Medsurg 2 Test 1
PAD: Intermittent Claudication
Ischemic muscle ache or pain that is precipitated by a constant level of exercise Resolves within 10 minutes or less with rest Reproducible
Pulonary Edema TX
LMNOP Lasix Morphine Nitrates O2 Position( upright)
HTT cardio
LOC, mucus membranes, PEERLA, JVD, Carotid (bilateral, bruit) Resp effort, Pulses, cap refill
LEFT SIDED HEART FAILURE
Left =Lung -most common -blood backs up into left atrium and pulmonary veins -Pulmonary congestion and edema
Aortic dissection CM: PAIN
Pain characterized as: Sudden, severe pain in anterior part of chest, or scapular pain radiating down spine to abdomen or legs, Described as "sharp" and "worst ever", May mimic that of MI
5 P's of assessment
Pain... Pulselessness... Paresthesia... Pallor... and. Paralysis
A client has been admitted to the coronary care unit. The nurse observes third-degree heart block at a rate of 35 bpm on the client's cardiac monitor. The client has a blood pressure of 90/60 mm Hg. What should the nurse do first?
Prepare for transcutaneous pacing.
A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation?
Rehabilitation will help me function as well as I physically can."
RIGHT SIDED HEART FAILURE
Right=REST OF BODY -blood backs up in right atrium and rest of body circulation -fatigue -ascites -enlarged liver and spleen -JVD -secondary pulmonary problems -weight gain
Atrial Flutter -increased risk of -tx
Saw tooth like - increased risk of stroke -Ca channel blocker or beta blocker, cardioversion, ablation
serum cardiac markers after MI
Troponin, CK-MB, Myoglobin
True vs false Aneurysm
True aneurysm: Wall of artery forms the aneurysm, At least one vessel layer still intact, False aneurysm-Disruption of all layers of arterial wall, Results in bleeding contained by surrounding structures
Treating congestive heart failure: UNLOAD FAST
Upright position Nitrates Lasix Oxygen ACE inhibitors Digoxin Fluids (decrease) Afterload (decrease) Sodium restriction Test (Dig level, ABGs, potassium level)
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as
a third heart sound (S3).
Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are
a.Hypertension and cigarette smoking.
PAD risk in diabetic
a1c above 7.0
A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of
acute pulmonary edema.
Stroke volume
amount of blood ejected with each contraction
Ascending aorta/aortic arch aneurysms CM
angina, hoarseness, if presses on Superior vena cava causes decreased venous return and distended neck veins with edema of face and arms
During a shift report for a client with heart failure, the nurse going off shift reports that the client had sinus bradycardia during the shift and a creatinine of 3.5 mg/dL. Which action does the nurse perform when administering digoxin to this client?
assess digoxin level
A client is admitted to the hospital through the emergency department with chest pain. Which intervention is the priority?
assessing troponin 1 levels
Normal BNP
below 100
AORTIC DISSECTION W NO SYMPTOMS
can be treated conservatoively for a period of time: pain relief and BP control
Stable angina further tx Key to localize cad
cardiac catheter, angiography
Aortic dissection complications
cardiac tamponade, aorta rupture
A client has atrial fibrillation. The nurse should monitor the client for which condition?
cerebrovascular accident
Systole Diastole
contraction relaxation
Vagus nerve stimulation
decreases heart rate
MAnagement of CAD
diet, excersice to lower lipid, if ineffective, pharm amanagement: STATINS and ANTIPLATELET
An older adult is admitted to the hospital with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for:
dig toxicity
A nurse is awaiting the arrival of a client from the emergency department with a diagnosis of anterior wall myocardial infarction. In caring for this client, the nurse would be alert for which signs and symptoms of left-sided heart failure? Select all that apply.
dyspnea, crackles, tachycardia
A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?
elevated ST segment
MYOCARDITIS cm
fever, fatigue, malaise, pericardial friction rub -late S/S HF (s3, crackles, JVD, peripheral edema, angina)
Chronica heart failure edema weight gain to watch for
gain of more than 3lb in 2 days
Prior to administering tissue plasminogen activator (t-PA), the nurse should assess the client for which contradiction to administering the drug?
history of cerebral hemorrhage
Assessment of Cardiovascular System- subjective
hx, medications, surgery hx, functional health patterns
postprandial hypotension
hypotension after eating by 20 mmhg
Surgical therapy for aortic aneurysm
if ruptures, emergent intervention required -in AAA ruptures, 90% mortality
The nurse is caring for a client in the coronary care unit when the cardiac monitor reveals ventricular fibrillation. The nurse should anticipate which intervention?
