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