NUR 504 Exam 1: Cardiac
how many hemoglobin are in 1 RBC?
4
telemetry leads:
5 telemetry leads: -RA --> right white -RL --> green (green under the clouds (aka white) -LA --> black (smoke over fire) -V1 --> brown (chocolate for my sweetheart) -need to have a medical order for telemetry, to remove leads for a bath/shower, or to leave the unit on/ off tele -leads need to be changes q 24 hrs -calculate strip q 4-8 hrs
what is a good reading on an incentive spirometer?
500 or more
*Indication for amiodarone:*
*Afib*
What class is amiodarone in?
Antiarrhythmic
lab testing for dysrhythmias:
CBC w/ differential --> H&H, WBC comprehensive Metabolic Panel --> potassium, calcium, magnesium Thyroid labs --> TSH
potential complications for CVP:
CLABSI --> central line associated bloodstream infection -monitor WBCs -dx with blood culture as well as lab values Bleeding -monitor H&H and platelets Pneumothorax/ hemothorax -if the lines shift they can puncture other vessels -will see tracheal deviation Misplacement Embolism
Metoprolol:
Class: beta 1 blocker Mechanism of action: decrease HR Indication: afib/aflutter SE: -bradycardia, fatigue, erectile dysfunction Antidote: glucagon Desired Outcome: normal heart rhythm and increased activity tolerance Pt education: do NOT stop taking abruptly can cause life threatening cardiac dysrhythmias
Dx testing for ACS:
*EKG IMMEDIATELY* upon onset of symptoms -needs to be repeated if symptoms have went away and then suddenly return chest X-ray -shows us the outline and size of the heart -if it seems enlarged we need more information echocardiogram -done bedside via ultrasound -gives us a view of the valves and blood flow TEE --> transesophageal echo -pt is sedated and ultrasound goes down the esophagus to get imaged of the backside of the heart -gets a better view of the posterior side of the heart where an echocardiogram gets an anterior view -echo is done first and if needed TEE is preformed cardiac catheterization (agiogram): - goes through an artery to view the heart and coronary vessels -contrast dye is used -if a vessel is found to be occluded or needs treatment then it becomes an intervention and not a dx test stress test: -assess cardiac response to an increased workload -can identify dysrhythmias that occur with exercise -exercise --> done on treadmill -nuclear stress test --> contrast dye is given to view vessels during the test EP studies: -invasive -electrical stimulation is used to induce an impulse (dysrhythmia) CT scan/ MRI: -views cardiac structures --> give limited information for someone who has a heart attack or plumbing problem
STEMI:
*ST interval is above baseline (ST elevation)* -100% thrombus occlusion --> patient will need to go to the cath lab immediately -cardiac enzymes will be elevated -severe tissue damage and myocardial necrosis will occur goal: door-to-balloon time of 90 min or less
NSTEMI:
*ST interval is either at baseline or inverted (ST depression)* -cardiac enzymes will be elevated -90-80% thrombus occlusion
*Nursing interventions for adenosine:*
*must know these!* -requires use of infusion pump and continuous cardiac and hemodynamic monitoring during infusion -emergency resuscitation equipment should be immediately available -adenosine could produce bronchoconstriction in patients with COPS or emphysema (asthma)
Nursing interventions for calcium gluconate:
*must know* - IV infusion monitor ECG, VS, and CNS -observe infusion site closely -avoid extravasation -obtain calcium levels q 1 -4 hrs during continuous infusion
nursing interventions for diltiazem:
*must know* -IV: requires an infusion pump and continuous cardiac and hemodynamic monitoring
*nursing interventions for lidocaine (infusion)*
*must know* -IV: requires continuous cardiac monitoring/ hemodynamic monitoring during infusion -patient needs to be kept supine to reduce hypotensive effects -assess for s/s CNS toxicity
*treatment for unstable SVT:*
*must know* -adenosine -cadioversion
*Indications for verapamil*
*must know* -angina -afib -aflutter -hypertension -SVT
*desired outcomes for amiodarone:*
*must know* -conversion to NSR -control rate of Afib
*desired outcome for diltiazem: *
*must know* -rate control for Afib -decreased chest pain
*desired outcome for adenosine:*
*must know* -conversion of SVT to a normal sinus rhythm (to control the very fast rhythm)
*indications for adenosine:*
*must know* -supraventricular tachycardia (SVT)
*indication of diltiazem:*
*must know* -afib -cardiomyopathy -angina
*Desired outcomes for verapamil:*
*must know* -afib rate control -conversion to NSR -prophylactic management of SVT and HTN
*indication for atropine (IV):*
*must know* -bradycardia
*indication for lidocaine infusion:*
*must know* -cardiac arrest
*desired outcome for atropine (IV)*
*must know* -increased HR >60
Nursing interventions for amiodarone:
*must know* -monitor for S/S pulmonary toxicity (nonproductive cough, dyspnea, pleuritic pain, wt loss, fever, malaise) -if given IV continuous cardiac/ hemodynamic monitoring during infusion is required -advocate for baseline pulmonary function tests prior to using medication (if not urgent)
nursing interventions for nicardipine:
*must know* -monitor patients for cardiovascualr status including BP, HR, rhythm, ECG changes, and signs of new heart failure -monitor infusion site closely -peripheral infusion sites should be changes q 12 hrs
*desired outcome for lidocaine infusion*
*must know* -return of spontaneous circulation
*atrial fibrillation (Afib):*
*must know* multiple impulses originating in the atria -the atria "quiver" at a rate of 300+ bpm -because of the "quivering" blood pools in the atria decreasing ventricular filling and cardiac output -pooling blood = clots
*surgical treatment for pericarditis:*
*pericadiocentesis:* -CT scan guided with a catheter and needle into the pericardium to drain the fluid -fluid will look cloudy and sometimes thick and purulent *pericardial window:* -surgical opening in the pericardium through a small chest incision to drain thick and purulent fluid from the pericardium
Labs for ACS:
*troponin* -gold star lab for ACS -a myocardial muscle protein released into the bloodstream with injury to myocardial tissue -absent except for with myocardial injury -start to elevate 3-6 hrs after onset of symptoms; initially it will negative so troponins are checked 3x q 6 hrs -troponin will peak, then decline, returning to normal around day 6
central venous pressure monitoring (CVP):
- BP in vena cava/ right atrium -normal value --> 3-8cm H2O or 2-6 mmHg - measures right ventricular function and venous return tot he right side of the heart
mechanism of action for iniotropic meds:
- increase strength of hear muscle contraction, stroke volume, and cardiac output
risk factors for an aneurysm:
-*HTN (increases risk for enlargement and early rupture)* -atherosclerosis -hyperlipidemia -nicotine/smoking non modifiable: -age 50-60 -males -family hx -connective tissue disorders (marfans)
indications for nicardipine:
-*HTN* -angina
indications for nitroglycerin IV:
-*angina pectoris* -chest pain -heart failure -*HTN*
*indications for epinephrine:*
-*cardiac arrest* (if you give too much epinephrine you can cause cardiac arrest; but it is also used for someone who is in cardiac arrest) -anaphylactic allergic reactions -hypotension -bradycardia -heart failure
side effects of Nicardipine:
-*flushing* -*edema* -*hypotension* -N/V -weakness
S/S pericarditis:
-*pericardial friction rub* -chest pain w/ radiation to neck, shoulder, and back -pain increased with inspiration, coughing or swallowing -*pain increased in supine position --> relief in orthopnic position* -fever -elevated WBC -*ST wave elevation in all leads* -new or worsening pericardial effusion (the amount of fluid)
nursing interventions for an emergent rupture of an aneurysm:
-2 large bore IVs -foley w/ urometer to closely monitor urine output -morphine for pain -beta blockers and fluids to maintain MAP > 60 and decrease HR -prepare pt for emergent surgery
indications for phenylephrine injection:
-BP (or MAP) -heart rate
nursing interventions for nipride:
-BP monitoring via arterial line -HR and BP monitoring required
labs to monitor for valve disorders:
-CBC -CMP -cardiac workup
labs for pericarditis:
-ESR and CRP --> inflammatory markers -CBC W/ differential --> monocytes - antinuclear antibody (ANA) -rheumatoid factor, anti CCP antibodies
Atrial Flutter:
-Foci are more organized -*characteristic sawtooth pattern*
risk factors for Afib:
-HTN -heart failure -CAD -genetics -increased risk w/ age
risk factors for endocarditis:
-IV drug use -valve replacements -structural cardiac defects -congenital heart defects -rheumatic fever -dental procedures -skin rashes, lesions, abcesses -infection -surgery and invasive procedures
nursing interventions for verapamil:
-IV: require an infusion pump and continuous cardiac and hemodynamic monitoring -monitor BP, HR, rhythm, and ECG
non-surgical treatment for pericarditis:
-NSAIDs for pain and inflammation (dont hold them if their pain is a 0 out of 10 the need it for the inflammation) -corticosteroids -colchicine -treat underlying cause: -bacterial --> antibiotics -uremic --> hemodialysis -malignant --> radiation or chemotherapy
potential complications for sinus bradycardia:
-SOB -chest pain -fatigue -memory problems -confusion -difficulty concentrating -dizziness, lightheaded, synoscope -irritability, agitation, other personality changes -unstable: cardiac arrest
*S/S organ rejection*
-SOB -->sign of HF -fatigue --> sign of HF -edema/ wt gain --> sign of HF -abdominal bloating -new onset bradycardia -hypotension -afib/ flutter -decreased activity tolerance -decreased ejection fraction
what does a surgical CABG procedure entail?
