**Cardio**

6. When does a nurse know if a pacemaker is functioning properly?

spikes before each QRS complex

61. When giving blood how long do you have until it must be given?

■ Complete the transfusion within a 2- to 4-hr time frame to avoid bacterial growth (ATI MS p 381) *Remember that blood is permitted* *to be out of the blood bank no longer* *than 4 hours*. (CK p. 547) -it is essential to follow the protocol regarding discarding or returning of the container to the blood bank whenever a unit of blood is infused; on addition, use fresh (not reused) tubing for the primary tubing to administer each new unit of blood, piggybacking it into the primary IV line; and flush the tubing with normal saline before another unit of blood is infused so that the blood from both units is not mixed within the tubing.

83. What is atrial repolarization?

Atrial repolarization is not represented but does occur; it is covered by the large QRS complex and cannot be seen on the ECG tracing.

90. What should be in the patient teaching for taking Coumadin? Such as interactions.

Avoid Aspirin, Manicure, Vitamin K. Advise the patient to limit foods high in vitamin K, such as leafy green vegetables, beans, broccoli, cabbage, cauliflower, cheese, fish, and yogurt. Vegetables with large amounts of vitamin K can interfere with the anticoagulant's effect (see Home Care Checklist: Ensuring Appropriate Vitamin K Intake Instruct patient to take medication as directed. Take missed doses as soon as remembered that day; do not double doses. Inform health care professional of missed doses at time of checkup or lab tests. Inform patients that anticoagulant effect may persist for 2-5 days following discontinuation. Advise patient to read Medication Guide before starting therapy and with each Rx refill in case of changes. •Review foods high in vitamin K (see food sources for specific nutrients). Patient should have consistent limited intake of these foods, as vitamin K is the antidote for warfarin, and alternating intake of these foods will cause PT levels to fluctuate. Advise patient to avoid cranberry juice or products during therapy. •Caution patient to avoid IM injections and activities leading to injury. Instruct patient to use a soft toothbrush, not to floss, and to shave with an electric razor during warfarin therapy. Advise patient that venipunctures and injection sites require application of pressure to prevent bleeding or hematoma formation. • Advise patient to report any symptoms of unusual bleeding or bruising (bleeding gums; nosebleed; black, tarry stools; hematuria; excessive menstrual flow) and pain, color, or temperature change to any area of your body to health care professional immediately.Patients with a deficiency in protein C and/or S mediated anticoagulant response may be at greater risk for tissue necrosis. • Instruct patient not to drink alcohol or take other Rx, OTC, or herbal products, especially those containing aspirin or NSAIDs, or to start or stop any new medications during warfarin therapy without advice of health care professional. •Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding. •Instruct patient to carry identification describing medication regimen at all times and to inform all health care personnel caring for patient on anticoagulant therapy before lab tests, treatment, or surgery. • Emphasize the importance of frequent lab tests to monitor coagulation factors Drug-Drug •Abciximab, androgens, capecitabine, cefotetan, chloramphenicol, clopidogrel, disulfiram, fluconazole, fluoroquinolones, itraconazole, metronidazole (including vaginal use), thrombolytics, eptifibatide, tirofiban, sulfonamides, quinidine, quinine, NSAIDs, valproates, and aspirin may ↑ the response to warfarin and ↑ the risk of bleeding. •Chronic use of acetaminophen may ↑ the risk of bleeding. •Chronic alcohol ingestion may ↓ action of warfarin; if chronic alcohol abuse results in significant liver damage, action of warfarin may be ↑ due to ↓ production of clotting factor. •Acute alcohol ingestion may ↑ action of warfarin. •Barbiturates, carbamazepine, rifampin, and hormonal contraceptives containing estrogen may ↓ the anticoagulant response to warfarin. •Many other drugs may affect the activity of warfarin. Drug-Natural Products: • St. John's wort ↓ effect. •↑ bleeding risk with anise, arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, licorice , and others. Drug-Food: Ingestion of large quantities of foods high in vitamin K content (see list in food sources for specific nutrients) may antagonize the anticoagulant effect of warfarin

87. What is most important in a patient with jaw pain, back pain, and nausea? A. admin oxygen B. ensure pt has patent airway C. Pain scale D. start ECG

B. (Signs of heart attack) Maintain patent airway

79. What is ventricle repolarization?

CK p.1544-1545 Ventricle repolarization is represented as the T wave in an ECG. Repolarization is the relaxation phase of the heart rhytm.

43. A patient with heart valve disease is experiencing left sided heart failure, what kind of breath sounds would you expect to find?

...Pulmonary congestion (dyspnea, cough, bibasilar crackles) ati Med surg pg 309 Crackles in lungs -Possible diminished lung sounds Ati Med surg pg 324

40. What should you do for a blood transfusion patient experiencing lower back pain, chills and shiver?

...Stop transfusion immediately

13. What position should the patient be in for a cardiac catherterizaion and for how long?

...Supine Position for 6hrs following

116. Is a platelet count of 9,000 high or low? What is the normal range? CK, 1523

-Platelet transfusions are generally not recommended until the count is below 10,000/mm3 unless the patient is actively bleeding. -A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood

73. What is plasma?

-Straw colored liquid that carries the cells and the platelets which help blood clot. Contains carbon dioxide, glucose, amino acids, proteins, minerals, vitamins, hormones, and waste material. NORMAL count is 150K-400K; draw 7mL in a lavender top

81. What is the early s/s of a patient with pulmonary edema and CHF?

"PINK FROTHY SPUTUM"; dyspnea; orthopnea; pulmonary crackles; wheezing; and cough.

