UWorld Adult Health: Cardiology
What are the physical characteristics of PAD?
Shiny, hairless lower extremities, small ulcers on toes
What is AV block associated with?
myocardial ischemia (eg, coronary artery disease) or certain medications (eg, beta blockers, digoxin).
What medications should be discontinued before contrast dye procedures via cardiac cath?
- metformin and anti-diabetics should be discontinued 24-48 hrs prior to prevent lactic acidosis - there are more in different flaskcard
What does arterioventricular pacing look like?
Two pacer spikes are visible on the ECG, one prior to the P wave and a second prior to the QRS complex.
What is a therapeutic INR following a mechanical valve replacement?
2.5-3.5
What is a normal MAP?
70-110 mm Hg
What is the normal CVP?
2-8
Chest tube info
An air leak is indicated by bubbling of fluid in the base of the water seal chamber of a chest tube drainage unit. The client with a known pneumothorax is expected to have an intermittent air leak, with bubbling in the water seal chamber. Continuous bubbling indicates an air leak somewhere in the chest tube system.
A client comes to the emergency department with severe dyspnea and a cough. Vital signs are temperature 99.2 F (37.3 C), blood pressure 108/70 mm Hg, heart rate 88/min, and respirations 24/min. The client has a history of chronic obstructive pulmonary disease (COPD) and chronic heart failure. Which diagnostic test will be most useful to the nurse in determining if this is an exacerbation of heart failure?
B- type natriuretic peptide - Elevation of BNP >100 pg/mL helps to distinguish cardiac from respiratory causes of dyspnea.
A nurse is reviewing the laboratory results of a client admitted for an asthma exacerbation. Elevation of which of these cells indicates that the client's asthma may have been triggered by an allergic response?
Eosinophils
What is failure to capture and in what form does it show up on the ECG monitor?
Failure to capture appears on the cardiac monitor as pacemaker spikes that are not followed by QRS complexes
failure to sense vs failure to capture
Failure to sense appears on an ECG as asynchronous pacer spikes in inappropriate or random locations (eg, pacer spike on the T wave). It should not be confused with failure to capture, in which pacer spikes are located appropriately but there is no electrical response elicited from the heart (eg, no QRS complex after a pacer spike).
A client with heart failure has gained 5 lb (2.26 kg) over the last 3 days. The nurse reviews the client's blood laboratory results. Based on this information, what medication administration does the nurse anticipate? labs showed normal K+, low Na+, and normal Ca+
Furosemide - Loop diuretics (eg, furosemide) promote free water excretion, allowing for hemo-concentration and increased sodium levels.
What is the normal amount of chest tube drainage?
Immediately following a thoracotomy, chest tube drainage (50-500 mL for the first 24 hours) is expected to be sanguineous (bright red) for several hours and then change to serosanguineous (pink) followed by serous (yellow) over a period of a few days. A rush of dark bloody drainage from the chest tube when the client was turned following a period of minimal drainage is most likely related to retained blood due to a partial blockage in the tube.
What should the nurse do if no shock is advised on the defibrillator during a code?
Resume compressions
A client diagnosed with a ST-segment elevation myocardial infarction (STEMI) is receiving an intravenous thrombolytic infusion. In evaluating the client's response to treatment, which assessment finding by the nurse is the best indicator that reperfusion has occurred?
Return of ST segment to baseline
What is Virchow's triad?
Stasis, hypercoagulability, endothelial damage
What are the characteristics of supraventricular tachycardia?
Supraventricular tachycardia (SVT) is a regular narrow-complex (QRS) tachycardia. The heart rate is typically 150-220/min with no visible P wave.
Which subjective or objective assessment finding would the nurse expect to find in a client with severe aortic stenosis?
Syncope upon standing - When these valves are stiff and difficult to close (as with aortic stenosis), S2 is soft or absent. - Clients will develop exertional dyspnea, chest pain, and syncope as the heart is unable to overcome the obstruction to pump enough blood to meet metabolic demands. A systolic ejection murmur over the aortic area, soft or absent second heart sounds, and weak peripheral pulses are characteristic.
What is second-degree atrioventricular (AV) block, type 1?