-a bone saw is used to open thoracic cavity and make a sternal incision -retractors are used to hold the chest open during surgery -the heart is exposed -once procedure is completed the sternum is wired back together -the pt will be mechanically ventilated upon transfer to the ICU/ post ip area until respiratory status is stable -pt comes out with pacemaker wires because they are at risk for bradycardia
non-modifiable risk factors for ACS:
-aging -family hx of chest pain, heart disease or stroke -hx of high BP, preeclampsia, or diabetes during pregnancy -COVID
risk factors for dilated cardiomyopathy
-alcohol abuse -chemotherapy -infection -inflammation -poor nutrition -pregnancy
Premature ventricular contractions (PVCs):
-an abnormal beat that originates from irritability of ventricular cells -a non perfusing beat (heart beats but does not perfuse HR could be 80 but it is really 40) -can be uniform of variable -if shown in a pattern it is more concerning than it not being in a pattern
coronartyartery bypass graft (CABG)
-an occluded artery is bypasses (aka detour) w/ the patients own venous or arterial vessels or a synthetic graft to reestablish blood flow below occlusion -it is common to see mammary artery in the thoracic cavity -vein harvest --> saphenous vein from the lower leg is used
non surgical treatment for Afib:
-antiarrhythmics --> amiodorone -caclium channel blockers --> diltiazem -LT anticoagulants (initially they are started on a heparin drip bridged with PO coumadin until they have a therapeutic INR (2-3) then heparin is stopped) -cardioversion
non surgical treatment for endocarditis:
-antibiotics --> usually 4-6 wks -supportive therapy for heart failure -anticoagulants are not effective for vegitative emboli
nursing interventions for Afib:
-anticoagulation therapy -monitor for signs of emboli (sudden SOB)
Aortic regurgitation:
-aortic valve leaflets do not close properly during diastole; the annulus may be dilated, loose, or deformed -the left ventricle becomes dilates to accommodate increased blood flow and hypertrophies
nursing interventions for Vtach/ Vfib
-assess for underlying cause -monitor HR -support code team -support family
nursing interventions for SVT:
-assess for underlying cause -monitor HR and VS -assist with valsalva maneuver -follow ACLS protocol if unstable
Mean arterial pressure (MAP):
-best indicator of cardiac output and is noninvasive -normal MAP: 70-100 mmHg -MAP of at least 60 mmHg is necessary for adequate cerebral perfusions
labs for endocarditis:
-blood cultures -CBC w/ differential --> low H&H, increased monocytes (d/t inflammation), elevated neutrophils (if bacterial),elevated lymphocytes (if viral) -CRP and inflammatory markers
side effects of norepinephrine:
-bradycardia -cardiac arrhythmias -cardiomyopathy -peripheral vascular insufficiency -anxiety -headache -dyspnea
side effects of digoxin:
-bradycardia -dig toxicity (weakness, fatigue, vision changes ---> yellow halos)
S/S vfib:
-cardiac arrest -pulselessness
Nursing interventions for a heart transplant:
-care is similar to CABG and cardiac cath -psychological -lifestyle changes -life long medication compliance and follow up care -grief impending death -requires lifelong immunosuppressents -increased risk for infection -increased risk for pericardial bleeding and tamponade
discharge interventions for surgical repair of an aneurysm:
-case management because recovery is 2-3 months -skilled care -limited activity --> no driving or lifting -limited stair use -follow up care and life long monitoring -wound care -BP monitoring -lifestyle changes --> moderate physical activity, smoking cessation, and a healthy diet
Potential complications for ACS:
-cerebral anoxia --> d/t prolonged cardiac arrest -acute mitral regurgitation -left ventricular wall rupture/ aneurysm -dysrhythmias -congestive heart failure
ventricular tachycardia (vfib)
-chaotic firing of multiple irritable ventricular focci -ventricles quiver -no cardiac output -*requires immediate medical attention*
dx testing for pericarditis:
-chest X-ray (we will see an enlarged heart) -EKG --> MI rule out -echocardiogram -CT scan -MRI -dx cardiac cath
side effects of epinephrine:
-chest pain -dysrhythmias -pulmonary edema -tachycardia -decreased urine output
S/S ACS:
-chest pain (angina) -discomfort (described as aching, pressure, tightness or burning, "i feel like i have heart burn" -pain spreading from chest to shoulder, arms, upper abdomen , back, neck, or jaw -N/V -diaphoresis -indigestion -SOB (dyspnea) -lightheaded, dizzy or fainting -unusual/ unexplained fatigue -feeling restless or apprehensive
dx testing for cardiomyopathy:
-chest x-ray -echocardiogram -dx angiogram/ cardiac cath -holter monitor -CT/MRI -ECG -stress test
indications for arterial lines:
-comfort -frequent ABGs -lab draws -real time BP and MAP monitoring (the most accurate measurement) -accuracy
risk factors for aortic stenosis:
-congenital bicuspid or tricuspid aortic valve -rheumatic heart dz -atherosclerosis -degenerative calcification
risk factors for mitral valve prolapse:
-connective tissue dz --> marfans -congenital heart disease -family hx
potential complications of Vtach/ vfib:
-death -cerebral anoxia
side effects of vasopressin:
-decreased cardiac output -hyponatremia
desired outcomes for nicardipine:
-decreased chest pain -*decreased in BP to WNL*
desired outcomes for nitroglycerin IV:
-decreased chest pain -decreased BP WNL -dilation of coronary arteries
discharge nursing interventions for a PCI (cardiac catheterization):
-discuss restarting home medications like metformin and review education for newly prescribed medications -limit activity including lifting and exercise (dont lift anything heavier than a gallon of milk) -confirm with provider if the pt is cleared to operate a motor vehicle (if they had slight sedation they cannot drive home) -leave dressing in place for the 1st day home (to decrease risk of dislodging a clot and bleeding) -teach pt to observe for s/s of swelling/bleeding -consider need for cardiac rehab
acute coronary syndrome (ACS):
-disorder including unstable angina and MI -results from obstruction of the coronary arteries by ruptures plaques; leads to platelet aggregation, thrombus formation, and vasoconstriction -damage and chest pain occurs when the artery reaches 50% occlusion of blood flow -myocardial ischemia occurs because myocardial demand is increased but cannot be delivered
Pharmological treatment for valve disorders:
-diuretics--> for extra blood flow and volume -beta blockers -ACE inhibitors -digoxin --> to increase cardiac contractility -oxygen -nitrates --> caution hypotension and increased risk for synscope -calcium channel blockers -antiarhythmics --> if afib develops -anticoagulants --> if afib develops
Ejection fraction:
-done at bedside; noninvasive -end diastolic volume --> how much blood is filling in the left ventricle -end systolic volume --> how much blood is left in ventricle *normal EF = 50-60%*
S/S aortic stenosis:
-dyspnea -angina -synscope -fatigue -orthopnea -*peripheral cyanosis* -*narrow pulse pressure* -*harsh systolic crescendo decrescendo murmur*
S/S mitral valve stenosis:
-dyspnea -orthopnea -hemoptysis --> blood in sputum; very late sign -pulmonary edema --> late sign -right sided heart failure -JVD -hepatomegaly --> happens gradually - pitting edema --> early sign that progresses -*rumbling apical diastolic murmer*
s/s of aortic regurgitation
-dyspnea -orthopnea -palpations -fatigue -angina -tachycardia -*bounding pulses* -*wide pulse pressure* -*blowing decrescendo diastolic murmur*
dx testing for endocarditis:
-echocardiogram and TEE --> to look for valve issues -EKG --> because they are at risk for dysrhythmias
dx tests for valve disorders:
-echocardiogram with ejection fraction -TEE (need to be NPO prior to procedure) -bubble study -chest X-ray --> tells us the size of the heart -exercise tolerance --> to test perfusion -EKG
Nursing interventions for sinus tachycardia:
-education: avoid nicotine, alcohol, caffeine, stress management -assess for underlying cause -monitor HR and VS
desired outcomes for dobutamine:
-end organ perfusion -MAP >60
desired outcomes for dopamine hydrochloride:
-end organ perfusion (when the body is in shock it shunts blood to vital organs like the brain, heart, and lungs, so peripheries and other organs don't get blood supply) -MAP >60
S/S of mitral regurgitation:
-fatigue -dyspnea -orthopnea -palpations --> because regurgitation can cause electrical changes -afib -right sided HF -JVD -hepatomegaly -pitting edema -*high pitched holosystolic murmur* -*may hear S3 heart sound*
S/S of sinus tachycardia:
-fatigue -weakness -SOB -palpations -lightheadedness -dizzy -exercise tolerance -chest pain
s/s of dilated cardiomyopathy:
-fatigue/ weakness -s/s L sided HF -dysrhythmias -emboli -S3 and S4 gallop -moderate to severe cardiomegaly
S/S endocarditis:
-fever -new onset cardiac murmur or a change in an existing murmur -onset of HF -L sided --> fatigue, SOB, crackles in the lungs -R sided --> peripheral edema, wt gain, anorexia, JVD -*systemic emboli* -petchiae -*splinter hemorrhages* (purple lines on finger nails) -*osler nodes* (tender and painful bumps on the tops of fingers and toes) -*janeway lesions* (painless spots on palms and soles of the feet -roth spots -positive blood cultures
SE of adenosine:
-flushing -dysrhythmias -headache
types of closure devices:
-for radial or femoral insertion site -a TR band is filled with air to create pressure placed on the puncture site assess the site frequently: -inspect the skin dorsal to insertion site -high risk for retroperitoneal bleed --> especially in femoral (there will be a large amount of ecchymosis on dorsal side (lower back, hips, back of thigh) -men need to check the posterior side of their scrotum
Risk factors for premature ventricular contractions:
-frequency increases with age -MI -heart failure -COPD -anemia -electrolyte imbalances -caffeine -alcohol -stress -infection -med SE --> anesthesia