109. Post op acute obstruction? Leg pain begins when walking then stops. Something about peripheral problems in both legs and calcium?

**PVD!**-affects the arteries or veins of the older adult which is insufficient amount of oxygenated blood to tissues in the legs and feet; arterial disorder: Aching to sharp cramping; brought on by exercise; relieved by rest -venous disorder: Aching to cramping pain; relieved by activity or elevating extremity

88. What is Anginal Pain?

*Angina means a spasmodic, cramplike, choking feeling. Pectoris refers to the breast or chest area. Angina pectoris refers to the paroxysmal (severe, usually episodic, increase in symptoms) thoracic pain and choking feeling caused by decreased oxygen or anoxia (lack of oxygen) of the myocardium. *Chest pain. loss of oxygen to the heart. * Atherosclerosis of the coronary arteries is the most common cause. *The narrowed lumina of the coronary arteries are unable to deliver enough oxygen-rich blood to the myocardium

65. What are the normal levels for RBC, Platelet, WBC?

*RBC*: Females: 4.2-5.4 million/uL Males: 4.7 to 6.1 million/uL *WBC*: 5,000 to 10,000/uL *Platelets*: 150,000 to 400,000 mm3 -Increased level can be evidence of malignancy or polycythemia vera. -Decreased level can be evidence of autoimmune disease, bone marrow suppression, or enlarged spleen.

111. What is a venous doppler used for? CK, 1381, 1586 med surge, 669/339

- A Doppler ultrasound device may be useful to determine the presence or absence of blood fl ow if unable to palpate distal pulses - Doppler laser and ultrasonography studies - Measures speed of blood flow in an extremity - A Doppler probe is used to take various blood pressure measurements (thigh, calf, ankle, brachial) for comparison -Doppler ultrasound: A Doppler ultrasound fl owmeter measures blood fl ow in arteries or veins to assess intermittent claudication, obstruction of deep veins, and other disorders of peripheral veins and arteries.

117. What is CK, creatinine kinase? Over how long should this monitored for? med surge, 297, 262

- Creatine kinase-MB - Peaks around 24 hr after onset of chest pain. Levels no longer evident after 3 days. -CARDiAC ENZYME: creatine kinase MB isoenzyme (cK-MB) - more sensitive to myocardium -ExPECTED REFERENCE RANGE: 0% of total CK (30 to 170 units/L) -ELEvATED LEvELS FiRST DETECTABLE FOLLOWiNG MYOCARDiAL iNJURY: 4 to 6 hr -ExPECTED DURATiON OF ELEvATED LEvELS: 3 days

75. What is an aneurysm?

- an enlarged, dilated portion of an artery that is more than one half times the artery's circumference. The defect must involev ALL 3 layers, or "tunics". - May be a result of arteriosclerosis, trauma, or a congenital defect. An aneurysm starts with a weakened arterial wall that becomes dilated from blood fl ow and pressure in the area. - usually caused by atherosclerosis and hypertension or, less frequently, by trauma, infection, or a congenital weakness in the vessel wall. It ruptures as a result of a small hole that occurs in a part of the aneurysm.

49. What nurse is in charge of blood transfusions?

- per Nilo oncology nurse Following facility protocol, confirm the client's identity, blood compatibility, and expiration time of the blood product with another nurse. Ati med surg pg 380 See box in picture Registered nurse Ck pg 547

103. What is the Bundle of His? ck, 1541

-. The impulses then pass to a group of conduction fibers called the bundle of His and divides into right and left branches of AV bundle to travel to smaller branches called the Purkinje fibers

97. What is 3rd degree heart block?CK, 1552

-AV block occurs when a defect in the AV junction slows or impairs conduction of impulses from the SA node to the ventricles. - hypotension, angina, bradycardia, heart rate often in the 30s, and HF for third-degree block. - The third-degree block indicates a worsening of the impairment in the AV junction and a complete heart block. - Atropine and isoproterenol may be prescribed. A pacemaker frequently is needed with third-degree block

69. What is a Lymphocyte?

-Agranular white blood cell that functions in immunity -25%-38% of WBCs -are the second most numerous of the white cells; although lymphocytes originate in the red bone marrow, they develop to maturity in lymphoid tissue and can multiply in this tissue as well; they circulate in the lymphatic system -function: Immunity (T cells and B cells) -memory cells, remember antigens

50. What is ecotrin and its action?

-Aspirin Action: Decreases platelet aggregation. Therapeutic effect: Decreased incidence of transient ischemic attacks and MI Davis drug online

44. CHF patient taking Lanoxin 0.25mg is admitted, what is the nurses first priority to get?

-Check Vitals Monitor apical pulse for 1 full min before administering. Withhold dose and notify health care professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant. Also notify health care professional promptly of any significant changes in rate, rhythm, or quality of pulse. Davis drug guide online Ati med surg pg 312 and says the same :)

71. S/S of Hemophilia A?

-Hereditary coagulation disorder; caused by a lack of antihemophilic factor VIII, which is needed to convert prothrombin to thrombin through thromboplastin component -Hemophilia, a hereditary coagulation disorder, is characterized by a disturbance of the clotting factors. In hemophilia A, the more common type (representing 80% of the total incidence), antihemophilic factor VIII is absent. This factor is essential for conversion of prothrombin to thrombin through thromboplastin component. -A decrease in the formation of prothrombin activators occurs as a result of the decrease in clotting factors -Internal or external hemorrhage occurs with large ecchymoses into tissue—especially muscles, which may show deformity; and joints, which become ankylosed. Hemarthrosis, or bleeding into a joint space, is a hallmark of severe disease and usually occurs in the knees, the ankles, the elbows, the shoulders, and the hips. Pain, edema, erythema, and fever accompany hemarthrosis. Small cuts can prove fatal; blood loss from simple dental procedures may be significant. *Subjective data* include reports by patient and family of incidents of ecchymoses and hemorrhage from even the slightest trauma. Pain is associated with joint motion. *Collection of objective data* includes noting blood in subcutaneous tissues, urine, or stool and noting edematous or immobile joints.

