activity tolerance bc symptoms are improved
how should nitro be given?
in 5-minute increments, a total of 3 doses may be administered
when can a defibrillator be used?
in vfib and pulseless vtach
how does digoxin work for patients with heart failure?
increase contractility and improve cardiac output
what lab value indicates heart failure for post menopausal women?
increased WBC
cardiac manifestations of hypokalemia
increased electrical instability, ventricular dysrhythmias, and an increased risk for digitalis toxicity
which factors can increase systemic arterial pressure?
increased heart rate, increased peripheral vascular resistance, increased stroke volume
how does nitroglycerin work physiologically?
increases collateral blood flow, redistributes blood flow toward the subendocardium, and dilates the coronary arteries - decreases myocardial oxygen demand by peripheral vasodilation, which decreases both preload & after load
purpose of dobutamine
increases the heart's contractility - thereby increasing the HR during a pharmacological stress test to mimic exercise
typical woman s/s in atypical angina?
indigestion, aching jaw pain, decreased pattern of activity
a patient undergoing a dental procedure, getting a piercing, or a tattoo are at risk for developing which heart disease?
infective endocarditis
client education for patients taking loop/thiazide diuretics?
ingest foods high in potassium
nephrogenic diabetes insipidus
inherited - renal tubules do not react to ADH
what does calcitonin do?
inhibits mobilization of calcium from bone and reduces blood calcium levels
what does a ST-segment elevation indicate?
injury to heart
define panhypopituitarism
insufficient secretion of hormones from the anterior pituitary - affecting all of the hormones
quality and severity of chest pain caused by MI
intense stabbing, viselike pain or pressure, severe
which insulin is cloudy?
intermediate NPH
which symptom is the most common initial manifestation of PAD?
intermittent claudication
what is percutaneous coronary intervention?
invasive but nonsurgical technique that is performed within 90 minutes of an acute MI -includes:atherectomy, stent, & percutaneous transluminal coronary angioplasty
what is angiography
invasive diagnostic procedure that involves fluoroscopy and the use of contrast media - evaluates the presence and degree of coronary artery blockage
which allergy should the nurse assess for prior to an angiography?
iodine or shellfish
chest pain caused by pericarditis
is usually sharp, stabbing and moderate to sever
how does occlusion of blood flow occur? (flow chart)
ischemia --> injury --> necrosis
what two conditions can cause extremity pain?
ischemia from atherosclerosis & venous insufficiency of the peripheral blood vessels
difference between ischemia & infarction
ischemia is reversible - infarction is caused by prolonged ischemia
how does aspirin help during an MI?
it inhibits both platelet aggregation and vasoconstriction -- decreases the likelihood of thrombosis
why is hypotension such a concern after a CABG?
it may result in the collapse of the graft
what is goiter caused by?
lack of iodine
define ischemia & how it occurs
lack of oxygen - occurs when insufficient oxygen is supplied to meet the requirements of the myocardium
impaired tissue perfusion, pulmonary congestion, and edema are associated with (left/right) heart failure
left
crackles or wheezes may indicate what?
left-sided heart failure
dyspnea, orthopnea, noctural dyspnea, fatigue, displaced apical pulse, s3 sound (gallop), pulmonary congestion (dyspnea, cough, crackles), frothy pink sputum, AMS, organ failure are expected findings of ?
left-sided heart failure
risk factors for right-sided heart failure
left-sided heart failure, right ventricular MI, & pulmonary problems (COPD, pulmonary fibrosis)
extremity pain related to venous obstruction
leg pain that results from prolonged standing or sitting
normal range of troponin I
less than 0.03 ng/mL
normal range of troponin T
less than 0.10 ng/mL
normal range for c-reactive protein (CRP)
less than 1.0 mg/dL
normal range of LDL
less than 130 mg/dL
normal range of VLDL
less than 130 mg/dL
normal range for cholesterol
less than 200 mg/dL
normal range of myoglobin
less than 90 mcg/L
drug-induced diabetes insipidus
lithium carbonate or demeclocycline can alter the way the kidneys respond to ADH
is the first heart sound high pitch to low pitch?
low pitch
which chronic illnesses may mask (cover up, hide) heart failure?