side effects of nitroglycerin IV:
-headache (give acetaminophen or a stronger analgesic) -hypotension -synoscope
side effects of verapamil:
-heart failure -*hepatotoxicity* (know AST and ALT B4 starting meds) -bradyarhythmias
Indications for digoxin:
-heart failure -afib/flutter
Indications for milrione:
-heart failure -inotropic support
post-op interventions for CABG procedure:
-hemodynamic monitoring -epicardial pacing wires (d/t risk for bradycardia) -chest tube management -cardiac monitoring -mechanical ventilation management -dangle at bedside within 2 hrs after extubation (extubation is taking them off the ventilator) -pt is up to a chair 4-8 hrs after extubation -early ambulation encouraged; goal is to ambulate 1 day post op -thoroughly assess all surgical sites
Nursing interventions for pericarditis:
-hemodynamic monitoring -pain control -treat underlying cause -*position upright for comfort * - NSAIDS -avoid ASA and anticoagulants (increases the risk for cardiac tamponade
complications of an aneurysm surgical repair with graft:
-high mortality rate -bleeding -disruption of BP to the spinal cord (can lead to paralysis) - dysrhythmias -infection -renal impairment --> oliguria d/t decreased perfusion -pneumonia -stroke
indications for nipride:
-hypertensive crisis (we want BP to decrease slowly) -heart failure
indications for dopamine hydrochloride:
-hypotension -shock (cardiogenic shock can occur as a result of an MI)
indication for phenylephrine injection:
-hypotension -cardiogenic shock
S/S Vtach:
-hypotension -dizziness -synoscope -cardiogenic shock -cardiac arrest -pulselessness
indications for dobutamine:
-hypotension -shock
indications for norepinephrine:
-hypotension -shock
desired outcome for phenylephrine injection:
-increase BP -MAP > 60
desired outcomes for milrione:
-increase HR & BP -increase cardiac output
*desired outcome for epinephrine:*
-increase cardiac output -ROSC (return of spontaneous circulation) -dilate airways
desired outcome for vasopressin:
-increased BP -MAP >60
desired outcomes for norepinephrine:
-increased BP -MAP >60
risk factors for aortic regurgitation:
-ineffective endocarditis -congenital valve abnormalities -HTN -marfans syndrome
endocarditis:
-infection of the inner lining of the heart wall -usually from viral, bacterial, or fungal (most common strep virdans and staph) -blood flows from high pressure to a low area and erodes the pericardial lining, platelets and fibrin adhere to the erosion and create *vegitative lesions* and trap the bacteria --> emboli can form and enter systemic circulation
risk factors for pericarditis:
-infestation -trauma -renal failure (uremic pericarditis) -malignancy (tumors like lymphoma) -autoimmune dzs (lupus or RA) -MI -open heart surgery -radiation therapy -percutaneous treatment (cardiac cath, ablation etc.)
Nursing interventions for epinephrine:
-infusion pump and continuous cardiac and hemodynamic monitoring are required during inpatient therapy -Assess IV site frequently -frequent vital signs -monitor cardiac status, respiratory status and CNS status
nursing interventions for dopamine hydrochloride:
-infusion pump and continuous cardiac monitoring are required for inpatient therapy -monitor I & O -check blood sugars -monitor infusion site for extravasation -monitor for peripheral ischemia -monitor electrolytes
Mechanism of action for amiodarone:
-inhibits andrenergic stimulation; affects sodium, potassium, and calcium channels; slows conduction through the AV node
surgically inserted pace maker:
-inserted in pocket of subcutaneous tissue in the chest wall -once inserted the patients arm remains immobile on the side it was placed after surgery -has a battery life of 10 yrs -risk for infection and hematoma
where can central lines be placed?
-internal jugular (IJ) -subclavian -femoral
S/S Afib:
-irregular pulse -fatigue -dizziness -weakness -confusion -palpations -SOB -chest pain
risk factors for Vtach and Vfib:
-ischemic heart disease -myocardial infraction -cardiomyopathy -electrolyte imbalance -valvular heart disease -heart failure -drug toxicity -hypotension -hemorrhage -hypovolemia -trauma
nursing interventions for nitroglycerin IV:
-med needs to me titrates -place pt on cardiac telemetry -assess cardiac rhythm and monitor for hypotension
risk factors for mitral valve regurgitation:
-mitral valve prolapse -rheumatic heart disease (if this is the cause typically stenosis and regurgitation are present) -ineffective endocarditis -MI -connective tissue dz --> marfans -dilates cardiomyopathy
nursing interventions for norepinephrine:
-monitor BP and HR -monitor peripheral perfusion
nursing interventions for heparin drip:
-monitor PT and aPTT -monitor potassium
nursing interventions for milrione:
-monitor cardiac/ hemodynamic status continuously during therapy -monitor for fluid retention
nursing interventions for vasopressin:
-monitor serum and urine sodium -IV requires use of infusion pump -Monitor IV site closely for extravasation -monitor cardiac status and BP
dialted cardiomyopathy
-most common kind -enlargement and dilation of one or both of the ventricles along with impaired contractility -walls stretch and become thin
what are the 3 layers of the heart wall:
-myocardium --> inner -endocardium --> middle -pericardium --> outer
Mitral stenosis:
-narrowing of the mitral valve -the valve thickens with fibrosis, stiffens, and chordea tendineae contract and shorten (fibers that help open and close the mitral valve) -inhibits the normal blood flow from the left atrium t the left ventricale -left arterial pressure rises -left atrium becomes dilated -right atrium hypertrophy pulmonary congestion and R sided HF occurs
risl factors for premature atrial contractions (PACs):
-nicotine -fatigue -alcohol -ischemia -hypoxia -electrolyte imbalances -med SE --> digoxin
Asystole:
-no ventricular activity -pulseless -no cardiac output -treatment --> high quality CPR -not a shockable rhythm
premature atrial contractions (PACs):
-occur from irritable cells in the atria -results in a P-wave having a different morphology then previous P-waves
S/S heart attack in women:
-often report emotional stress prior to event -SOB -N/V -back or jaw pain -unexplained anxiety -weakness and fatigue -mild flu like symptoms
sinus tachycardia:
-overactive SA node firing -initially tachycardia increases cardiac output and BP but if its prolonged it creates the opposite effect (decreases cardiac output and perfusion and increases oxygen demand)
surgical treatment for dilated cardiomyopathy:
-pace maker --> for sinus bradycardia -automated plantable cardioverter-defibrillators (AICD) --> for vtach and vfib because they cause sudden cardiac arrest -left ventricular assist devices (LVAD) --> enhances left ventricular function -invasive -a continuous flow pump that connects to the left ventricle to the ascending aorta via an internal cannula -pt will have to walk around with a battery pack and keep it dry when showering -heart transplant
nursing interventions for sinus bradycardia:
-patient is a fall risk --> needs to call for assistance -monitor HR and VS -assess for underlying cause -HR less than 30 = chest compressions
potential complications for pericarditis:
-pericardial effusion -progression to *cardiac tamponade* -medical emergency --> build up of fluid, blood or air in pericardial sac that is compressing the heart *Becks triad:* -*JVD* -*muffled heart sounds* -*hypotension* -tachycardia -pulsus paradoxus --> drop in BP of more than 10 with inspiration treatment --> emergency bedside pericardiocentesis
risk factors for sinus tachycardia:
-physical activity -pain -anxiety -stress -fever -anemia (because there isnt enough RBCs carrying oxygen) -hypoxemia (low oxygen; HR will increase because body is trying to get more oxygen) -hypothyroidism -dehydration/ hypovolemia
nursing interventions for dobutamine:
-place on cardiac telemetry -assess cardiac rhythm and BP
S/S sinus bradycardia:
-possible synoscope -dizziness -weakness -confusion -hypotension -diaphoresis -SOB -chest pain
nursing interventions for endocarditis:
-post op surgical repair (similar to valve replacement/ CABG) -long term antibiotics (monitor for superinfection) -PICC or central line care at home -case management -substance misuse treatment -prophylactic antibiotics prior to dental procedures
labs to monitor for digoxin
-potassium (can cause hypokalemia) -therapeutic range
treatment for Vfib/ vtach
-preform high quality CPR -establish and airway and provide oxygen to keep sat >94% -monitor hear rhythm and blood pressure -defibrillation -meds: epinephrine, amiodarone, lidocaine, mag (for torsades de pointes/ polymorphic)
surgical treatment for endocarditis:
-removal/repair of infected valve and chordae tendinae -repair/ removal of congenital shunts -draining of abscess -similar procedure as valve replacement/ CABG
risk factors for mitral valve stenosis:
-rheumatic fever -calcium deposits -radiation therapy -congenital heart conditions
PCI (percutaneous coronary intervention) --> invasive non-surgical treatment:
-same thing as cardiac catheterization -recommended door-to-balloon time 90 min or less -performed in cath lab under guide fluoroscopy (uses contrast dye) - a balloon tipped cath is threaded through an arterial sheath through the aorta -the catheter is positioned in the obstruction and the balloon is inflated displacing the obstruction and opening the vessel wall -the patient is typically awake or slightly sedated (there are no pain receptors on the inside of our vessels) -a retrieval device can be used if the clot is visualized
Pre-op interventions for a CABG procedure:
-shave pts chest -chlorhexidine wash/ shower -pre op antibiotics -oral meds for diabetes are d/c and transition to insulin for temporary management -teach use of cough pillow (aka splinting) and use of IS -provide family support
what are non tunneled central lines used for?