94. Right sided HF? Such as JVD, edema, enlarged liver?

-Peripheral edema -distended jugular vein -weight gain -ascites -Increased peripheral venous pressure.

45. What primary manifestation would you see with right sided heart failure?

-Peripheral edema Right-sided heart (ventricular) failure results in inadequate right ventricle output and systemic venous congestion (peripheral edema). Ati Med surg pg 307 Other symptoms ■ Jugular vein distention ■ Ascending dependent edema (legs, ankles, sacrum) ■ Abdominal distention, ascites ■ Fatigue, weakness ■ Nausea and anorexia ■ Polyuria at rest (nocturnal) ■ Liver enlargement (hepatomegaly) and tenderness ■ Weight gain

110. What is pernicious anemia and the diagnostic test? memm, 300 CK, 1508

-autoimmune disease -antibodies in the parietal walls of the stomach prevent the production of the intrinsic factor ("gastric juice secretion" that is responsible for vitamin B12 absorption from the intestine). -deficiency of vit B12 (substance essential for proper red cell formation). -neglection s/s: deterioration in the nervous system, causing difficulty in walking, weakness and stiffness in the extremities, mental changes, and permanent damage to the spinal cord. -treatment, IM injection of vitamin B12 and attention to a prescribed diet. -Diag. test: Schilling test shows malabsorption of vitamin B12 - the serum megaloblastic anemia profile: reveals decreased serum levels of vitamin B12, serum methylmalonic acid, and homocysteine. -Bone marrow aspiration: reveals abnormal RBC development. The erythrocytes appear large (macrocytic) and have abnormal shapes; serum cyanocobalamin (B12) levels are reduced.

53. What is myelogenous anemia?

-bone marrow the white cells have two main sources: red marrow, also called myeloid tissue, and lymphoid tissue. If this wild proliferation of white cells stems from cancer of the bone marrow, the condition is called myelogenous leukemia. When the cancer arises in the lymphoid tissue, so that most of the abnormal cells are lymphocytes, the condition is called lymphocytic leukemia. Both types of leukemia appear in acute and chronic forms. Memmlers pg 300

59. What is a heart rate of 55 be called?

-bradycardia Bradycardia (any rhythm less than 60/min) Ati med surg 273

47. What food would cause an interaction with Coumadin? Why?

-cabbage Advise the patient to limit foods high in vitamin K, such as leafy green vegetables, beans, broccoli, cabbage, cauliflower, cheese, fish, and yogurt. Vegetables with large amounts of vitamin K can interfere with the anticoagulant's effect Roach pg 423

46. What symptom would you find in a patient in the compensatory stage of shock?

-confusion

52. What kind of pulse would you expect to find for a patient in atrial fibrillation?

-irregular An episode of rapid, wild, and uncoordinated heart muscle contractions is called fibrillation, which may involve the atria only or both the atria and the ventricles. Memmlers pg 323

95. Left sided HF?

-paroxysmal nocturnal dyspnea -pulmonary congestion -tachycardia -crackles/wheezes -cough -fatigue -confusion -cyanosis (d/t decreased tissue perfusion) Restlessness

70. What is a Neutrophil?

-stain with either acidic or basic dyes -Neutrophils are the most numerous of the white cells, constituting approximately 60% of all leukocytes. Because the nuclei of the neutrophils have various shapes, these cells are also called polymorphs (meaning "many forms") or simply polys

39. What is the purpose of the cardiovascular system?

-transportation of oxygen and removal of CO2 -removal of metabolic waste products -transportation of hormones.

113. For a severe DVT in the left leg, what is the best intervention?med surg, 344

-◯ DVT and thrombophlebitis ■ Encourage the client to rest. ☐ Facilitate bed rest and elevation of the extremity above the level of the heart as prescribed. (Avoid using a knee gatch or pillow under knees.) ☐ Administer intermittent or continuous warm moist compresses as prescribed. ☐ Do not massage the affected limb. ☐ Provide thigh-high compression or antiembolism stockings.

104. What are the purkinje fibers?

...

2. Premature Ventricular Contraction EKG

...

5. 1st Degree Heart Block EKG

...

58. What is the normal range of sodium, calcium, chloride, and potassium?

...

99. Something about HTN and increase heart rate.

...

14. What is a normal white blood count and what is a low count called?

...5,000 - 10,000 Leukopenia is the terminology

8. For a patient in the ER, what step should the nurse take first without having to wait for an order?

...Administer oxygen

7. When administering Nitroglycerin for Angina pain, how should it be given?

...Administer prescribed nitroglycerin. Repeat every 5 minutes, three times. If pain is unrelieved, notify physician.