immediate defibrillation
How common are dysrhythmias in MI pt?
in 80%
A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation?
irregularly irregular heart rate
Pulonary Edema
life threatening situation, alveoli filled with fluid
Ventricular failure leads to
low BP, poor perfusion, decreased ejection fraction
CM Infective endocarditis
low grade fever, chills, weakness, malaise, fatigue, anorexia, myalgias, back pain, abdominal discomfort, headache, clubbing, splinter hemorrhages in nail bed, petechiael oldernodes, janeways lesions, roth spots, murmur, heart failure
Pt teaching with chronic heart failure
meds, daily weights, watch vitals, heart healthy diet and low salt, no smoking, weight management
ACUTE CORONARY SYNDROME continuued tv
monitor close for bleeding if on thrombolytics, assess reperfusion and return of ST segment to baseline, IV hep to prevent reocclusion
PAD complications
nonhealing arterial ulcers and ganegrean, can lead to sepsis and amputation
A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure? Select all that apply.
orthopnea, crackles, cough
MYOCARDIAL INFARCTION CM: PAIN
pain -severe, not alleviated with rest, more common in morning, substernal, retrosternal, epigastric, atypical in women and elderly, _NO PAIN IF DIABETIC NEUROPATHIC
PAD: CM
pain at rest, atrophy of skin and muscles, ulcers, tissue necrosis, wound infection
afterload
periph resistance the left ventricle must pump against
MAP
pressure/perfusion the organs actually feel (NORMAL GREATER THAN 60)
Baroreceptors
regulate cardiovascular system, sensitive to pressure, in aortic arch, carotid sinus
Aortic Anneurysm Rupture
serious complication -bleeding into retroperitoneal space, severe back pain, MAY OR MAY NOT HAVE BACK ECCHYMOSIS
AAA
spontaneous embolize plaque causes blue toe syndrome
After receiving the shift report, a registered nurse in the cardiac step-down unit must prioritize the client care assignment. The nurse has an ancillary staff member available to help care for the clients. Which of these clients should the registered nurse assess first?
the client with heart failure who is having some difficulty breathing
Serum lipids
triglycerides
A client is to have a treadmill stress test. Prior to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated laboratory value to the health care provider (HCP) before the stress test?
troponin level
The nurse is admitting a client with substernal chest pain. Which diagnostic tests does the nurse anticipate the client will receive to confirm or rule out a diagnosis of myocardial infarction (MI)? Select all that apply.
troponin, myglobin
Assessment of Cardiovascular System- Objective data
vital signs, physical exam, PULSES, bruit, PETM, thorax,
Preload
volume of blood in ventricle at the end of diastole
Excercise therapy with PAD
walking 30-60 min daily 3x/week
The nurse is teaching a client with a demand pacemaker. What should the nurse tell the client about how the device functions by providing stimuli to the heart muscle:? The pacemaker will provide a stimulus:
when the heart rate falls below a specified level.
aortic aneurysm risk factors
§Age §Male gender §High blood pressure (BP) §Coronary artery disease §Family history §High cholesterol §Lower extremity PAD §Carotid artery disease §Previous stroke -tobacco use -obesity -white and native american
Arteries PAD affects
§Iliac artery §Femoral artery §Popliteal artery §Tibial artery §Peroneal artery HArd time for blood to get to leg
PAD risk factors
§Tobacco use §Hyperlipidemia §Hypertension §Diabetes mellitus
H & T s
•Hypovolemia •Hypoxia •Hydrogen ion (acidosis) •Hyper-/hypokalemia •Hypoglycemia •Hypothermia •Toxins •Tamponade (cardiac) •Thrombosis (MI and pulmonary) •Tension pneumothorax •Trauma
A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement?
"I sleep on three pillows each night."
An obese male client with history of heart failure is prescribed a beta blocker. Which of the following is important to teach regarding home drug therapy? Select all that apply.
"Take your medication at the same time daily." "Contact the health care provider if you have difficulty getting or maintaining an erection." "Change positions between sitting and standing carefully. "Check your pulse for a full minute before administering your medication."
Which client statement should the nurse evaluate as indicating the client's correct understanding of the causes of coronary artery disease (CAD)?
"The leading cause of CAD is atherosclerosis.