-short term with no cuff -placed at bedside
S/S premature ventricular contractions:
-skipped beat or palpations (cant hear it or feel it but can see it on tele strip) -irregular heart beat -decreased peripheral pulses
modifiable risk factors for ACS:
-smoking -lack of physical activity -obesity -nicotine -unhealthy diet -high BP -high blood cholesterol -diabetes -metabolic syndrome
potential complications for a CABG procedure:
-sternal wound infection -fluid and electrolyte imbalances -hypotension/ HTN -hypothermia (d/t having surgery under anesthesia) -bleeding -cardiac tamponade -decreases LOC (they can become anoxic) -anginal pain --> d/t inflammation form the manipulation of heart tissue during the procedure (get an EKG and monitor VS)
what are tunneled central lines used for?
-surgically placed for long term use -less risk for infection
Potential complications for sinus tachycardia:
-synoscope (fainting/ passing out) -hypotension -restlessness -anxiety -decreased perfusion -unstable sinus tachycardia --> cardiac arrest
desired outcomes for heparin drip:
-therapeutic range of anticoagulation -typically discontinues once therapeutic range of oral anticoagulation is achieved
Surgical treatment for an aneurysm:
-they have pain and are at a large risk for rupture repair w/ graft: -large incision along the side of the chest down to the umbilicus -clamps are placed temporarily in the affected segment of the aorta -the damaged section is removed and replaced with a synthetic graft -pts will need to use a cough pillow --> encourage then to deep breathe and cough post op: -long recovery --> 2-3 months -early ambulation -encourage use of IS and cough pillow -hemodynamic monitoring endovascular stent: -typically done when its a more elective surgery -minimally invasive -catheter and special wires are inserted through the femoral artery n -contrast dye is used to visualize aneurysm -a stent is placed to replace the wall post op: -1-2 days in the hospital -recovery is about 4 wks -care is similar to a PCI --> monitor femoral site, keep limb straight, bed rest, cardiac and hemodynamic monitoring
Metformin
-this med needs to be d/c immediately with any diagnostic treatment intervention that uses contrast dye d/t risk for renal failure and lactic acidosis -must be stopped 48 hrs before contrast dye and can be resumed 48 hrs after if renal function is normal -acetylcysteine (mucomyst( can be administered as a phrophylactic prevention of contrast induced nephropathy
ballon catheter procedures for valve disorders:
-transcatheter aortic valve replacement (TAVR) -valvuloplasty -mitraclip, mitral valve (treatment for mitral prolapse and regurgitation) -femoral access -post op supine for 6 hrs -lifelong daily aspirin and clopidogril for 6 months for TAVR or valvuloplasty
S/S of an aneurysm:
-typically asymptomatic because they grow and develop over time -pain develops when its starting to rupture -abdominal pain -flank pain -back pain -chest pain -classic sign --> pain between the shoulder blades -pulsations/ bruit/ thrill in upper abdomen -evidence of thrombi distal to aneurysm --> in legs petechia/ decreased circulation risk for shock if aneurysm ruptures: -hypotension -diaphoresis -decreased LOC -oliguria (small urine output) -loss of pulses distal to rupture -dysrhythmia --> because of the shock -retroperitoneal bleed/ hematoma -SOB -difficulty swallowing (if thoracic possible hoarse voice as well and cough)
S/S heart attack in men:
-uncomfortable pressure in the chest --> often predisposed by physical activity -pain that spreads to the shoulders, neck and arms
nursing intervention for atropine (IV):
-use cardiac monitor -monitor for tachycardia and hypotension -monitor for S/S atropine toxicity (fever, muscle fasciculations, delirium)
non surgical treatment for SVT:
-valsalva maneuvers -bear down -ice to the back of the neck -beta blockers -calcium channel blockers
side effects of heparin drip:
-vasospasm -hemorrhage -hyperkalemia
indications for use for central lines:
-vesicant drugs (drugs that are caustic like chemo) -drugs / titration -fluids/ blood volumes -hemodialysis -poor vascular access -hemodynamic monitoring
risk factors for sinus bradycardia:
-vomiting -suctioning -valsalva maneuvers -hypoxia -medication SE: beta blockers, calcium channel blockers, digoxin -electrolyte imbalances -ICP -hypothyroidism -MI
how many seconds is 1 small square on a telemetry reading?
0.04 seconds
how many seconds is 1 large square on a telemetry reading?
0.2 seconds
what is the therapeutic range for digoxin?
0.5-2
how many seconds is 5 large squares on a telemetry reading?
1 second
Pathway of cardiac electrical activity:
1. SA node (pacemaker node) 2. SV node 3. bundle of his/ bundle branches 4. pukinje fibers 5. ventricles contract
what order does normal cardiac conduction occur through the heart?
1. Sinoatrial node (SA node) 2. atrioventricular (AV) node 3. bundle of his 4. bundle branches 5. purkinje fibers
path of blood going from the vena cava to the aorta:
1. inferior and superior vena cava 2. right atrium 3. tricuspid valve 4. right ventricle 5. pulmonary semilunar valve 6. pulmonary trunk 7. pulmonary arteries 8. lungs 9. pulmonary veins 10. left atrium 11. mitral valve (bicuspid valve) 12. left ventricle 13. aortic semilunar valve 14. aorta 15. body (systemic circulation)
what are the 5 steps of BLS assessment?
1. scene safety 2. assess breathing 3. activate EMS 4. get the automated external defibrillator (AED) 5. CPR
Non surgical treatment for ACS:
1st --> EKG MONA -morphine --> to treat chest pain -oxygen --> d/t decreased amount of oxygen reaching myocardial tissue (2L nasal cannula) -nitro (need to know BP B4 giving -aspirin --> 4 baby aspirin chews (for platelet aggregation) Other: -beta blocker --> metoprolol IV push -anticoagulation --> heparin drip -fibrinolytic -statin -IV drips w/ parameters -obtain daily wt -hemodynamic monitoring -telemetry -highly vesicant drugs consider ventral line or large bore -monitor IV site frequently
dx testing for dysrhythmias:
ECG --> telemetry monitoring EKG --> 12 leads Holter monitor --> worn for days/ weeks to capture dysrhythmias are paradoxal (come and go) or start and end abruptly
mean arterial pressure (MAP) calculation:
MAP = SBP + 2(DBP) ---------------- 3
characteristics of dysrhythmias caused by hyperkalemia:
P -wave --> widened and low amplitude d/t slowing of conduction QRS --> widened *T-wave --> tall and tented* normal K value --> 3.5-5
PQRST:
P waves --> *atrial depolarization* or contraction PR --> beginning of atrial depolarization to the beginning of ventricular depolarization (measures from the beginning of the P to the QRS complex) QRS --> *ventricular depolarization* (activity through lower heart chambers) T wave --> *atrial repolarization* (activity though upper heart chambers
characteristics of dysrhythmias caused by hypomagensaemia:
PR interval --> prolonged QT interval --> prolonged *predisposition to Vtach & torsades de pointes* normal mag level --> 1.8-2.6
characteristics of dysrhythmias caused by hypocalcemia:
QRS --> narrow PR interval --> reduced T-wave --> flattened and inverted QT interval --> prolonged (predisposes someone to Vtach) ST --> prolonged and ST depression
EKG features of Afib:
Rate: >350 bpm rhythm: irregular P-wave: absent; erratic waves present PR interval: absent -QRS: normal; may be widened if there are conduction delays
ECG features of Vtach:
Rate: fast (100-250) rhythm: regular P-wave: absent PR interval: not measurable QRS: wide w/ bizarre appearance
EKG features of sinus bradycardia:
Rate: slow <60 Rhythm: normal P-wave: normla PR interval: normal QRS: normal
EKG features of premature atrial contractions:
Rate: usually normal but depends on underlying rhythm rhythm: irregular P-wave: premature and abnormal PR interval: normal or longer QRS: 0.10 sec or less
pulse pressure (PP) calculation:
SBP -DBP
T-P-R-BP-02
T-measures temperature of the environment -if temp is too high --> pulse increases and body demands more O2 -if temp is too low --> pulse slows P - rate of O2 carrying RBCs which carry oxygen needed for profusion -if too slow --> body is delivering enough oxygen -if too fast --> most likely isn't delivering enough oxygen and decreased perfusion will occur R - measures amount of O2 to lungs -RR to low --> not enough oxygen -RR to fast --> decreased perfusion BP - measures PERFUSION -too high --> vessels are narrow/ volume is high and backed up -too low --> vessels are open, but there is little force to push O2 into tissue O2 - measures gas exchange from the lungs to RBCs -high --> lots of full RBCs -low --> partially empty RBCs or decreased amount of RBCs
characteristics of dysrhythmias caused by hypokalemia:
T-wave --> depressed and flat may cause prolonged QT interval
Angina:
a symptom of ACS that *does not cause EKG changes* -*EKG with no ST changes* -troponin will be normal -predisposition to MI treatment: -nitrogylcerin -rest nitro education: -can cause hypotension; do not take a second one if you become lightheaded or dizzy
electrical cardioversion:
a synchronized countershock that may be performed to restore normal conduction in a hospitalized patient with new-onset A-fib. -it is intended to stop the re-entry circuit and allow the sinus node to regain control of the heart -emergency equipment must be available during this procedure
the nurse is teaching a client with a new pacemaker. which client statement indicates a need for further teaching? a. "i no longer need my heart pills" b. "i need to take my pulse everyday" c. "i will be able to shower again soon" d. "i might trigger airport security metal detectors"
a. "i no longer need my heart pills"