41. What is a liquid connective tissue?

...Blood -Circulating connective tissue has a fluid consistency; its cells are suspended in a liquid matrix. The two types are blood, which circulates in blood vessels (memmlers pg65) -ck pg1246-47 connective tissue

3. Atrial Flutter EKG

...In atrial fibrillation, electrical activity in the atria is disorganized, causing the atria to fibrillate, or quiver, rather than contract as a unit. Atrial fibrillation is a very rapid production of atrial impulses. The atria beat chaotically and are not contracting properly. It is characterized by an atrial rate of 350 to 600 bpm. If untreated, the ventricular response rate may be 100 to 180 bpm.

17. What would be elevated levels with Troponin 1, CPK, SGOT, AST.

...Myocardial Infarction Triponin Cardiac Cell protein. Elevated levels sensitive indicator of MI. normal 140-200 AST (aspartate aminotransferase; formerly serum glutamic oxaloacetic transaminase [SGOT]): Adult: 0 to 35 units/L. AST level is elevated in myocardial infarction, hepatitis, cirrhosis, hepatic necrosis, hepatic tumor, acute pancreatitis, and acute hemolytic anemia. • ALT (alanine aminotransferase; formerly serum glutamic pyruvic transaminase [SGPT]): Adult or child: 4 to 36 units/L. ALT level is elevated in hepatitis, cirrhosis, hepatic necrosis, and hepatic tumors and by hepatotoxic drugs. • LDH (lactic dehydrogenase): Adult: 100 to 190 units/L. Values are increased in myocardial infarction, pulmonary infarction, hepatic disease (e.g., hepatitis, active cirrhosis, neoplasm), pancreatitis, and skeletal muscle disease. • Alkaline phosphatase: Adult: 30 to 120 units/L. Alkaline phosphatase level is elevated in obstructive disorders of the biliary tract, hepatic tumors, cirrhosis, hepatitis, primary and metastatic tumors, hyperparathyroidism, metastatic tumor in bones, and healing fractures. • Gamma GT (gamma glutamyl transferase): Male and female older than age 45: 8 to 38 units/L; female younger than age 45: 5 to 27 units/L. Levels are elevated in liver cell dysfunction such as hepatitis and cirrhosis; in hepatic tumors; with the use of hepatotoxic drugs; in jaundice; and in myocardial infarction (4 to 10 days after), heart failure, alcohol ingestion, pancreatitis, and cancer of the pancreas.

16. Why would a cardiac patient be on Coumadin/Warfarin and what therapeutic effects will it have?

...They could be on it for Atrial Fibrillation. It will slow heart rate and prevent blood clots and stroke. •Prophylaxis and treatment of: ◦Venous thrombosis, ◦Pulmonary embolism, ◦Atrial fibrillation with embolization. •Management of myocardial infarction: ◦Decreases risk of death, ◦Decreases risk of subsequent MI, ◦Decreases risk of future thromboembolic events. •Prevention of thrombus formation and embolization after prosthetic valve placement.

15. What dietary teaching should be included for a patient with a Myocardial Infarction?

...Turkey is a healthier protein (Low Sodium, Low Fat, Squash, Salad, Baked Turkey)

9. What blood type will cause no donor rejection?

...Type O

10. What are risks for coronary heart disease?

...Weight, Diet, Exercise, Smoking traditional: -high LDL cholesterol -low HDL cholesterol -high blood pressure -family history -diabetes -smoking -being post-menopausal for women -being older than 45 for men -obesity -stress

12. What pulse check would the nurse perform for a cardiac catheterization?

..Pedal pulse (Most distal site from point of insertion)

The nursing diagnosis of decreased cardiac output, related to loss of myocardial contractility, would be appropriate for the patient who has had an acute myocardial infarction. The correct nursing interventions for this nursing diagnoses would include: (Select all that apply.) 1. Assess for and report decreased blood pressure and dysrhythmias. 2. Assess for oliguria. 3. Administer oxygen therapy as ordered. 4. Give opioids sparingly.

1. 2. 3.

55. What is Orthophrenia?

1. Rarely used term for soundness of mind. 2. Rarely used term for a condition of normal interpersonal relationships. Online medical dictionary could not find anything else in books not sure if that's what she meant I have that same word in my study guide..?

77. Average lifespan of erythrocyte?

120 days

105. When are the atrial ventricles closed?

92. ventricular systole)

20. Triponin 1?

A troponin test Measures the levels troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damaged, such as occurs with a heart attack. The more damage there is to the heart, the greater the amount of troponin T and I there will be in the blood. Triponin Cardiac Cell protein. Elevated levels sensitive indicator of MI. normal 140-200

102. What is the A/V node? ck, 1541

AV node, which is located in the base of the right atrium. The AV node slows the impulses to allow the atrium to complete contraction and to allow the ventricles to fi ll. The impulses then pass to a group of conduction fi bers called the bundle of His

98. Patient is taking medication for HTN; potassium is 6.8, what should be done?

Administer EKG Management of hyperkalemia ■ Provide for cardiac protection. Prepare to administer calcium gluconate or calcium chloride. ■ Withhold potassium supplementation as prescribed (IV infusion or oral potassium). ■ Provide a potassium-restricted diet (avoid foods high in potassium [avocados, broccoli, dairy products, dried fruit, cantaloupe, bananas]). ■ Promote movement of potassium from ECF to ICF. ☐ Monitor clients receiving IV fluids with dextrose and Regular insulin. ☐ Monitor clients receiving sodium bicarbonate to reverse acidosis. ■ Administer loop diuretics (furosemide [Lasix]) if renal function is adequate. Loop diuretics increase the depletion of potassium from the renal system. ■ Administer cation exchange resins (sodium polystyrene sulfonate [Kayexalate]). Laxative effects cause excretion of excess potassium from the body. Can be used on clients with renal problems