lung disease or kidney failure
risk factors for angina and MI
male gender or postmenopausal women, sedentary lifestyle, HTN, tobacco use, hyperlipidemia, obesity, excessive alcohol, meth or cocaine use, stress, etc
what is atypical angina
manifests as indigestion, pain between the shoulders, an aching jaw or a choking sensation that occurs with exertion
what does MAWDS stand for?
medications, activity, weight, diet & symptoms heart failure self-management health teaching
which cardiac medication is given by IV for acute MI?
metoprolol tartrate
indications for an stent:
might reduce ischemia during an acute MI by opening coronary arteries and restoring perfusion
rheumatic fever is the most common cause of which cardiac disease?
mitral stenosis
pitting edema is a sign for which type of valvular disease?
mitral valve stenosis and insufficiency
what should be monitored when a patient is taking a ACE inhibitor?
monitor for decreased urine output, hypotension & cough
nursing considerations for ACE inhibitors
monitor for persistent cough; for angioedema (swelling of tongue & throat), & hyperkalemia
why is morphine used in patients with heart failure?
morphine decreases sympathetic nervous system response & anxiety & promotes milk vasodilation
which movements seen when assessing the precordium are considered abnormal?
movement over the aortic, pulmonic and tricuspid areas
pathophysiology of afib
multiple, rapid impulses from many atrial foci depolarize the atria in a totally disorganized manner at a rate of 350 to 600 times per minute; ventricular response is usually 120 to 200bpm
ANGINA vs MI: which one can only be relieved by opioids?
myocardial infarction
what does an elevation in myoglobin indicate?
myocardial infarction
what do elevations in the troponin indicate?
myocardial injury or infarction
what is the earliest marker detected of the cardiac markers?
myoglobin
where are the best areas to asses circulation?
nail beds, mucous membranes and conjunctival mucosa
what does an abnormal Q wave indicate?
necrosis
define infarction & how it occurs
necrosis, or cell death - occurs when severe ischemia is prolonged & decreased perfusion causes irreversible damage to tissue
which medication reduces myocardial oxygen demand?
nitroglycerin
what is the focus of the patient history? (cardiovascular assessment)
obtaining information about risk factors & symptoms
what causes peripheral cyanosis?
occurs when blood flow to the peripheral vessels is decreased by peripheral vasoconstriction -
physiology oc myocardial infarction
occurs when myocardial tissue is abruptly and severely deprived of oxygen
what is unable (pre infarction) angina?
occurs with exercise or at rest, but increases in occurrence, severity and duration over time
what is stable (exertional) angina?
occurs with exercise or emotional stress and is relieved by rest or nitroglycerin
describe anginal pain
often described as a tight squeezing, heavy pressure, or constricting feelings - pain radiates to the jaw, neck or arm
which patients are most likely to undergo a balloon valvuloplasty?
older adults who are nonsurgical candidates
what is a pericardial friction rub?
originates from he pericardial sac and occurs with the movements of the heart during the cycle - usually signs of inflammation, infection or infiltration
pulmonary edema manifestations?
orthopnea, tachypnea, persistent cough
extremity pain related to arterial tissue perfusion
pain in legs or butt associated with an activity - claudication - usually relived by resting or lowering the affected extremity to decease tissue demands
what separates angina from an MI
pain unrelieved by rest or nitroglycerin and lasting for more than 15 minutes is an MI
what are some vascular changes in an affected extremity? (heart failure)
paresthesia, muscle fatigue, discomfort, numbness, pain, coolness and loss of hair distribution from a reduced blood supply
patient education/nursing actions preprocedure pharm stress test
patients are required to be NPO for 3 - 6 hours prior
which patients might you hear a pericardial friction rub?
patients with pericarditis resulting from MI, cardiac tamponade, or post-thoracotomy
what is the peak and fall of CK-MB?
peak in 24 hours after onset of chest pain & fall during 3 days
which heart disease causes a pleural friction rub?
pericarditis
which infection of the heart commonly follows a respiratory infection?
pericarditis
STEMI can lead to:
platelet aggregation and thrombus formation
what non cardiac conditions can cause chest pain?
pleurisy, pulmonary embolus, hiatal hernia, gastroesophageal reflux disease, neuromuscular abnormalities, and anxiety
most known clinical manifestations of diabetes insipidus
polyuria and polydipsia
what are the most common electrolyte imbalances after a CABG?
potassium and magnesium depletion
what does a T-wave inversion indicate?
presence of ischemia
what is planning and implementation focused on for patients with afib?