which assessment finding indicates a need for the nurse to consult with the HCP before administering the prescribed metoprolol to a client with stable angina? a. BP 142/90 b. report of chest pain when walking c. sinus bradycardia d. large Q waves on the electrocardiogram
a. BP 142/90
which risk factors are known to contribute to atrial fibrillation? select all a. advancing age b. palpations c. high BP d. excessive alcohol use e. use of beta blockers
a. advancing age c. high BP d. excessive alcohol use
which action would the nurse take first when a 20 yr old client seen in the ED reports frequent "skipped heart beats", and the nurse notes frequent premature ventricular complexes (PVCs) on the cardiac monitor? a. ask the client about use of caffeine or stimulant drugs b. teach the client that PVCs may lead to cardiac arrest unless treated c. question the client about any family hx of sudden cardiac death d. prepare to inser an IV catheter, anticipating medication admin
a. ask the client about use of caffeine or stimulant drugs
which electrical activity of the cardiac conduction system is reflected in the P-wave? a. atrial depolarization b. atrial repolarization c. ventricular depolarization d. ventricular repolarization
a. atrial depolarization
the nurse is caring for a client with a HR of 143 bpm. which assessment date will the nurse anticipate? select all a. chest discomfort b. hypotension c. flushing of the skin d. increased energy e. palpations
a. chest discomfort b. hypotension e. palpations
a client has just returned from coronary artery bypass graft surgery. which assessment data requires immediate nursing action? a. chest tube drainage 175 mL last hr b. temp 98.2 F c. incisional pain 6 on a scale of 0-10 d. serum potassium 3.9
a. chest tube drainage 175 mL last hr rationale: 150 mL/hr is excessive drainage
the nurse in the coronary care unit is caring for a group of clients who had a MI. which client will the nurse see first? a. client with third degree heart block on the monitor b. client with dyspnea on exertion when ambulating to the bathroom c. client who refuses to take heparin or nitroglycerin d. client with normal sinus rhythm and PR interval of 0.28 seconds
a. client with third degree heart block on the monitor
which action would the nurse take when a client on a telemetry unit demonstrates a sinus rhythm with an occasional premature atrial contraction (PAC)? a. continue to monitor the client b. activate the rapid response team c. ensure that a defibrillator is available close by d. give lidocaine IV as per protocol
a. continue to monitor the client rationale: PACs are benign and will not affect cardiac output
which assessment data causes the nurse to suspect that a client who had a MI is developing cardiogenic shock? select all a. cool, diaphoretic skin b. crackles in the lung fields c. anxiety and restlessness d. respiratory rate of 12 breaths per minute e. temp 100.4 F f. bradycardia
a. cool, diaphoretic skin b. crackles in the lung fields c. anxiety and restlessness
which intervention is the priority for the unconcious client in ventricular fibrillation? a. defibrillation b. starting IV access c. bag mask ventilation d. high quality chest compressions
a. defibrillation
the nurse is providing community education regarding myocardial infarction. what teaching will the nurse include? select all a. denial is common reaction to chest pain b. a MI can occur in minutes c. age is a significant risk factor in the development of CAD d. women are more likely to experience atypical chest pain e. atherosclerosis is a primary risk factor in the development of CAD
a. denial is common reaction to chest pain d. women are more likely to experience atypical chest pain e. atherosclerosis is a primary risk factor in the development of CAD
the nurse is teaching a client with a new pacemaker. what teaching will the nurse include? select all a. do not lean over electrical or gasoline motors b. take your pulse for 20 seconds each day and record the rate c. you may bathe, taking only showers d. be sure that you remember the rate at which your pacemaker is set e. avoid the use of microwave ovens f. avoid sudden jerky movements for 8 wks
a. do not lean over electrical or gasoline motors d. be sure that you remember the rate at which your pacemaker is set f. avoid sudden jerky movements for 8 wks
the nurse is teaching a group of teens about prevention of heart disease. which point is most important for the nurse to emphasize? a. do not smoke or chew tobacco b. avoid alcoholic beverages c. reduce abdominal fat d. implement stress reduction techniques
a. do not smoke or chew tobacco
which finding requires rapid action by the nurse after a client has has a cardiac catheterization? a. heart rate 114 bpm b. RR 24 c. urine output 1200 mL in the first hr post op d. premature atrial contractions noted on the cardiac monitor
a. heart rate 114 bpm
which response would the nurse give when a client is admitted with chest pain and a family member asks about the purpose of the prescribed 12 lead ECG? a. indicates whether a heart attack is occurring b. detects changes in the structure in the heart c. shows wether the heart muscle is pumping d. evaluates for prognosis after heart attack
a. indicates whether a heart attack is occurring
which prescribe action would the nurse question when caring for a client who has heart failure, with a BP 102/70 mmHg, pulse 106 bpm, and bilateral lung crackles? a. infuse normal saline at 100 mL/hr b. give furosemide 40 mg intravenous now c. administer potassium chloride 10 mEq orally now d. titrate oxygen by mask to keep oxygen saturation 93% or higher
a. infuse normal saline at 100 mL/hr
which information would the nurse include in the preprocedure teaching for a client who requires emergency cardiac catheterization? a. mild sedation is maintained during the procedure b. the procedure will take approximately 15 minutes to complete c. ambulation is encourages shortly after the procedure d. procedure results will be available after about 24 hrs
a. mild sedation is maintained during the procedure
which action would the nurse take for the first hour after a client has a cardiac catheterization using the brachial artery? a. monitor VS q 15 min b. maintain the client in the supine position c. keep the clients lower extremities in extension d. ensure that the client is able to swallow clear liquids
a. monitor VS q 15 min
which nursing action is the priority for a client who has a serum potassium of 6.7? a. monitor for cardiac dysrhythmias b. inquire about changes in bowel patterns c. assess for leg muscle twitching or weakness d. assess for s/s of dehydration
a. monitor for cardiac dysrhythmias
which intervention would the nurse preform when caring for a client in the ED reporting chest pain? select all a. providing oxygen b. assessing vital signs c. obtaining a 12 lead EKG d. drawing blood for cardiac enzymes e. auscultating heart sounds f. administering nitroglycerin
a. providing oxygen b. assessing vital signs c. obtaining a 12 lead EKG d. drawing blood for cardiac enzymes e. auscultating heart sounds f. administering nitroglycerin
which dietary restriction will the nurse expect to be included in the plan of care for a client with left ventricular failure? a. sodium b. calcium c. potassium d. magnesium
a. sodium
which finding in a client who has a CABG 1 day previously is most important for the nurse to communicate to the HCP? a. temp of 102 F b. 7/10 incisional pain c. sinus rhythm with PR interval of 0.22 seconds d. 120 mL of blood in the chest tube collection chamber
a. temp of 102 F rationale: mild temp after surgery is normal d/t inflammatory response; a high temp may indicate would infection
the nurse is preparing to discharge a client who recently experienced a STEMI/ which client statement indicates understanding of nitroglycerin use? a. the nitroglycerin should tingle when i put it in my mouth b. i will keep nitroglycerin in the glove compartment of my car c. sine the pills are small the wont be hard to swallow d. the nitroglycerin should relieve the pain immediately
a. the nitroglycerin should tingle when i put it in my mouth
which finding in a client who has just arrived in the cardiac ICU after having a CABG requires the most rapid action by the nurse? a. the serum potassium level is 3.1 b. the client is confused about the date and time of day c. the client reports incisional pain at level 8 (0-10 scale) d. chest tube collection chamber has 150 mL of bloody fluid
a. the serum potassium level is 3.1
to assess if the client has had a myocardial infarction, which lab value will the nurse assess? a. troponin b. total cholesterol, low density lipoprotein, and high density lipoprotein cholesterol c. creatine kinase- MB fraction (CK-MB_ and alkaline phosphatase d. homocysteine and C-reactive protein
a. troponin
which statement by the women indicates that the teaching has been effective after the nurse teaches a group of women about CAD and MI? a. unusual fatigue is a common symptom of CAD in women b. women usually have a more rapid recovery than men after an MI c. cardiac surgery is generally more successful in women than men d. HDL levels increase after menopause
a. unusual fatigue is a common symptom of CAD in women
the nurse is teaching a client about the risk for bradydysrhythmias. what teaching will the nurse include? a. use a stool softener b. stop smoking and avoid caffeine c. avoid potassium containing foods d. take nitroglycerin for a slow heartbeat
a. use a stool softener we want them to avoid bearing down or straining during a bowel movement if they are at risk for bradydysrhythmias
surgical treatment for Afib:
ablation --> cauterization of the atria foci that are causing the atrial impulses
what class of med is epinephrine in?