23. Hemoglobin is 9.8, which is low, what is the normal range? What would you give diet wise?

Answer: Raisin But double read your question on the test. Foods rich in iron include: •Red meat. •Pork. •Poultry. •Seafood. •Beans. •Dark green leafy vegetables, such as spinach. *•Dried fruit, such as raisins and apricots.* •Iron-fortified cereals, breads and pastas

1. The function of the cardiovascular system involves any one or more of the following functions. Check all that apply. a. Oxygen transportation b. Metabolic waste removal c. Hormone transportation d. Neural connectivity e. CO2

Answer: a. b. c. e. The cardiovascular system is responsible for the transportation of oxygen and removal of CO2, the removal of metabolic waste products and the transportation of hormones. It is not responsible for neural connectivity.

21. CHF patient admitted into hospital three times in last four month with a no comply with medication, what would be the nurses course of action?

Assess the patient. Collect more information. S/S CHF: Fatigue, weakness, dyspnea, cold intolerance, dizziness

DIC

Disseminated intravascular coagulation (DIC) begins with excessive clotting. The excessive clotting is usually stimulated by a substance that enters the blood as part of a disease (such as an infection or certain cancers) or as a complication of childbirth, retention of a dead fetus, or surgery. People who have a severe head injury or who have tissue damage caused by shock, burns, frostbite, other injuries, or even a bite by a poisonous snake are also at risk. As the clotting factors and platelets are depleted, excessive bleeding occurs. *disseminated intravascular coagulation* *DIC Acquired* *hemorrhage syndrome of clotting, cascade* *overstimulation,* *and anticlotting processes.*

86. For an ER patient with chest pain and MI, what device would you want to place on the patient?

EKG 12 lead

29. For a patient taken diuretics for heart failure, what are they are risk for and what would be the symptom?

Electrolyte imbalance. Hypokalemia. Fatigue

115. What is an erythrocyte? memm, 288

Erythrocytes (eh-RITH-ro-sites), from erythro, meaning "red," are the red blood cells, which transport oxygen.

36. What patient symptom would you expect to find with a malfunctioning pacemaker?

Fatigue Chest pain Vertigo

22. Three days following CABG a patient has a 92 radial pulse, what would the nurse do next?

Check vital signs. Apical pulse for 1 minute first.

74. What are the cardiac valve threads?

Chordae tendineae The chordae tendineae (tendinous chords), or heart strings, are cord-like tendons that connect the papillary muscles to the tricuspid valve and the mitral valve in the heart. Small cordlike structures, chordae tendineae, connect the AV valves to the walls of the heart and work with the papillary muscles located in the walls of the ventricles to make a tight seal to prevent backflow when the ventricles contract.

48. What is 3rd degree heart block?

Ck pg 1552 AV block occurs when a defect in the AV junction slows or impairs conduction of impulses from the SA node to the ventricles. Three types of blocks are seen: first degree, second degree, and third degree. The third-degree block indicates a worsening of the impairment in the AV junction and a complete heart block. Common causes of AV block include: -atherosclerotic heart disease (ASHD) -MI -heart failure (HF). Other causes may be: -digitalis toxicity -congenital abnormality, -drugs -hypokalemia. Clinical manifestations: -no symptoms for first-degree block -vertigo, weakness, and irregular pulse for second-degree block -hypotension, angina, bradycardia, heart rate often in the 30s, and HF for third-degree block. Medical management involves evaluating the patient's response and determining the cause of the dysrhythmia. -Atropine and isoproterenol may be prescribed. -A pacemaker frequently is needed with third-degree block

34. What is congenital narrowing of the aortic arch?

Coarctation of the Aorta. The blood pressure in the arms will be 20 mm Hg higher than that in the legs (reversal of normal pattern). Other manifestations include bounding pulses in the lower extremities, signs of heart failure, leg cramping on exertion in older children, and epistaxis.

32. Patient with left sided heart failure, what would you expect to find?

Crackles, wheezes, nocturia, shortness of breath, cyanosis, cough, frothy, blood-tinged sputum, orthopnea

18. What is CPK?

Creatine phosphokinase (CPK) is an enzyme in the body. It is found mainly in the heart, brain, and skeletal muscle. CPK-2 levels rise 3 to 6 hours after a heart attack. If there is no further heart muscle damage, the level peaks at 12 to 24 hours and returns to normal 12 to 48 hours after tissue death.

42. What are the normal Hematocrit levels?

Females: 37 to 47% Males: 42 to 52% Ati Med surg 373 Females: 37%-47% Males: 42%-52% Ck pg 1499

57. Would a potassium level of 2.3 be dangerous?

Hypertension which result would be crucial.. Often first line of hypertension medications are diuretics. Those on loop diuretics such as Lasix decrease sodium reabsorption and increase potassium excretion. Monitor closely for hypokalemia Ati med surg pg 354

85. What is INR and the levels?

INR 0.7 to 1.8 (2 to 3 on warfarin [Coumadin] therapy)