A FIB -what is it, common? increased in? -what does it cause? -Most at risk for -Treatment
- no p wave with erratic fibrillation waves, most common, increased prevalence with age -causes decreased CO -STROKE!!!!!!!! STROKE ALERT -Medication to revert to correct ventricular rate (Beta blockers, digoxin, ca channel block, amiodarone -anticoagulation
Acute coronary syndrome protocol
-12 lead ecg -semi fowlers -O2 -IV access -Nitroglycerin SL and ASA chewable -morphine -statin
MYOCARDITIS TX
-ACEI, Beta blockers, digoxin, immunosuppresants, bed rest, IVABP, VAD, - most recover spontaneously, some develop cardiomyopathy
Pulmonary Edema CM
-Anxious, pale, cyanotic -Cool and clammy skin -Dyspnea -Orthopnea -Tachypnea -Use of accessory muscles -Cough with frothy, blood-tinged sputum -Crackles, wheezes, rhonchi -Tachycardia
Aortic Dissection initial goal
-Decrease BP and myocardial contractibility to diminish pulsatile forces within aorta **HR LESS THAN 60 **SBP BELOW 100-110
Unstable andgina and MI Diagnostic
-EKG: Q wave damage d/t necrosis
HF and endocarditis
-HF occurs in up to 80% of patients with aortic valve endocarditis and in approximately 50% of patients with mitral valve endocarditis
Cardiac Tamponade
-Heart in a sac of fluid -muffles heart sounds - dec CO
ACUTE CORONARY SYNDROME tx
-MONA -EMERGENT PCI (90 min from doorway to cath lab)
Sinus Bradycardia -what is it -CM -TX
-Normal rhythm below 60 bpm -hypotension, pale, cool, weakness, angina, dizzy, confusion, SOB - check O2, ATROPINE, transcutaneous pacemaker, stop offending drugs
SINUS Tachycardia -What is it -CM - Tx
-Normal rhythm, above 100 bpm -dizzy, dyspnea, hypotension, angina -treat cause, VAGAL maneuver, Beta blockers
Premature Ventricular Complex
-PVC interrupts regularity - ASSESS APICAL RADIAL PULSE DEFICIT
STABLE ANGINA -EKG results -goal of tx -tx(Process of admin, when to call ems)
-ST segment depression of T wave inversion -decrease o2 demand or increase o2 supply -short acting nitrates to dilate blood vessels, if no relief in 5 min call EMS, can be taken prophylactic -long acting nitrates, ACE , Bblockers, ca channel blockers
ACUTE PERICARDITIS
-Severe sharp chest pain -Worse with deep inspiration or supine -Referred to shoulder/upper back -Phrenic nerve -Hallmark-pericardial friction rub
pt teaching infective endocarditis
-Teach importance of adherence to treatment regimen - avoid infectious people, rest, hygiene, prophylactic antibiotics -s/s infection, monitor temp, follow up
Defibrillation -choice tx for -when most effective -Biphasic
-VFIB and pulseless VTACH -completed within 2 min of dysrhythmia onset -BETTER: shock in 2 areas, fewer postschock abnormalities
Synchronized Cardioversion -choice treatment for - what happens -Sync on or off? -what if pt becomes pulseless
-Vtach with a pulse or SVT -Synchronized circuit delivers a countershock on the R wave of the QRS complex of the ECG -Sync on Turn off sync and defibrillate
Ejection Fraction -normal -What is it measured by
-above 50% -echocardiogram
Risk factors for CAD -Lipid number
-age, gender, ethnicity, fam hx, -triglycerides above 150 -Cholestrol above 200 -HYPERTENSION
Acute pericarditis treatment
-antibiotic if bacterial -NSAID Pericardiocentesis *Monitor kidney and bleeding
Paroxysmal Supraventricular Tachycardia -causes -treatment
-associated with over exertion, deep inspiration, stimulants and dig toxicity -Vagal stim, Adenosine, Beta blocker, calcium Channel blocker, Amiodarone, Cardioversion, ablation
interventional radiology/surgical PAD
-atherectomy: removal of obstructing plaque -peripheral artery bypass with autogenous vein
ACUTE PERICARDITIS -common cause -after MI
-coxsackie virus -common after MI: Dressler syndrome
Third degree AV heart block
-decreased CO, can lead to HF and shock -Pacemaker, meds to increase HR while awaiting pacemaker
VFIB -what is it -can lead to -CM -TX
-derangement of rhythm,, no CO -MI, ischemia, disease -Unresponsive, pulseless, apneic -CPR and ACLS Defib, drugs
Diastolic failure Systolic Failure
-doesn't relax -doesn't contract
PEA -WHAT IS IT -PROGNOSIS -TX
-electrical activity on ECG but no pulse -poor, unless underlying cause can quickly be treated -CPR, epi, intubation
infective endocarditis vegetation
-embolization when part of vegetation breaks off and enters circulation
Surgical therapy for aortic dissection