adrenergic
what med class is atropine (IV) in?
anti-cholinergic
what class is adenosine in?
antiarhythmic
what class is lidocaine (infusion) in?
antiarrhythmic
indication for heparin drip:
anticoagulation (prophylaxis of thromboembolic disorders)
S/S of premature atrial contractions:
asymptomatic and typically benign
Supraventricular Tachycardia (SVT)
atria/ AV junction takeover the SA node causing rapid HR -considered paroxysmal as it starts and stops abruptly -rates always above 100 bpm and are typically 150-250 bpm -a fast HR does not allow for the ventricles to fill and contract resulting in decreased perfusion and cardiac output
AV paced
atrial and ventricular paced
A- paced
atrial paced -straight upward line B4 P-wave
S/S mitral valve prolapse:
atypical chest pain -EKG and troponin will be normal -echocardiogram will be abnormal will be able to see backflow and prolapse dizziness synscope -synscopal episodes require a cardiac workup palpations tachycardia -because the body is trying to compensate *systolic click*
which finding for a client who has just returned to the nursing unit after an emergency cardiac catheterization would be most important to report to the HCP? a. anxiety about the results of the procedure b. ST segment elevation on the electrocardiogram c. pain at the femoral artery d. premature atrial contractions on the cardiac monitor
b. ST segment elevation on the electrocardiogram
which characteristics place women at high risk for MI? select all a. breast cancer b. abdominal obesity c. family hx d. increasing age e. premenopausal
b. abdominal obesity c. family hx d. increasing age
which action will the nurse take first when two hours after a cardiac catheterization that was accessed through the right femoral route, a client reports numbness and pain in the right foot? a. call the primary HCP b. check the clients pedal pulses bilaterally c. take the clients BP and pulse d. teach about postcatherization embolus
b. check the clients pedal pulses bilaterally
the client in the cardiac care unit has has a large MI. what assessment data indicated to the nurse the onset of left ventricular failure? a. expectoration of yellow sputum b. crackles in the lung fields c. pedal edema d. urine output of 1500 mL on the preceding day
b. crackles in the lung fields
which explanation would the nurse include when teaching a client with heart failure about the reason for a low-sodium diet? a. body weight control b. decreased fluid retention c. lowering of BP d. prevention of hypernatremia
b. decreased fluid retention
which atypical symptoms may be present in a female client experiencing MI? select all a. sharp, inspiratory chest pain b. dyspnea c. extreme fatigue d. dizziness e. anorexia
b. dyspnea c. extreme fatigue d. dizziness
which lab result will the nurse expect when caring for a client who presents to the ED with an ST segment elevation MI (STEMI)? a. decreased WBC b. elevated serum troponins I and T c. decreased creatine kinase -MB d. decreased B-type natriuretic peptide (BNP)
b. elevated serum troponins I and T
which factor would the nurse identify as the cause of pain experienced by a client who is experiencing acute coronary syndrome? a. arterial aneurysm b. heart muscle ischemia c. blocking of the coronary veins d. irritation of nerve ending in the cardiac plexus
b. heart muscle ischemia
which client statement indicates a need for more education after the nurse has taught about self-care to a client who has has a mitral valve replacement? a. I should wear a medical alert bracelet b. i will start a vigorous aerobic exercise program c. i will take anitbiotics when i have my teeth repaired d. i should go to the doctor when i get respiratory infection
b. i will start a vigorous aerobic exercise program
which finding for a client who has a potassium level of 2.8 would be of most concern to the nurse? a. abdominal cramps b. irregular heart rate c. decreased reflexes d. muscle weakness
b. irregular heart rate
the nurse assesses a client who has a CABG yesterday. which assessment finding will cause the nurse to suspect cardiac tamponade? a. incisional pain with decreased urine output b. muffled heart sounds with the presence of JVD c. sternal wound drainage causing nausea d.increased blood pressure and decreased heart rate
b. muffled heart sounds with the presence of JVD
which explanation will the nurse give when a client who is admitted for CABG surgery asks about the purpose of pacemaker wires inserted during surgery? a. defibrillation of the heart after surgery b. prevention of slow HR after surgery c. maintenance of rate of at least 100 bpm during surgery d. inhibition of too-rapid HR during the post op period
b. prevention of slow HR after surgery
which finding by the nurse would be concerning after a client has had a permanent demand pacemaker implanted? a. blood on the dressing b. pulse rate 40 bpm c. BP 104/76 d. pain at the incisional site
b. pulse rate 40 bpm
which finding will cause the nurse to suspect cardiac tamponade in a client who has had cardiac surgery? select all a. HTN b. pulsus paradoxus c. muffled heart sounds d. JVD e. increased urine output
b. pulsus paradoxus c. muffled heart sounds d. JVD
which client information is important to communicate to the HCP when the nurse is obtaining a health hx for a client scheduled for a cardiac catheterization? a. drinks 2 cups of coffee daily b. reports allergy to most shellfish c. recently had dobutamine stress test d. takes daily low dose aspirin tablets
b. reports allergy to most shellfish
which autoimmune disease can result in damage to the heart? a. uveitis b. rheumatic fever c. myasthenia gravis d. graves disease
b. rheumatic fever
which information is most important to include when the nurse is teaching a client who has had an ST segment elevation myocardial infraction (STEMI) about the purpose of salt restriction? a. low salt intake helps prevent ankle swelling b. salt intake increases the work of the heart c. decreasing salt intake will lower blood pressure d. salt intake prevents diuretics from being effective
b. salt intake increases the work of the heart
which description would the nurse use to document the rhythm when a clients cardiac monitor shows a PQRST wave for each beat with a regular rhythm and a rate of 120 bpm? a. atrial fibrillation b. sinus tachycardia c. ventricular fibrillation d. first degree atrioventricular block
b. sinus tachycardia
which instruction would the cardiac rehab nurse give when the pulse for a client with a recent MI increases from 70 bpm to 135 bpm while climbing the stairs? a. continue climbing b. stand still and rest c. walk down the stairs d. climb but at a slower rate
b. stand still and rest
the nurse is caring for a client receiving IV heparin for treatment of a DVT who begins to vomit blood. what action should the nurse be prepared to take? a. administer vitamin K b. stop the infusion of heparin c. administer an antiemetic d. insert a nasogastric tube
b. stop the infusion of heparin
a client is admitted to the hospital with an abdominal aortic aneurysm. which assessment data wound cause the nurse to suspect that the aneurysm has ruptured? a. shortness of breath and hemoptysis b. sudden, severe lower back pain and bruising along the flank c. gradually increasing substernal chest pain and diaphoresis d. rapid development of patchy blue mottling on feet and toes
b. sudden, severe lower back pain and bruising along the flank
a client undergoing coronary artery bypass grafting asks why the surgeon has chosen to use the internal mammary artery for surgery. which nursing response is appropriate? a. this way you will not need to have a leg incision b. these arteries remain open longer c. the surgeon has chosen this approach because of your age d. the surgeon prefers this approach because its easier
b. these arteries remain open longer
for which clinical manifestation will the nurse monitor for when caring for a client admitted with heart failure? select all a. wt loss b. unusual fatigue c. dependent edema d. nocturnal dyspnea e. increased urinary output
b. unusual fatigue c. dependent edema d. nocturnal dyspnea
during discharge planning after admission for a MI, the client states "I wont be able to increase my activity level. I live in an apartment and there is no place to walk." which nursing response is appropriate? a. you must find someplace to walk b. where might you be able to walk c. you are right. focus more on your diet d. walk around the edge of your apartment complex
b. where might you be able to walk
Post op nursing interventions for PCI (cardiac catheterization):
biggest risk post op *bleeding* telemetry monitoring --> because they are at risk for cardiac dysrhythmia bed rest --> depending on the site -pt can get up if brachial/ radial insertion site --> arm will be splinted -femoral artery --> pt needs to be lying supine (2-6hrs) and on bed rest; if they need to use the bathroom they need to be log rolled and use a bed pan insertion site needs to be straight provide compression --> d/t hight risk for bleeding -manual closure device -if needed apply manual pressure --> if still bleeding after using a closure device monitor VS q 15 min for 1 hr, q 30 min for 2 hrs, q 4 hrs once stable assess peripheral pulse distal to insertion site (if there is no pulse it can indicate occlusion)
patient education for heparin drip:
bleeding precautions
which finding would be of most concern when the nurse is caring for a client who has just arrived in the ICU after coronary artery bypass graft surgery? a. BP 152/90 b. BG 120 c. afib, rate 112 bpm d. 100 mL of blood in the chest drainage system
c. afib, rate 112 bpm
which action would the nurse take when a client who just returned from a cardiac catheterization reports that the pressure bandage on the right groin is tight? a. loosen the dressing slightly b. notify the primary HCP c. assess the circulatory status of the extremity d. have the client flex the joints of the right leg
c. assess the circulatory status of the extremity
which information will the nurse include when planning discharge teaching for a client who has a coronary artery bypass graft (CABG) surgery using a vein graft? a. call immediately if you experience any incisional pain b. mild fever is expected for several weeks after a CABG c. elevate the leg that provided the vein graft whenever you are sitting d. avoid walking or light housework until after the follow up appointment
c. elevate the leg that provided the vein graft whenever you are sitting
which assessment findings by the nurse caring for a client with new-onset fibrillation would be most important to communicate to the HCP? a. irregular apical pulse b. sudden vision changes c. exertional dyspnea d. lower extremity edema
c. exertional dyspnea
which information will the nurse include in preprocedure teaching when a client is scheduled for a cardiac catheterization through a femoral artery access? a. plan to ambulate shortly after the procedure b. need for conscious sedation before the procedure c. expect to experience a feeling of warmth during the procedure d. prepare to be in semi-fowler position for 12 hrs after the procedure
c. expect to experience a feeling of warmth during the procedure
the nurse administers amiodarone to a client with ventricular tachycardia. which monitoring by the nurse is necessary with this drug? select all a. urine output b. respiratory rate c. heart rate d. heart rhythm e. QT interval
c. heart rate d. heart rhythm e. QT interval
a client who is 9 days post op CABG presents to a follow up appointment. which client statement requires nursing action? a. my chest hurts when i sneeze or cough b. if i get tired when i walk then i stop and rest for a bit c. i have a bandage on my sternum to collect drainage d. i haven't had my normal appetite since surgery
c. i have a bandage on my sternum to collect drainage
the nurse is caring for a client who is scheduled for a percutaneous transluminal angiplasty (PTCA). which client statement indicates a need for further teaching? a. I will be awake during this procedure b. i must lie still after the procedure c. my angina will be gone for good d. i will have a balloon in my artery to widen it
c. my angina will be gone for good