93. What is ITP, idiopathic thrombocytic purpura?

Idiopathic (cause unknown) thrombocytopenia purpura (ITP) is characterized by a marked decrease in the amount of circulating platelets with resultant bleeding beneath the skin. ITP is the most common thrombocytopenia of childhood, occurring most frequently in the 2- to 10-year age-group. It occurs in either acute or chronic form. As its name implies, the cause ofITP is unknown; however, it is believed to be an autoimmune response to disease-related antigens. The acute form of ITP usually follows a viral infection (such as a respiratory infection, rubella, rubeola, mumps, or chickenpox; or after infection with parvovirus B19) and is selflimiting; the chronic form has periods of remission. -symptoms: •easy or excessive bruising (purpura) — your skin naturally bruises and bleeds more easily as you age, but this shouldn't be confused with ITP •superficial bleeding into your skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on your lower legs •Prolonged bleeding from cuts •Spontaneous bleeding from nose •Bleeding gums, especially after dental work •Blood in urine or stools •Unusually heavy menstrual flow •Fatigue

31. Patient has PVC (premature ventricular contractions) and is experiencing lightheadedness, what kind of pulse would you expect to find?

Irregular pulsations

100. Serum potassium is 5.5, which corrects patient's EKG? She mentioned kayexalate.

Kayexalate

19. Elevated LDH is bad, why?

Lactic Intracellular enzyme found in many normal 80-120 Dehydrogenase tissues: incl heart. Elevates 8 hrs after MI (LDH) returns to baseline in 7 days It collects in the walls of your blood vessels, where it can cause blockages. Higher LDL levels put you at greater risk for a heart attack from a sudden blood clot that forms there.

92. For cardiac catheterization post care what is included in nursing care?

Legs flexed, 45 degrees, NPO 4hr, 2-6hr in bed

51. A cardiac monitor shows dysrhythmia, what would you give, Liidocaine, nitroglycerin, digitalis, or amyl nitrate?

Lidocaine, by raising the threshold of myocardial fibers, reduces the number of stimuli that will pass along these fibers and therefore decreases the pulse rate and corrects the arrhythmia

80. What are antibodies & antigens?

MEMMLERS P. 384-385, 387 Antigens=any foreign substance that induces an immune response; they are large protein molecules-carbs and some lipids may act as antigens; normally only nonself antigens stimulate an immune response; found on surface of pathogenic organisms, transfused blood cells, transplanted tissues, cancer cells, pollen, toxins, & food. *critical feature: it stimulates the activity of certain lymphocytes classified as T or B cells Antibodies= Y-shaped proteins secreted by plasma cells (activated B cells) in response to specific antigens. B cells are 2nd class of active lymphocytes in immunity; surface receptors on B cells bind w/a specific type of antigen which exposure to the antigen stimulates the cells to multiply rapidly producing clones or plasma cells; mature cells produce antibodies against the original antigen & release them into the blood providing humotal immunity. *ALL antibodies contained in part of plasma called gamma globulin

62. What is mitral valve prolapse?

Mitral valve prolapse manifestations: -palpitations, dyspnea, chest pain, activity intolerance, syncope; midsystolic click (CK p.1578) -Mitral valve prolapse is a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly. Mitral valve prolapse is also known as click-murmur syndrome, Barlow's syndrome or floppy valve syndrome -When the heart pumps (contracts) part of one or both flaps collapse backward into the left atrium. In some cases, the prolapsed valve lets a small amount of blood leak backward through the valve, which may cause a heart murmur -The most common cause of MVP is due to small, usually harmless, tumor-like growths of collagen on the valve leaflets (called myxomatous changes). Mitral valve prolapse occurs in 2 percent to 3 percent of the population. A person can be born with the genetic risk of developing MVP or it can be caused by other health problems, such as some connective tissue diseases -Many people live with this condition without symptoms but when a prolapsing valve allows blood to leak back into the atrium, this is called regurgitation. A regurgitating, (or leaky) mitral valve may need to be treated Symptoms, which in some cases may be related to leaking of the mitral valve, can include: •Chest pain (not caused by coronary artery disease or a heart attack) •Dizziness •Fatigue •Sensation of feeling the heart beat (palpitations) •orthopnea or SOB with activity (AHA website)

108. What are the therapeutic effects of Epogen?

Therapeutic Effects Produced in the kidney and stimulates bone marrow production of RBCs (erythropoiesis). Uses Elevates the hematocrit of patients with anemia secondary to chronic kidney failure (CRF); patients may or may not be on dialysis; other anemias related to malignancies and AIDS. Autologous blood donations for anticipated transfusions. Reduces need for blood in anemic surgical patients.

56. If heart rhythm is symptomatically brady, why would you give Atropine?

Therapeutic effect of Atropine is to increase heart rate Davis drug guide online

63. What clinical manefestations would you expect to find in a patient with a Acute MI?

Myocardial infarction (MI) is an occlusion of a major coronary artery or one of its branches with subsequent necrosis of myocardium caused by atherosclerosis or an embolus (a foreign object, a quantity of air or gas, a bit of tissue, or a piece of a thrombus that circulates in the bloodstream until it becomes lodged in a vessel) Subjective Data: Heavy pressure or squeezing in center of chest behind sternum Pain, retrosternal and in heart region, often radiating down the left arm and to the neck, jaw, and teeth Anxiety Dyspnea Weakness, faintness Nausea Objective Data: Pallor Erratic behavior Hypotension, shock Cardiac rhythm changes Vomiting Fever Diaphoresis S/S: Severe, crushing chest pain; prolonged heavy pressure or squeezing pain in center of chest; may spread to shoulder, neck, arm, fourth and fifth fingers on left hand, teeth, and jaw; may radiate as with angina; not relieved with rest or nitroglycerin; may be associated with dyspnea, diaphoresis, apprehension, nausea, and vomiting; signs and symptoms of cardiogenic shock may develop; the pain is prolonged and more intense than anginal pain Medical Management: Relief of pain (oxygen), morphine, and other analgesics ECG monitoring Thrombolytic therapy to dissolve clot Reduction of oxygen demand (rest) Prevention of complications (through use of stool softeners, anticoagulants) Treatment of complications (dysrhythmias, HF) Anticoagulants to prevent further clotting In women, these classic symptoms are far less common; most frequent early warning symptoms: unusual fatigue, sleep disturbances, shortness of breath, weakness, indigestion, and anxiety; in one study, only 30% of women reported chest pain, and acute chest pain was absent in 43% (Sherrod et al., 2007).