This is an intermittent block usually occurring at the level of the AV node characterized by a progressively lengthening PR interval until a QRS complex is dropped.
The nurse is assessing a client with a possible diagnosis of peripheral artery disease. Which client statement is consistent with the diagnosis?
When I sit down and elevate my legs the pain worsens
What symptoms are associated with worsening chronic heart failure?
1) Crackles in lungs upon auscultation 2) Jugular vein distention 3) 3+ pitting edema on lower extremities
The nurse cares for a client who had an abdominal aortic aneurysm repair 6 hours ago. Which assessment findings would indicate possible graft leakage and require a report to the primary care provider?
1) Ecchymosis of the scrotum 2) Increased abdominal girth 3) Report of groin pain
Torsades de pointes info
- Torsades de pointes is a type of polymorphic ventricular tachycardia coupled with a prolonged QT interval; it is a lethal cardiac arrhythmia that leads to decreased cardiac output and can develop quickly into ventricular fibrillation. - The American Heart Association recommends treatment with IV magnesium sulfate.
What respiratory effects are associated with acute pancreatitis?
- acute respiratory distress syndrome - pleural effusions, atelectasis, and acute respiratory distress syndrome (ARDS). These complications are often due to activated pancreatic enzymes and cytokines that are released from the pancreas into the circulation and cause focal or systemic inflammation. ARDS can rapidly progress into respiratory failure.
What are the guidelines in assessing for orthostatic hypotension?
1) Have the client lie down for at least 5 minutes 2) Measure BP and HR 3) Have the client stand 4) Repeat BP and HR measurements after standing at 1- and 3-minute intervals - A drop in systolic BP of ≥20 mm Hg or in diastolic BP of ≥10 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.
The nurse is admitting a client with a diagnosis of right-sided heart failure resulting from pulmonary hypertension. What clinical manifestations are most likely to be assessed?
1) increased abdominal girth 2) JVD 3) Lower extremity edema - In clients with right-sided heart failure, the heart cannot effectively pump blood to the lungs. Clinical manifestations result from systemic venous congestion and include peripheral edema, jugular venous distension, increased abdominal girth (hepatomegaly, splenomegaly), and ascites.
A client is scheduled for a coronary arteriogram procedure. Which information should the nurse provide to the client prior to the procedure?
1) may be required to lie flat for several hours following the procedure 2) may feel warm or flushed while contrast dye is being inserted 3) do not eat or drink anything for 6-12 hours prior 4) client usually goes home the same day
The cardiac care unit has standing instructions that the health care provider (HCP) should be notified of an abnormal mean arterial pressure (MAP). The nurse will need to notify the HCP about which client?
A patient with HF on metoprolol with a BP of 106/42 - The client with the BP of 106/42 mm Hg has a MAP of 63 mm Hg, in the abnormal range. The nurse should report this to the HCP and monitor the client closely.
The nurse reviews and reinforces an asthma action plan with a client who has moderate persistent asthma. Which statement by the client indicates an understanding of how to follow a plan appropriately when peak expiratory flow (PEF) readings are in the green, yellow, or red zones?
A peak flow meter uses traffic signal colors to categorize degrees of asthma symptoms. Green zone indicates asthma is under control. Yellow zone indicates caution, symptoms are getting worse, PEF is 50%-80% of personal best, and there is a need for further medication. Red zone indicates the need for emergency treatment if the level does not immediately return to yellow after taking rescue medications.
What is the treatment of choice in SVT?
Adenosine is the treatment of choice. It is given rapidly via IVP over 1-2 seconds and followed by a 20-mL saline bolus. An increased dose may be administered 2 more times if previous administration is ineffective.
A client comes to the emergency department in acute decompensated heart failure. The client is very anxious, with a respiratory rate of 30/min and pink, frothy sputum. After placing the client on oxygen via nasal cannula, which of these actions is the next priority?
Administer furosemide 40 mg IV push
What are characteristics of venous insufficiency?
Brownish, hardened skin on the lower extremities
What is contraindicated with chest tubes during transport?
Chest tubes should not be clamped during transport of a client. A clamped chest tube may cause a tension pneumothorax, a potentially life-threatening event.
