Q and A PN: Cardiac disorders
Which question should the nurse ask a client with Right sided HF ?
"Are your clothes tight?"
What is a good question to ask a client with left sided HF ?
"How many pillows do you sleep with?"
What are the characteristics of Sinus Tachycardia?
*Rate*: HR 100 to 150 bpm all other parameters are the same as normal sinus rhythm
What are the characteristics of normal sinus rhythm?
*Rate*: HR 60 to 100 bpm *Rhythm*-regular *P wave* -P wave present ,and consistent, one P before each QRS *PR interval normal*- 0.12-0.2 secs *QRS Complex normal* 0.4-0.10 secs *ST segment* is isoelectric
Sinus Bradycardia
*Rate*: less than 60 bpm The other parameters are the same as NSR
What type of diet is used for clients with Heart Failure?
Low NA, Heart healthy
What is a normal QRS interval?
Narrow: Normal is 0.04 to 0.12 seconds
The patient with heart failure is feeling better. Should they stop taking their medications?
No
True or false: Bradycardia is always treated with medication.
No
When is sinus bradycardia treated?
Only Tx if symptomatic.
Why does the nurse give furosemide early in the day for an older adult?
Prevent falls
The nurse would hold a calcium channel blocker for __________________.
SBP less than 90 mmHg
What causes dysrhythmias? ( hint STOP Eating Dog Snacks Eat Healthy)
Stress ETOH Digoxin Stimulants: caffeine, tobacco Electrolyte imbalances Hyperthyroidism/ Hypoxia
What is the first sign of hypoxemia in pulmonary edema?
Tachycardia
What should the nurse determine first when interpreting a rhythm strip?
The rate and rhythm
True or False: A nurse would check if a patient has a pacemaker or AICD before an MRI.
True
True or False: A pacemaker can be combined with an AICD?
True
True or False: A patient with heart failure may develop a new productive cough.
True
True or False: A patient with pulmonary edema should be on bedrest to help correct fluid excess.
True
True or False: For the fatigued client the nurse should encourage the client to alternate periods of rest with activity.
True
True or False: HF in an Older Adult can be caused by any condition that increases the need for oxygen like pneumonia.
True
True or False: Tachycardia is caused by the body's need for increased oxygen.
True
True or false: A patient with pulmonary edema will have dyspnea.
True
Which rhythm is the deadliest of all rhythms?
V fib
What is the antidote for warfarin?
Vitamin K (phytonadione)
What is ventricular tachycardia?
a very rapid REGULAR rhythm that begins within the ventricles
What is the most common reason older adults are hospitalized?
heart failure
Which electrolyte disorder does the nurse monitor for a patient who takes furosemide?
hypokalemia
What is an important goal for the PN student regarding dysrhythmias?
identify when a strip is not normal sinus rhythm
When should a patient with heart failure call the HCP about weight gain?
if they gain more than 2 lbs/24 hours or more than 5 lbs in one week
What is heart failure (HF)?
inability of the heart to pump enough blood
Prevalence of atrial fibrillation ______________ with age.
increases
Where does the nurse check for an apical pulse?
left 5th intercostal space MCL
If atropine does not work to increase heart rate, what should the nurse prepare for?
pacemaker insertion
What does the sputum look like in pulmonary edema?
pink frothy sputum
Why is an anticoagulant indicated for A fib/A flutter?
prevent stroke
The nurse teaches the patient with a pacemaker to monitor their___________daily.
pulse
What is the priority in Ventricular fibrillation?
rapid defibrillation
Where would the nurse see edema for the patient on bedrest who has right sided heart failure?
sacrum
What does the QRS complex represent?
ventricular depolarization (contraction)
The nurse suspects a client has pulmonary edema. What should the nurse do first?
Elevate the head of bed
What are the signs and symptoms of Left sided heart failure (FORCED) ?
FORCED Fatigue orthopnea-can't get comfortable flat Rales/restlessness Cyanosis/confusion Extreme Weakness Dyspnea
True or false: Cyanosis is an early sign in respiratory disorders.
False
A patient's monitor displays a dysrhythmia. What should the nurse do first?
Check the patient's LOC and vital signs.
What are 3 goals of treatment for a fib?
Control the heart rate convert the rhythm prevent stroke
What are the two most common causes of heart failure?
Coronary artery disease (CAD)* HTN*
How should the nurse calculate the HR on a 6 sec strip?
Count the number of QRSs and multiply by 10
What is the definition of tachycardia?
HR > 100 bpm
What is the priority intervention for ventricular tachycardia without a pulse?
Defibrillate
The patient should report______________or the ankles and feet.
edema (swelling)
What are the characteristics of AFIB?
*Rate:* Atrial rate 350 to 600 bpm; Ventricular rate varies *Rhythm:* Rhythm is irregular "irregularly irregular" *P waves* are replaced with chaotic fib waves *PR interval* not measurable *QRS normal* shape and duration
What is the priority intervention for Ventricular fibrillation?
-Defibrillate
What is a therapeutic INR?
2-3
The nurse would hold a beta blocker for a heart rate less than __________.
50 bpm
The nurse would hold digoxin for a heart rate less than_______________.
60 bpm
what is a normal pulse?
60 to 100 bpm
What are the ABCD and LMNO mnemonics that help to remember the medication used to treat heart failure?
Ace inhibitors Beta blockers Calcium Channel blockers and Coumadin (Warfarin) Digoxin Lasix (furosemide) Morphine Nitroglycerin Oxygen
Which medications treat Afib? ( hint ABCD)
Amiodarone Beta blockers Calcium channel blockers/coumadin (warfarin) Digoxin
What is dysrhythmia(s) or Arrhythmia(s)?
An abnormal heart rhythm
What should the nurse do first for a patient in ventricular tachycardia?
Assess LOC and vital signs
What are the signs and symptoms of Right Sided Heart Failure (BACONED)?
BACONED Bloating Anorexia cyanosis/cool legs oliguria nausea edema distended neck veins (JVD)
What are the causes of afib in an older adult?
any type of stress
What does the P wave represent?
atrial depolarization (contraction)
How is symptomatic bradycardia treated?
atropine
What is an AICD?
automatic implantable cardioverter-defibrillator
A P wave should be _________________each QRS.
before
The nurse would expect the lung sound in pulmonary edema to be___________________.
crackles (rales)
What is the best way to monitor fluid status?
daily weights