1. Normal Sinus Rhythm EKG

Normal sinus rhythm originates in the SA node and is characterized by the following: • Rate: 60 to 100 bpm • P waves: precede each QRS complex (atrial depolarization) .12-.20 on EKG strip • P-R interval: interval between atrial and ventricular repolarization • QRS complex: ventricular depolarization. Should be <.12 sec • T wave: ventricular repolarization • Rhythm: regular

54. What is Orthopenia?

Orthopnea refers to a difficulty in breathing that is relieved by sitting in an upright position, either against two pillows in bed or in a chair. Memmlers pg 415 orthopnea (shortness of breath while lying down) Ati med surg 309 Objective/sub data seen in left sided heart faliure and pulmonary edema Ati med surg 309-16

35. What would be the first nursing action for a patient that came in with a suspected MI?

Oxygen

76. What are the ABG levels?

PH: (A)7.35-7.45 (B) PCO2: (B) 35-45 (A) Bicarb: (A) 22-26 (B)

82. What is atrial depolarization?

PR Interval Atrial contraction

112. What is the Homan's sign?

Pain and edema occur when the vein is obstructed. The circumference of the calf or thigh may increase. Active dorsiflexion of the foot may result in calf pain. This is referred to as a positive Homans' sign and may indicate thrombophlebitis. Homans' sign is a classic but unreliable sign because it is not specific for DVT and appears in only 10% of DVT patients. Superficial thrombophlebitis may show signs of inflammation such as erythema, warmth, and tenderness along the course of the vein.

60. For a patient with chronic angina pectoris, how would you give nitroglycerin?

Place nitroglycerin tablet under tongue to dissolve (quick absorption). The client can take up to two more doses of nitroglycerin at 5-min intervals. Ati med surg 298 ◯ Immediately put one sublingual tablet under the tongue and let it dissolve. Rest for 5 min. ◯ If pain not relieved by first tablet, call 911, then take a second tablet. ◯ After 5 more minutes, take a third tablet if pain is still not relieved. Do not take more than three sublingual tablets. Ati pharm 285

114. What is a thrombocyte? memm, 288

Platelets, also called thrombocytes (THROM-bo-sites), are cell fragments that participate in blood clotting.

30. Prothrombinase occurs in the clotting process, explain it more.

Prothrombinase converts prothrombin in the blood to thrombin. Calcium is needed for this step. Thrombin, in turn, converts soluble fibrinogen into insoluble fibrin. Threads of fibrin form a meshwork that entraps plasma and blood cells to form a clot.

27. Patient with occlusion of the lower extremities has cold feet and calls the nurse for assistance, what would be a proper nursing action?

Put on socks

26. Cardiac catheterization patient has a left antecubital IV inserted, what pulse site would you palpate?

Radial pulse

107. How long after must a patient be observed after blood transfusions? med surge, 380

Remain with the client for the first 15 to 30 min of the infusion (reactions occur most often during the first 15 min) and monitor: ☐ Vital signs (then every hour afterward). ☐ Rate of infusion. ☐ Respiratory status.

4. Bradycardia EKG

Sinus bradycardia is a slow rhythm originating in the SA node. It is characterized by a pulse rate of less than 60 bpm (or even less than 50 bpm, according to some sources). Causes of sinus bradycardia include sleep, vomiting, intracranial tumors, MI, drugs (espcially digitalis toxicity), carotid sinus massage, vagal stimulation, endocrine disturbances, increased intracranial pressure, and hypothermia. When found in association with MI, it is a beneficial rhythm because it reduces myocardial oxygen demand.

72. What are the risk factors for Atherosclerosis?

Smoking, HTN, obesity, hypercholesterolemia, animal fats, sedentary life style, DM, combo of BC pills and smoking Coronary artery disease (CAD) is the term used to describe a variety of conditions that obstruct blood flow in the coronary arteries. Atherosclerosis (a common arterial disorder characterized by yellowish plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls of large and medium-size arteries) is the primary cause of ASHD. The lumen (a cavity or channel within any organ of the body) of the vessel narrows as the disease progresses. Blood flow to the heart is obstructed when this process occurs in the coronary arteries. Atherosclerosis, the basic underlying disease affecting coronary lumen size, is characterized by changes in the intimal lining (the innermost layer) of the arteries. The severity of the disease is measured by the degree of obstruction within each artery and by the number of vessels involved. Obstructions exceeding 75% of the lumen of one or more of the three coronary arteries increase the risk of death. The basic physiologic changes of the atherosclerotic process result in problems with myocardial oxygen supply and demand. When the myocardial oxygen demand exceeds the supply delivered by the coronary arteries, ischemia results (Figure 48-10). The artery walls also become less elastic and less responsive to blood flow

28. What is erythropoietin?

Stimulates red blood cell production in the bone marrow. This hormone is produced when there is a decreased oxygen supply in the blood. Hypoxia stimulates the kidneys to secrete erythropoietin, prompting red bone marrow to manufacture more erythrocytes and hemoglobin. A problem with this can result in anemia.