-endocascular dissection repair, resection or aortic segment replaced with synthetic graft material
Asystole
-ends stage HF -immediate CPR, epi, intubation, poor prognosis
Chronic heart failure CM
-fatigue -dyspnea -orthopnea -Paroxysmal Nocturnal Dyspnea -Tachycardia `
myocardial infarction cm -cardiovascular
-increased hr and bp initiallu, then decreased, crackles, JVD, abnormal heart sounds (s3 and S4), murmur
infective endocarditis -what is it -cause -HACEK
-infection of inner layer of heart -bacterial most common, sometimes viral or fungi -in IVDA with needle saliva contamination
VTACH -why is it life threatening -H&T -PULSELESS tx -W PULSE tx
-life threatening d/t decreased CO and possible lead to VFIB -Identify precipitating cause -CPR AND DEFIB -Magnesium and cardioversion
ADHF tx
-monitor VS, o2, lung sounds, admin o2, high fowlers
myocardial infarction cm gastric
-nausea, vomiting, fever,
UNSTABLE ANGINA info
-new onset, occurs at rest, worsens, increased frequency, unpredictable, symptoms in women more vague -lead to MI
Thoracic aorta aneurysms CM
-often asymptomatic, deep diffuse chest pain, pain may extend to scapular area
AORTIC DISSECTION
-often misnamed dissecting aneurysm -not a type of aneurysm -torn intima causes blood flow up and normal blood flow occur at same time
Aortic Aneurysms -what is it -increased in
-outpouching or dilation of arterial wall -more common in men -increase with age
LEFT SIDED HEART FAILURE S/S
-paroxysmal nocturnal dyspnea -cough -crackles -wheezes -blood dinged sputum - restless -confusion -exertional dyspnea -cyanosis
CM of ANGINA
-squeezing, heavy, choking, suffocating, indegestion, burning (rarely sharp) pain in chest
Rheumatic Heart failure -caused by -treatment
-step infection -NSAID, antipyretic, antibiotics
PAD CM: ARTERIAL
-thin shiny skin -loss of hair in lower legs -diminished lower pulses -reactive hyperemia of foot with dependent positon -pallor of foot with elevation
ACUTE CORONARY SYNDROME thrombolytics
-when PCI unavailable -stops infarct by dissolving thrombus -ideally given in 30 min
Left ventricular wall is how many times thicker than right?
2-3x thicker
MI: how long does it take for entire myocardium wall thickness to necrotize
4-6 hours
Sinus node rate AV Junction rate ventricular rate
60-100 40-60 20-40
Normal Sinus Rhythm
60-100 bpm, regular rhythm
Drug therapy for PAD
ACEI Antiplatelet (aspirin or plavix)
A client admitted to the emergency department with atrial fibrillation has a heart rate of 160 bpm. The nurse should implement which prescription first?
Administer oxygen via nasal cannula.
Risk factors for heart failure
Age, Diabetes, TOBACCO USE, obesity, cholesterol
CO
Amount of blood pumped by each ventricle in 1 min CO=HRxSV normal 4-8L/min
Leading cause of CAD
Atherosclerosis
BP equals
BP=COxSystemic vascular resistance
BEFAST STROKE
Balance Eyes Facial symmetry Arms Speech Time
A client comes to the emergency department reporting severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit with a diagnosis of myocardial infarction (MI). Which should the nurse do first when the client is admitted to the coronary care unit?
Begin telemetry monitoring.
Test used to identify aortic aneurysm
CT/CAT SCAN Mri, echocardio, ultrasound, ecg, etc
The nurse observes the cardiac rhythm (see ECG strip) for a client who is being admitted with a myocardial infarction. What should the nurse do first?
Check for a pulse
-Stable angina diagnostic
Chest x-ray Cardiac biomarkers, lipids, CRP 12-lead ECG Echocardiogram Exercise stress test
Hypertrophy
Compensatory, overtime leads to less efficient heart contraction risk for cardiac dysrhythmias
A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which is the priority intervention?
Control the pain and support breathing and oxygenation
A client has been diagnosed with right-sided heart failure. The nurse should assess the client further for:
Dependent edema.
Indications of ortic aneurysm rupture
Diaphoresis, pallor, weakness, tachycardia, hypotension, abdominal back or groin pain, change in LOC and pulsating abdominal mass
infective endocarditis diagnostic studies
EKG, Echo, xray, blood culture
COmplications of MI
Heart failure, cardiogenic shock
Infective endocarditis tx:
IV antibiotics long term, antipyretic, supportive care antibiotic therapy for 4-6 weeks
AORTIC DISSECTION drug tx
IV beta blocker, antihypertensive drugs, morphine