which topic is priority to include in teaching when a client with acute coronary syndrome (ACS) is admitted to the coronary ICU? a. symptoms of worsening HF b. use of daily low dose aspirin after discharge c. need to report any chest discomfort to the nurses d. importance of starting a walking and exercise program
c. need to report any chest discomfort to the nurses
the nurses physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. which is the priority nursing intervention? a. obtain a chest X-ray film immediately b. notify the primary HCP c. place the client in a high fowlers position d. assess the clients oxygen saturation level
c. place the client in a high fowlers position
the nurse is teaching a client with Afib about a new prescription for warfarin. what teaching will the nurse include? a. avoid caffeinated beverages b. you would take aspirin or ibuprophen for headache c. report bruising to your HCP d. it is important to consume a diet high in leafy green vegetables
c. report bruising to your HCP could indicate excessive dosing of warfarin
the nurse is caring for a client 36 hrs after coronary artery bypass grafting. which assessment causes the nurse to terminate an activity and return the client to bed? a. incisional discomfort b. HR 72 bpm and regular c. respiratory rate 28 breaths per minute d. urinary frequency
c. respiratory rate 28 breaths per minute
which response by the nurse is best when a client who has had an ST segment elevation MI (STEMI) asks about the resumption of sexual activity? a. you can safely resume sexual activities when you are no longer fearful of sexual intimacy b. you will be able to discuss sexual activity with the health care provider before discharge c. sexual activities can be safely resumes after an exercise stress test with no heart symptoms d. many client wait a few weeks after MI before having sexual activity
c. sexual activities can be safely resumes after an exercise stress test with no heart symptoms
the nurse is assessing a client with chest pain to evaluate whether the client is experiencing angina or MI. which assessment is indicative of an MI? a. chest pain brought on by exertion or stress b. substernal chest discomfort relieved by nitroglycerin or rest c. substernal chest pressure relieved by opioids d. substernal chest discomfort occurring at rest
c. substernal chest pressure relieved by opioids
which collaborative intervention will the nurse anticipate to treat the dysrhythmia when a client has supraventricular tachycardia that has persisted despite treatment with vagal maneuvers and medications? a. defibrillation b. pacemaker placement c. synchronized cardioversion d. cardiac resynchronization therapy
c. synchronized cardioversion
which finding in a client who has just been admitted indicates that the nurse will anticipate assisting with insertion of a temporary pacemaker? a. shortness of breath b. substernal discomfort c. third degree heart block d. premature ventricular contractions
c. third degree heart block
a client with angina has received education about acute coronary syndrome. which client statement indicates understanding? a. because this is temporary, I dont need medications for my heart b. I need to tell my wife I've had a heart attack c. this is a warning sign i need to change my lifestyle to prevent a heart attack d. angina is a temporary blood flow problem that will resolve
c. this is a warning sign i need to change my lifestyle to prevent a heart attack
a patient with a coronary occlusion is experiencing chest pain and distress. which is the primary reason that the nurse administers oxygen? a. to prevent dyspnea b. to prevent cyanosis c. to increase oxygen concentration to heart cells d. to increase oxygen tension in the circulating blood
c. to increase oxygen concentration to heart cells
which explanation would the nurse give about the purpose of the procedure when a client with angina is scheduled to have a cardiac catheterization? a. to obtain the pressures in the heart chambers b. to determine the existence of congenital heart disease c. to visualize the disease process in the coronary arteries d. to measure the oxygen content of various heart chambers
c. to visualize the disease process in the coronary arteries
what class is verapamil in?
calcium channel blocker
what med class is diltiazem in?
calcium channel blocker
what med class is nicardipine in?
calcium channel blocker
potential complications for PVCs
can progress to cardiac arrest -Vtach -Vfib
what med class is digoxin in?
cardiac glycoside
sinus bradycardia:
caused by underactive SA node firing -decreased speed in electrical pathway resulting in decreased cardiac output and perfusion -can occur naturally during sleep
Polymorphic Ventricular Tachycardia
characteristic candle flame wave form -cause by hypmagenesemia
what should you do if a patient has a normal rhythm and then it all of a sudden becomes irregular?
check labs!
systole:
contraction and emptying of the atria and ventricles
which component of the electrocardiogram would the nurse analyze to determine whether a client is experiencing acute coronary syndrome (ACS)? a. P wave b. PR interval c. QRS complex d. ST segment
d. ST segment
which assessment data indicates proper function of the sinoatrial (SA) node? a. the QRS complex is present b. the ST segment is elevated c. the PR interval is 0.24 seconds d. a P wave precedes every QRS complex
d. a P wave precedes every QRS complex
which actions by a UAP who is assisting with post op care requires that the nurse intervene when caring for a client who has had a cardiac catheterization suing the femoral approach? a. taking the pulse every 15 min b. keeping the clients legs extended c. offering the client a sandwich and juice d. assisting the client to stand to void
d. assisting the client to stand to void
the nurse is caring for a patient on a telemetry unit who has a regular heart rhythm and a rate of 60 bpm; a P wave preceded each QRS complex, and the PR interval is 0.20 seconds. additional VS are: BP 118/68, RR 16, and temp 98.8. All of these medications are available on the medication record. what action will the nurse take? a. administer clonidine b. administer atropine c. administer digoxin d. continue to monitor
d. continue to monitor
the nurse is caring for a patient with Afib. In addition to an antidysrhythmic, what medication does the nurse anticipate administering? a. mag sulfate b. atropine c. dobutamine d. heparin
d. heparin
which information can be obained from monitoring the pulmonary artery pressure? a. stroke volume b. lung function c. coronary artery patency d. left ventricular function
d. left ventricular function
which assessment finding would prompt the nurse to activate the rapid response team when caring for a client who is 90 min postcoronary stenting through the femoral artery? a. drowsiness b. report of low back pain c. ecchymosis at femoral artery site d. loss of pedal pulse on the affected limb
d. loss of pedal pulse on the affected limb
which action would the nurse take next after cardiopulmonary resuscitation has been started by the code team for an unresponsive hospitalized client? a. contact the clients primary HCP b. move any other clients or visitors out of the room c. get the clients record and have it available in the room d. obtain the defibrillator and place paddles of the clients chest
d. obtain the defibrillator and place paddles of the clients chest
a client comes to the ED with chest discomfort. which action does the nurse preform first? a. administers oxygen therapy b. provides pain relief medication c. remains calm and stays with the client d. obtains the clients description of the chest discomfort
d. obtains the clients description of the chest discomfort
which rhythm is the client experiencing when the cardiac monitor shows sudden bursts of a regular heart rhythm with a rate of 220 bpm, normal QRS duration, and P waves that are difficult to see? a. sinus tachycardia b. afib c. ventricular tachycardia d. paroxysmal supraventricular tachycardia (PSVT)
d. paroxysmal supraventricular tachycardia (PSVT)
which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client? a. sodium 139 b. chloride 100 c. calcium 10.2 d. potassium 7.2
d. potassium 7.2
a client admitted after using cocaine develops ventricular fibrillation. after determining unresponsiveness, which action will the nurse take next? a. place an oral airway and ventilate b. start cardiopulmonary resuscitation (CPR) c. establish IV access d. prepare for defibrillation
d. prepare for defibrillation
which prescription by the health care provider would the nurse question when caring for a client who is hospitalized for an acute MI? a. long acting beta blocker b. daily low dose aspirin tablet c. H1 blocker to reduce gastric acid secretions d. rectal suppository as needed for constipation
d. rectal suppository as needed for constipation rationale: rectal stimulation can stimulate the vagus nerve and cause bradycardia
a clients rhythm strip shows a HR of 115 bpm, one p wave occurring before each QRS complex, a PR interval measuring 0.16 seconds, and a QRS complex measuring 0.08 seconds. how does the nurse interpret this rhythm strip? a. sinus rhythm premature ventricular contractions b. normal sinus rhythm c. sinus bradycardia d. sinus tachycardia
d. sinus tachycardia
after receiving change of shift report in the coronary care unit, which client will the nurse assess first? a. the client who has a percutaneous angioplasty who has a dose of heparin scheduled b. a client who has first degree heat block, rate 68 bpm, after having an inferior MI c. the client who had bradycardia after a MI and now has a paced heart rate of 64 bpm d. the client with acute coronary syndrome who has a 3 Ib weight gain and dyspnea
d. the client with acute coronary syndrome who has a 3 Ib weight gain and dyspnea
non surgical treatment for sinus tachycardia:
decrease HR to normal levels by treating the cause -beta blockers -calcium channel blockers
cardiomyopathy:
disease of the cardiac muscle (myocardium) -two types: dilated and hypertrophic
dx tet for aortic stenosis:
echocardiogram
Mitral regurgutation:
fibrotic and calcific changes prevent the mitral valve from closing completely during systole --> valve is always left open a little -backflow of blood in the left atrium when the left ventricle contracts -to compensate there is increases volume and pressure, the left ventricle and atrium *dilate* and *hypertrophy*
non-surgical treatment for an aneurysm:
for small and asymptomatic aneurysms -monitor growth --> CT and ultrasound -maintain BP within normal parameters: beta blockers and angiotensin II receptor blockers -may progress to elective surgery if aneurysm if increasing in size or symptoms develop -maintain lipids within normal parameters may need a statin
Anyeurysm:
forms when the middle layer (media) is weakened causing a stretching effect to the (intima) layer of the outer (adventia) layer -thrombi form within the wall from pooling blood -the larger the size of the aneurysm the greater the risk for rupture -rupture = bad (we want to recognize an aneurysm and treat it before it ruptures)
Ischemia:
inadequate blood supply (also resulting in lack of oxygen) to organs (aka heart muscles in this case)
non-surgical treatment for sinus bradycardia:
increase HR to normal levels by treating the underlying cause Unstable sinus bradycardia treatment: -IV atropine -fluid bolus -oxygen -pacing
mechanism of action for digoxin:
increases cardiac contractility (slows down HR)
mechanism of action for atropine (IV):
increases cardiac output (speeds up HR) and dries secretions
mechanism of action for lidocaine (infusion)
increases electrical stimulation threshold of ventricles
pulse pressure (PP):
indirect measurement of cardiac output (has to do with stiffness/ flexibility of arteries) -normal : 40-60 -wide PP > 60 mmHg (indicates arterial stiffness) -narrow PP < 40 mmHg (heart is not pumping as much blood as it should)
mechanism of action for diltiazem:
inhibits calcium ion from entering the "slow channels"' produces relaxation of coronary vascular smooth muscle and coronary vasodilation
mechanism of action for nicardipine:
inhibits calcium ion from entering the "slow channels"' produces relaxation of coronary vascular smooth muscle and coronary vasodilation
mechanism of action for verapamil:
inhibits calcium ion from entering the "slow channels"' produces relaxation of coronary vascular smooth muscle and coronary vasodilation
what med class is milrione in?