preventing embolus formation and preventing heart failure
how does nitroglycerin work for patients with heart failure?
prevents coronary artery vasospams and reduce preload and after load, decreasing myocardial oxygen demand
what assessment must the nurse make before giving IV potassium?
production of at least 30 mL/hr of urine
antidote for heparin/lovenox?
protamine sulfate
what are the outcomes/results of paroxysmal nocturnal dyspnea?
pulmonary congestion
which movements seen when assessing the precordium are considered normal?
pulses in the mitral area (apical pulse)
contraindications for thrombolytics:
recent abdominal surgery or stroke, intracranial hemorrhage, suspected aortic dissection, active bleeding, recent head trauma
which medical conditions may lead to valvular abnormalities of the heart?
recurrent tonsillitis, streptococcal infections and rheumatic fever
define near-syncope
refers to dizziness with an inability to remain in an upright position
atherosclerosis affects which larger arteries?
renal , femoral, coronary, aorta
side effects of morphine sulfate
respiratory depression, euphoria, sedation, decreased GI motility, hypotension, bradycardia, severe vomiting
systemic venous congestions & peripheral edema are associated with (left/right) heart failure
right
jugular vein distention dependent edema (legs, ankles, sacrum( abdominal distention, acites fatigue, weakness nausea & anorexia polyuria at rest live enlargement & tenderness weight gain are expected findings of ?
right-sided heart failure
why should morphine sulfate be used with caution in patients with asthma or emphysema?
risk of respiratory depression
a patient is prescribed diuretics for treatment of heart failure. which lab should the nurse monitor closely? a. peak and trough b. serum potassium c. serum sodium d. PT & PTT
serum potassium
which serum electrolyte is monitored when pt is taking diuretics, ACE inhibitors or ARBs?
serum potassium
which insulin can be administered IV?
short acting - regular
which insulin should be clear?
short acting - regular humulin R novolin R
cardiac manifestations of hypercalcemia
shortened QT, AV block, digitalis hypersensitivity and cardiac arrest
what is the assessment for afib?
signs of poor perfusion, anxiety, 12 lead ECG
which dysrhythmias frequently occur after an MI?
sinus tach with PVCs
cardiac manifestations of hyperkalemia
slow ventricular conduction, peaked T waves and contraction followed by asystole
what is microalbuminuria & its significance
small amounts of protein in the urine - clear marker of widespread endothelial dysfunction in CAD
which interventions are effective for a patient with potential for pulmonary edema caused by heart failure?
sodium & fluid restriction, administration of loop diuretics, position in semi-Fowler's to high-Fowler's position
quality and severity of chest pain caused by angina
squeezing, viselike pain
how do sulfonylurea agents work?
stimulate insulin release from beta cells
location & radiation of chest pain caused by MI
substernal; may spread through the anterior chest and to the arms, jaw, back, or neck
chest pain caused by pericarditis onset:
sudden
onset of chest pain caused by angina
sudden, usually in response to exertion, emotion, or extremes in temperature
onset of chest pain caused by MI
sudden, without precipitating factors, often early in the morning
which class of medications stimulates insulin release?
sulfonylurea agents
which class of diabetic medications should the nurse monitor CBC?
sulfonylurea agents -leukopenia -thrombocytopenia -hemolytic anemia
what is cardioversion?
synchronized countershock that may be performed in emergencies or electively
what causes heart failure?
systemic HTN, MI, pulmonary hypertension, dysrhythmias, valvular heart diseases, pericarditisis or cardiomyopathy
manifestations of heart failure (as a complication of angina/MI)
tachycardia; hypotension; inadequate urinary output; altered level of consciousness; respiratory distress (crackles and tachypnea); cool, clammy skin; decreased peripheral pulses; chest pain
nursing considerations for digoxin
take the apical pulse for 1 full minute before giving
what three compounds in cigarette smoke have been linked to the development of CAD?
tar, nicotine and carbon monoxide
what can hiccups indicate in a patient with a pacemaker?
that the generator is pacing the diaphragm
what is the second heart sound caused by?
the closing of the aortic and pulmonic valves
what is the the first heart sound (S1) caused by?
the closure of the mitral and tricuspid valves
what does a stress test help determine?
the functional capacity of the heart and screens of asymptomatic CAD - dysrhythmias that develop during exercise may be identified
where is the first heart sound best heard at?