91. What should you D/C in a patient with poor circulation in lower extremities?

Stockings or socks with elastic tops.

38. For a patent on anticoagulant therapy, when should they take their medication?

Take medication at the same time each day

64. What blood levels would you expect to find in a patient with iron deficiency anemia?

Tests for levels of hemoglobin indicate whether iron deficiency anemia (a condition of lack of iron needed to carry oxygen throughout the body) is present Confirmation of iron deficiency anemia should be undertaken if there is a low level of hemoglobin. These tests include total iron content, percent iron saturation, total iron-binding capacity, and levels of transferrin (a protein that binds and transports iron) and ferritin (the storage form of iron). Hemoglobin: The normal hemoglobin level is 14 to 18 g/dL for men and 12 to 16 g/dL for women. -Hematocrit -Ferritin -Serum Iron (Fe) -CBC *decreased RBCs or Hemoglobin *hypochromic and microcytic RBCs

78. What is ventricle depolarization?

The QRS complex represents the depolarization of the ventricles.

25. Blood returns from the lungs to the right atrium, is that correct?

The blood returns from the lungs to the LEFT atrium

101. What is the sinoatrial node? ck, 1541

The heartbeat is initiated in the sinoatrial (SA) node -located in the upper part of the right atrium, just beneath the opening of the superior vena cava. -AKA, the pacemaker. Impulses are then passed to the AV node.

67. What is a Monocyte?

Type of leukocyte (agranular) -are the largest in size; they average about 5% of the leukocytes -they lack easily visible granules; nuclei are round or curved and are not segmented -function: phagocytosis (engulfing of foreign matter) -some monocytes enter the tissues and mature into phagocytes called macrophages -2%-6%: expressed as percentage of total WBC -100-600/mm3- expressed in actual numbers X 10 to the 9th power/mm3

24. Pacemakers or Implantable Cardioverter-defibrillators are implanted on the left side, why should the patient avoid microwaves and use a cell phone on the left side?

Use cellphone on the opposite side of where the pacemaker/ICD is placed.

84. How would you reverse warfarin toxicity?

Vitamin K

37. What s/s would you expect to see with hypovolemic shock?

Weakness Decreased BP Rapid, weak, thready pulse Rapid respirations Cold, clammy skin w/ pallor Oliguria

96. Patient has flu like symptoms with petechiae in mount and legs, also chills. What is infective endocarditis?

\Endocarditis is an infection or infl ammation of the inner membranous lining of the heart, particularly the heart valves. Classifi ed on the basis of cause, it may result from invasion of an organism (infective endocarditis) or from injury to the lining. The term bacterial endocarditis has been replaced by infective endocarditis because causative organisms include fungi, chlamydiae, rickettsiae, viruses, and bacteria. The causative organisms—most commonly Streptococcus viridans, Streptococcus pyogenes, Staphylococcus aureus, Staphylococcus epidermidis, and enterococci— are deposited on the heart lining or valves. As the organism embeds into the tissue, a vegetative growth perforates the chambers or valve leafl ets. Fibrin and calciferous growths of the vegetation may ulcerate and scar the valves; or the growths may break away, causing emboli, infection, or abscess in organs where they lodge. The loss of portions of vegetative lesions into the circulation results in embolization. Systemic embolization occurs from left-sided heart vegetation, progressing to infarction of an organ (particularly the brain, the kidneys, and the spleen) and limb. Right sided heart lesions embolize to the lungs. Endocarditis may develop after cardiac surgery, which in itself is traumatic. People at risk include patients with rheumatic, congestive, or degenerative heart disease.

33. Orthopenia, orthopenic, why are they used and define?

an abnormal condition in which a person must sit or stand to breathe deeply or comfortably

89. S/S of hemolytic transfusion reaction?

flushed, febrile and has chills

68. What is a Eosinophil?

granular leukocyte; eosinophils (and basophils) make up a small percentage of the white cells but increase in number during allergic reactions -stain with acidic dyes

106. What are the five DVT risk factors?

high calcium

66. What is the best position for a patient with right sided HF?

● Right-sided heart failure (cor pulmonale) ◯ Air trapping, airway collapse, and stiff alveoli lead to increased pulmonary pressures. ◯ Blood flow through the lung tissue is difficult. This increased workload leads to enlargement and thickening of the right atrium and ventricle. ◯ Manifestations include the following. ■ Low oxygenation levels ■ Cyanotic lips ■ Enlarged and tender liver ■ Distended neck veins ■ Dependent edema ◯ Nursing Actions ■ Monitor respiratory status and administer oxygen therapy. ■ Monitor heart rate and rhythm. ■ Administer medications as prescribed. ■ Administer IV fluids and diuretics to maintain fluid balance. ◯ Right-sided failure Subjective/Objective findings: ■ Jugular vein distention ■ Ascending dependent edema (legs, ankles, sacrum) ■ Abdominal distention, ascites ■ Fatigue, weakness ■ Nausea and anorexia ■ Polyuria at rest (nocturnal) ■ Liver enlargement (hepatomegaly) and tenderness ■ Weight gain *orthopneic position most comfortable*