Medsurg 2 exam 2
Which statement by a client who is seen for follow-up in the heart failure clinic is most important for the nurse to communicate to the health care provider?
"I wake up at night short of breath."
ejection fraction
- % of blood volume in left ventricle at the end of diastole that is pumped out of the LV the next systole - amount pumped out/amount at beginning - 50-65: good, 50>: HF, 30>: pacemaker
Aspirin
- Antiplatelet - Prevents clots from getting bigger
HF diagnostic tests
- Chest X-ray: pulmonary edema - Pro BnP: fluid overload and pressure on the heart - KFT: HF leads to RF - ECHO: gives pressure, size, and valve function, estimated EF - MRI: most accurate EF estimate - Right cardiac cath: checks on RV + RA
MI complications
- Death - Arrhythmias - Rupture - Tamponade - HF - Valve disease - Aneurysm - Emboli - Recurrence, regurgitation
Digoxin (HF)
- Decreases hr, increases contractibility, increases cardiac out - Check K, HR, and output before administering - Toxicity: Ear ringing
Preload
- Degree of stretch of the cardiac muscle fibers at the end of diastole - Volume = fluid = blood - increase: hypertension, aortic valve disease, hypervolemia - decrease: rapid HR, hypovolemia - Larger heart muscle = less volume
HF therapies and interventions
- Diet: reduced Na - Fluid restriction - Daily weight (same scale, clothes, and time [in the morning after using br]) - Treatment of sleep apnea (CPaP) - O2 therapy - Cardiac resynchronization therapy - surgery - depression management
MI Dx tests
- EKG - Blood tests (CBC, Troponin, electrolytes, cardiac enzymes, etc.) - Chest x-ray - Echocardiogram - Cardiac catheterization
right sided heart failure
- Fatigue - Increase venous pressure - Ascites - Enlarged liver and spleen (absorption of fluid - bad tenderness) - Secondary to COPD - Distended jugular vein - anorexia and GI upset - dependent edema - peripheral edema
cardiomyopathy treatment
- HF meds - Transplant - LVAD (station: waiting on transplant, destination: can't get transplant)
Contractility
- Muscle effectiveness - Stronger contraction = stronger workload - increasing contractility raises SV by increasing ventricular emptying - Positive inotropic meds: increase contractility (digoxin, dobutamine, epi) - Negative inotropic meds: decrease contractility (beta blockers, calcium channel blockers)
NSTEMI
- Non ST segment elevation MI; a heart attack that is not diagnosed on the EKG but is diagnosed by an elevated troponin on blood test - ONLY ONE LAYER
Stable angina
- Predictable and preventable - occurs with increased workload (activity, physical or nonphysical) - can feel like gas/indigestion, may spread to arms back or other areas - pain usually doesn't change with position or breathing - DECREASE IN BLOOD SUPPLY, INCREASE IN DEMAND - TX: self admin nitro
myocardial infarction symptoms
- Pressure like, crushing chest pain *radiating* up neck, shoulder and jaw - Lasting >30 min - SOB, coughing - diaphoresis - anxiety - vertigo - tachycardia
Valvular heart disease treatment
- Repair Replace - Biological (pig/calf), don't need blood thinners for life - Mechanical, lifetime warfarin (heparin if planning on consumption) - treat underlying cause
STEMI
- ST elevation MI, real-time ongoing death of heart tissue due to ischemia - WHOLE HEART
acute coronary syndrome
- Wide range of conditions 1. EKG 2. Troponin - When chest pain from ischemia is prolonged and not immediately reversible
Nitroglycerin (CP)
- a&v dilation - 1-2 min onset - 3 doses given 5 min apart - Check BP before each dose (don't give if less an 100 systolic) - Burn = GOOD - store in a dark bottle, replace every 6 months
Ventricular dysrhythmias
- absence of p wave due to lack of atrial activity or depolarization - EMERGENCY - wide QRS
After load
- amount of systemic valvular resistance - vasoconstriction = BP - increase: aortic stenosis, HTN, can lead to ventricular hypertrophy - decrease: nitro, lisinopril, calcium channel blockers - increase AL = increase cardiac workload
Warfarin
- anticoagulant (prevents clots that may cause stroke or heart attack) - AE: Bleeding
defibrillation
- application of an electric shock to the myocardium through the chest wall to restore normal cardiac rhythm - always start CPR first
coronary artery disease
- atherosclerosis of the coronary arteries that reduces the blood supply to the heart muscle - Chronic
regurgitation
- back flow of blood - incomplete closure (often from infection)
Calcium Channel Blockers (-pines) (CAD)
- decreases contraction - NOT USED IN HF W LOW EF - AE: tachycardia
ACE inhibitors (-prils) (HF)
- dilates blood vessels to improve blood flow - decreases after load - AE: dry nagging cough (stop taking)
Morphine (MI)
- given with MI's - decreases workload on heart and need for oxygen
CAD risk factors
- hypertension: clots - high cholesterol: fat streaks - obesity - smoking/vaping: vascular contraction - stress: high BP + HR - Nonmodifiable: aging, sex (men), heredity
dilated cardiomyopathy
- impaired left ventricular contraction - middle aged males
Atropine
- increases heart rate - AE: anticholernergic, blindness, CP
Left sided heart failure symptoms (LEFT=LUNGS)
- paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnea) - restlessness - confusion - orthopnea - tachycardia - exertional dyspnea - fatigue - cyanosis
Atrial Dysrhythmias
- problems with atrial contraction - cardioversion: 1st choice treatment
cardiac catheterization
- radial preferred (ALLEN TEST FIRST) - PT InR, CBC, type n screen - empty bladder first - partially sedated to prevent vasovagal attacks (only complication) - Post-op: vitals, insertion site, bleeding, NEUROVASCULAR ASSESSMENT
cardioversion
- restoration of a normal heart rhythm by electric shock or medication - shock synchronized with existing r wave
Adenosine
- restores normal HR - used during stress tests - treats SVT - AE: fainting
sinus dysrhythmia
- risks: reduced co (Brady), increased myocardial demands (tachy) - look for the cause and treat it - Management: meds, electrolyte imbalances, natural deterioration of cardiac system, pacemaker if symptomatic
Amiodarone
- slows nerve impulses in the heart - prevents and treats fast or irregular HR - AE: cough
Beta Blockers (HF)
- slows ventricular rate - AE: bradycardia (don't give if less than 60)
Coronary artery bypass graft - CABG
- surgical technique to bring a new blood supply to heart muscle by detouring around blocked arteries - radial artery preferred - post-op: art line for continuous BP monitoring - complications: systemic inflammation, bleeding, fluid and electrolyte imbalances, infections, hypothermia
myocardial infarction
- the occlusion of one or more coronary arteries caused by plaque buildup - irreversible death of the heart muscle
Unstable angina
- unexpected and unpredictable - Reduced blood flow due to the formation of a clot (clotting factors release to repair the rupture leading to myocardial ischemia) - occurs while, resting, sleeping, or with little exertion (rest and meds don't help) - tx: aspirin (prevents clot from getting bigger) and heparin (prevents new clots) - Procedures: cardiac cath, angioplasty (50-80% blockage), stent (80%< blockage)
Stenosis
- valve does not completely open - rigid, narrowed valves - decreased CO = decreased energy
QRS Time-Interval
.06 - .1 1-3 small boxes
PR interval
0.12-0.20 seconds 3-5 small boxes < or = to 1 large box
Purkinje fiber rate
20-40 bpm
AV node rate
40-60 bpm
V2 placement
4th intercostal space to the left of the sternum
V1 placement
4th intercostal space to the right of the sternum
V4 placement
5th intercostal space, left midclavicular line
V5 placement
5th intercostal space, midway between V4 & V6
Sa node rate
60-100 bpm, primary pacemaker of the heart fastest rate of automaticity
V3 placement
Between V2 and V4
Cardiac Index
CO/BSA (body surface area), most accurate for decision making 2.8-4.2
Which concern when caring for a client prescribed furosemide 40 mg every day in conjunction with digoxin would prompt the nurse to ask the health care provider about potassium supolements?
Digoxin toxicity occurs rapidly in the presence of hypokalemia
Lateral EKG leads
I, aVL, V5, V6
Inferior EKG leads
II, III, aVF
Left sided heart failure
Left ventricles of the heart are unable to pump blood properly
MI meds
Morphine Oxygen Nitro Aspirin
cardiac pathway
Sa Av Av junctions Bundle of his L + R bundle branches Purkinje fibers
stroke volume
The amount of blood ejected from the heart in one contraction
right sided heart failure
The right ventricle loses its ability to pump efficiently, causing blood, that would normally be pumped through the heart into the lungs, to back up into the systemic circulation
Cardiac output
The volume of blood ejected from the left side of the heart in one minute
Anterior EKG leads
V1, V2, V3, V4
P wave
atrial depolarization (contraction)
Which assessment is the priority when a client with heart failure reports a 9-pound (4-kilogram) weight gain in the past 2 weeks?
auscultate lung sounds
systolic heart failure
heart can't contract and pump out oxygenated blood
restrictive cardiomyopathy
heart muscle hardens, restricting the expansion of the heart, thus limiting the amount of blood it can pump to the rest of the body
hypertrophy cardiomyopathy
increase in muscle decrease ventricle size and filling, causing low CO
endocarditis
inflammation of the inner lining of the heart - splinter hemorrhages - fever, chills, sweats - murmur - dyspnea can be caused by drug abuse and dental infections
pericarditis
inflammation of the membrane surrounding the heart - acute CP aggravated with respirations - pericardial friction rub - fever, dyspnea, tachycardia
V6 placement
level with V5 at left midaxillary line (directly under the midpoint of the armpit)
cardiac tamponade
pressure on the heart caused by fluid in the pericardial space - becks triad: low BP, muffled heart sounds, JVD
CAD treatment
quit smoking, exercise, control of angina, hypertension, anticoagulant therapy, lifestyle modifications, cardiac cath, stent, angioplasty - diet: increase fiber, avoid canned foods, limit added sugars, reduce salt intake, avoid processed meats
diastolic heart failure
ventricles can't relax and fill, muscle becomes stiff and harder than normal
QRS complex
ventricular depolarization and atrial repolarization
T wave
ventricular repolarization and relaxation