iniotropic
what med class is dobutamine in?
ionotropic
what med class is dopamine hydrochloride in?
ionotropic
pt education for diltiazem:
limit grapefruit juice consumption while taking this med
characteristics of dysrhythmias caused by hypercalcemia:
mild --> tall peaking T-waves severe --> extremely wide QRS, low R wave, disappearance of P waves, tall peaking T-waves normal calcium level --> 9-10.5 priority intervention for high calcium --> cardiac assessment and order for telemetry
mitral valve prolapse:
mitral valve leaflets enlarge and prolapse into the left atrium during systole -will progress to regurgitation and R sided HF
Mechanism of action for calcium gluconate:
moderates nerve and muscle prefromance
aortic stenosis:
most common valve disease because of "wear and tear" --> increased risk with age -narrowing and obstruction of left ventricular outflow during systole -increased resistance to ejection or afterload = ventricular hypertrophy -cardiac output becomes fixed meaning it cannot respond to demands during exertion -progression leads to --> left ventricular HF, blood backs up into the left atrium and pulmonary congestion occurs; resulting into R sided HR (a late sign)
Myocardial infraction (MI):
occurs suddenly when myocardial tissue is deprived of oxygen -blood flow is reduced to 80-90% and ischemia develops -*ischemia = damage that is not reversible* can progress to necrosis and tissue death -goal: quick response and intervention time to restore blood flow and oxygenation *MI results in irreversible damage to the heart muscle due to lack of oxygen; it is rare that the client returns to full baseline status*
labs for aneurysms:
only done if they are symptomatic -cardiac workup including troponin --> for if they are symptomatic and have chest pain -D-dimer --> to detect if theres blood clots -CBC w/ differential --> monocytes will be elevated, platelets and H&H -comprehensive metabolic panel --> too look at their electrolytes -ABORh type and screen --> incase they need a transfusion
Hemodynamic monitoring's main goal is to prevent ____________
organ failure -hemodynamic monitoring monitors movements and pressures of blood flow within blood vessels
sinus dysrythmias:
originate in the SA node
atrial dysrhythmias:
originate in the atria
ventricular dysrhythmias:
originate in the ventricles
cardiac output is an indicator of ....
perfusions status
pericarditis:
pericardial effusion --> fluid accumulation in the pericardial sac and becomes infected pericarditis --> inflammation of the pericardial sac -develops suddenly and can last from weeks to months -fluid causes constrictive pericarditis (the inflamed layers of the pericardium stiffen, develop scar tissue, thicken, and stick together infectious pericarditis --> results from viral, bacterial, fungal, or parasitic infection traumatic pericarditis --> result of an injury to the chest (such as a car accident) chest pain results from inflammation when the heart contracts
cardiogenic shock
post-myocardial infraction heart failure in which necrosis of more than 40% of the left ventricle has occurred
dental prophylaxis for heart valve conditions:
prophylactic antibiotics prior to dental work r/t increased risk of valve infection -azithromycin --> limit to no more than 5 days -doxycycline --> taken once (causes rash and thickening of the skin with sun exposure) -cephalexin --> one time use
Pace makers:
provide electrical impulses to SA or AV node on demand = only initiates impulse if natural HR falls below 60 fixed = its on all the time; initiates 100% of all impulses (will have the same HR all the time)
treatment goals for Afib:
rate control <100 (less risk of clots going into circulation) -if rate is over 100 it is a priority intervention because it poses aa higher risk for clots in circulation (known as rapid Afib) -rhythm control to NSR
ECG features of sinus tachycardia:
rate: > 100 bpm rhythm: regular P-wave: normal PR interval: normal (0.12-0.20 sec) QRS: normal (0.06 -0.10 sec)
EKG features of Vfib:
rate: unmeasurable rhythm: highly irregular P-wave: absent PR interval: not measurable QRS: none
diastole:
relaxation and filling of the atria and ventricles
Surgical treatment for valve disorders:
reparative: -similar to CABG if valve disease is identified -common to do an aortic valve repair at the same time as a CABG -used to -> debris calcium, annuloplasty and leaflet repair replacement: -prosthetic (synthetic) or biological (tissue (bovine/porcine) -need to know pts culture for this procedure -*synthetic valves require lifelong anticoagulation therapy*
Ventricular tachycardia (Vtach):
repetitive firing of irritable ventricular foci -reduces cardiac output that can progress to no cardiac output -*requires immediate medical attention*
ECG features of premature ventricular contractions (PVCs):
rhythm: irregular P-wave: absent PR interval: not measurable QRS: wide (.0.10 sec) bizarre appearance
ECG features of SVT:
rhythm: regular P-wave: merged with T wave PR interval: normal QRS normal *rate: 180-280*
Potential complications for PCI (cardiac catheterization)
risk of complications is increase if intervention was preformed on multiple vessels (known as multivessel disease) -*bleeding*/ infection at the insertion site -blood clots in heart or stent -renarrowing artery -stroke -dysrhythmias
desired outcome for calcium gluconate:
serum calcium within desired range
indication for vasopressin:
shock and other vasodilatory shock states
mechanism of action for adenosine:
slows conduction time through the AV node resulting in restored normal sinus rhythm (slows a very fast rhythm)
mechanism of action for epinephrine:
stimulates alpha 1 and beta 2 andrenergic receptors; relaxes smooth muscle in bronchi and cardiac stimulation
when a patient has an arterial line what position do they need to be in?
supine
what med class is calcium gluconate in?
supplement
what part of the PQRST is characterized by the SA node?
the P-wave
infective endocarditis:
they will need antibiotics to treat
what med class is heparin drip in?
thrombin inhibitor
labs for cardiomyopathy:
toxicology screen --> because alcohol use can cause this condition genetic testing --> if we are suspecting hypertrophic cardiac workup
non surgical treatment for premature ventricular contractions (PVCs):
treat underlying cause
indication for calcium gluconate:
used to treat hypocalcemia
indications for a CABG:
used when a PCI (cardiac catheterization) is not the preferred option -left main artery occlusion -multi-vessel disease -ischemia with heart failure -valvular disease
mechanism of action for nipride:
vasodialtion
mechanism of action for nitroglycerin IV:
vasodilates
what med class is sodium nitroprusside (nipride) in?
vasodilator
what med class is norepinephrine in?
vasopressor
what med class is phenylephrine injection (neo-synephrine) in?
vasopressor
what med class is vasopressin in?
vasopressor
V- paced
ventricular paced straight upwards line B4 QRS
non-surgical treatment for cardiomyopathy:
we want to increase contractility of the heart -ACE inhibitors -ARBs -diuretics (for L sided HF) - digoxin -anticoagulants -antidysrhythmics -anticoagulants