A registered nurse is making pre-procedure phone calls to clients scheduled for cardiac pharmacologic nuclear stress testing the following day. Which instructions should the nurse give the clients?
Clients scheduled for cardiac nuclear pharmacologic stress testing should not eat, drink, or smoke on the day of the test; avoid both caffeinated and decaffeinated products for 24 hours before the test; and avoid taking theophylline or antianginal medications unless otherwise instructed by the health care provider. - do not take beta blockers on day of test
A 62-year old client was admitted to the telemetry unit after having an acute myocardial infarction 3 days ago. The client reports to the nurse that the left calf is very tender and feels warm to the touch. Which assessment by the nurse is the priority?
Complete neuromuscular assessment on lower extremities
What are the indications of pulmonary edema?
Diffuse bilateral crackles at lung bases - Acute-onset dyspnea and cough with frothy, pink-tinged sputum indicate pulmonary edema.
What is dopamine used to treat for the heart?
Dopamine is used to treat hypotension r/t bradycardia - if hypotension persists after use of transcutaneous pacing, an inotrope such as this may be used
Chest tube drainage should be reported to the provider when it exceeds what amount?
Drainage over 100mL/hr
The nurse is caring for a client who just had a permanent ventricular pacemaker inserted. The nurse observes the cardiac monitor and sees a pacing spike followed by a QRS complex for each heartbeat. How should the nurse assess for mechanical capture of the pacemaker?
For clients with a newly implanted permanent pacemaker, the nurse should assess for electrical capture of heart rhythm (eg, ECG) and mechanical capture of heart rate (eg, pulse). A central pulse (eg, auscultation of apical, palpation of femoral) should be assessed to determine mechanical capture.
The nurse is assessing for the presence of jugular venous distension (JVD) on a newly admitted client with a history of heart failure. Which is the best position for the nurse to place the client in when observing for JVD?
HOB at a 45 degree angle
A client with a permanent pacemaker with continuous telemetry calls the nurse and reports feeling lightheaded and dizzy. The client's blood pressure is 75/55 mm Hg. What is the nurse's priority action?
Initiate transcutaneous pacing - Signs and symptoms of a failing pacemaker include failure to capture (pacer spikes without associated QRS complexes) with bradycardia and hypotension. The nurse should use a transcutaneous pacemaker to stabilize the client until the internal pacemaker can be repaired or replaced.
What should the nurse do FIRST when a patient is experiencing second-degree atrioventricular (AV) block, type 1?
Take vital signs - Assess the client with second-degree atrioventricular block, type 1 for symptoms associated with the rhythm (eg, hypotension, dizziness, shortness of breath). - If no symptoms are present, closely monitor the client. - If symptoms are present, anticipate using atropine or temporary pacing.
How is third degree AV block treated?
Temporary or permanent pacing is necessary to stabilize the client.
What is the initial goal of hypertensive crisis treatment?
The initial goal is to lower MAP by 25% or less or to maintain MAP of 110-115 mm Hg.
What is the treatment for supraventricular tachycardia?
Treatment includes vagal maneuvers and IV adenosine. Hemodynamically unstable clients with SVT may require synchronized cardioversion.
A client is 48 hours post abdominal aneurysm repair. Which assessment by the nurse is cause for greatest concern?
Urinary output of 90 mL in the past 4 hours
In what timeframe are thromboembolitics administered in events such as MI?
Within 12 hours
How is MAP calculated?
[(2 x diastolic) + systolic] / 3 MAP is calculated by adding the systolic blood pressure (SBP) and double the diastolic blood pressure (DBP), and then dividing the resulting value by 3.
What is third degree AV block and what are its manifestations?
complete heart block, occurs when electrical conduction from the atria to the ventricles is blocked, causing decreased cardiac output (eg, dizziness, syncope, mental status changes, heart failure, hypotension, bradycardia).
What clinical symptoms might the nurse expect to find in a client with a central venous pressure (CVP) of 24 mm Hg?
crackles in lungs, jugular venous distension, and peripheral edema as evidence of fluid volume overload.
How does third degree AV block appear on the ECG?
presents as a regular rate and rhythm with disassociated P waves and QRS complexes. This type of AV block requires temporary or permanent pacing to restore electrical conduction and hemodynamic stability.