the lower left sternal border or the apex of the heart
what can be identified by the ECG changes?
the occurrence and the location of ischemia (angina) or necrosis (infarction)
what will a patient's pH look like if they had DKA?
the pH would be low - indicating metabolic acidosis
how is perfusion affected by afib?
the rapid and irregular ventricular rate decreases ventricular filling and reduces cardiac output, further impairing the heart's perfusion ability
how do beta blockers work physiologically?
the slow the heart rate and decrease the force of cardiac contraction - they prolong the period of diastole and increase myocardial perfusion while reducing the force of contraction
how do ACE inhibitors, ARBs & calcium channel blockers work for patients with heart failure ?
they are after load-reducing agents.- they help the heart pump more easily by altering the resistance to contraction.
how do incretin mimotics work?
they promote insulin release and slow gastric emptying
what are murmurs?
they reflect turbulent blood flow through normal or abnormal valves - classified according to their timing in the cardiac cycle
which clients are at risk of infective endocarditis?
those who have structural cardiac malformations, cardiac devices (pacemaker), prosthetic heart valves, or IV substance abuse
complications of right-sided heart catheterization
thrombophlebitis, PE, vagel response
what is a sign of aspirin toxicity?
tinnitus
what does an elevation in CRP indicate?
tissue infarction or damage
what is cardiopulmonary bypass used for
to provide oxygenation, circulation, and hypothermia during induced cardiac arrest - blood is diverted - where it is heparinized, oxygenated, and returned to the circulation though a annular placed in the ascending aortic arch or femoral artery
chest pain caused by MI usually radiates:
to the arms, jaw, back or neck
lab test most specific for MI & cardiac necrosis?
troponin
which cardiac marker has a wide diagnostic time frame? (still useful when patients wait awhile to come in after onset of chest pain)
troponin
Which troponin stays in the system longer?
troponin T
why is troponin an indicator of heart disease?
troponin T and I are not found in healthy patients, so any rise in values indicates cardiac necrosis or acute <I
what are the cardiac markers?
troponin, creatine kinase-MB, and myoglobin
what are non modifiable risk factors?
uncontrollable - age, gender, ethnic origin, & family history
what is acute coronary syndrome (ACS)?
unstable angina or an acute MI
stress procedure - how long do they walk on the treadmill?
until one of these occurs -a predetermined HR is reached & maintained -s/s of chest pain, fatigue, extreme dyspnea, vertigo, hypotension, and ventricular dysrhythmias -significant ST-segment depression or T-wave inversion -after 20 minutes
cautions of nitroglycerin
use with caution with other antihypertensive mediations
purpose of diuretics in heart failure?
used to decrease preload
what is a thallium scan?
uses radioisotope imaging to assess for ischemia or necrosis muscle tissue - radioisotopes cannot reach areas with decreased or absent perfusion
duration and relieving factors of chest pain caused by angina
usually lasts less than 15 minutes; relieved with rest, nitrate administration, or oxygen therapy
location and radiation of chest pain caused by angina
usually the left side of chest without radiation substernal; may spread across the chest and the back and/or down the arms
which cardiac dysrhythmia may or may not have a pulse?
v tach
what can cause localized edema?
venous obstruction (thrombosis) or lymphatic blockage (lymphedema)
which dysrhythmias are considered cardiac arrest?
ventricular asystole, v fib, & pulseless v tach
cardiac manifestations of hypocalcemia
ventricular dysrhythmias, a prolonged QT interval & cardiac arrest
antidote for warfarin
vitamin K
what is the most reliable way to monitor fluid gain or loss?
weigh the patient daily at the same time with the same scale
what is the best indicator of fluid balance?
weight gain/weight loss
when is BNP produced and released for a patient with heart failure?
when a patient has fluid overload
when are thrombolytic agents most effective?
when administered within the first 6 hours of a coronary event
when is an angiography indicated?
when arterial obstruction, narrowing or an aneurysm is suspected
what is mitral regurgitation?
when the blood flows "backwards" into the left atrium
when should urine ketones be checked?
when the blood glucose is above 300
what is paroxysmal nocturnal dyspnea?
when the pt has been lying down for awhile, blood from the lower extremities is redistributed --> which increased venus return to the heart - a diseased heart can't handle that
nursing considerations for planned cardioversion
without digoxin for 48hr & ensure anticoagulant therapy has been going on for 4-6 weeks
