cardaic
if heart isnt compensating for HF give what drugs
IV inotropes (dobutamine) vasodilators (nitrropressuide)
diuretic causes _____ and ________ which traps more blood out in the arms and legs and reduces ______
diuresis vasodilation preload
medications to decrease preload
diuretics nitrates
s/s of dig toxicity early late
early: anorexia, N/V late: arrythmias and vision changes
most common complications post op pace maker
electrode displacemnt
the left coronary artery supplies
entire left ventricle
pt education for stable angina - low _____ and high _____ diet -avoid caffiene of drugs that ______ _____ -wait -___ hours after eating to exercise -temp extremes can
fat, fiber -increase HR -2 hours -increase chest pain
nesiritide should not be given .... what does it do
for more than 48 hours -vasofilates the veins and arteries and has a diuretic effect
women usually present with what when having an MI
gi symptoms or chocking sensation
worry about the STEMI pt bc
having a heart attack and the goal is to get them to the cath lab in less than 90 min
fluid retention think
heart problems
tx of pulm edema
high flow o2
side effect of amiodarone
hypotension
what should we have the pt do to help not displace the electrodes
immbolize arm passive ROM keep pt from raising arm higher than shoulder
ACE results in
increase in arterial dilation and increase stroke vol
triad MI for women s/s
indigestion of feeling of fullness unusual fatigue inability to catch ones breath
drugs that improve contractility
inotropes (dopamine, dobutomine)
systolic think
contract
what do beta blockers do
decrease BP P and myocardial contractility
cardiac diet
decrease fat, salt, cholesterol
decreased contractility=
decreased CO
why do we want the pt head up
decreases workload on the heart and increases CO
how to tx vfib if that doesnt work then we
defiburlate and CPR give epi
any electrolyte imbalance can lead to =
dig toxicity
A 70 year old female client reports an occasional choking sensation over the past 12 hours. What additional symptoms reported by the client would indicate to the nurse that the client may be having a myocardial infarction? Correct! Select All That Apply1. Unusual fatigue.2. Indigestion.3. Aching jaw.4. Feeling faint5. Pain between the shoulder blades.6. Left arm paresthesia.
1., 2., 3., 4., & 5. Correct: Look at the hints - elderly, female, choking sensation. Women often present with GI signs and symptoms, epigastric complaints, or pain between the shoulders, aching jaw, or choking sensation. The triad of symptoms: feeling of fullness in the abdomen, unusual fatigue, and an inability to "catch one's breath". Remember that the elderly may just faint or only have SOB. 6. Incorrect: Left arm paresthesia sounds more like a stroke rather than an MI.
digitalizing dose
loading dose-give more than they will go home on
left sided heart failure think
lungs
safest time to have sex
morning 8-9AM, when pt is well rested
troponin has a high specificity to
myocardial damage
unstable angina=decreased blood flow to ______ which will lead to both ____ and _______
myocardium ischemia necrosis
unstable angina does anyhting bring this pain on?
no, can happen when coming out of REM sleep
what are things that can cause pacemaker malfunction
not programmed correctly electrodes dislodged battery may be dead
arrythmias are not big deal unless what
they affect cardiac output- check for perfusion problems
hypok+ + dig=
toxicity
best cardiac biomarker
troponin
if pt is on nesiritide do what before drawing a BNP
turn it off 2hr b4
pulm edema positioning
upright position legs down due to promoting pulling of blood in lower extremities
2mg of morphine can
vasodialte to decrease preload and afterload decrease aggitation to not being able to breath
right sided heart failure think
venous
BNP is secreted when
ventricular tissues in the heart when the volumes adn pressures increased
beta blockers relax _____ and decrease _____ _____
vessels bP
amiodarone is given when
vfib and pulseless VT are resistant to tx
class 4 HF is the
worst
is diuresis a good thing in HF pt
yes! good perfusiojn
drugs that help prevent angina
beta blockers calcium channel aspirin
rate control drugs
beta blockers calcium channel blockers digoxin
beta blockers block
beta cells which are the receptor sites for catecholamines epi and norepi
CPK-MB elevates within peaks within
cardiac specific isoenzyme increases with damage to cardiac cells. elevates in 3 to 6 hours and peaks in 12 -24 hours.
calcium channel blockers do what
cause vasodilation of the arterial system
decreased CO will lead to
chest pain wet lungs SOB cold and clammy UO decreased
amniodarone helps with
rhythm
how can cardiac tamponade happen
right venticlar biopsy mi percarditis
Swan-Ganz catheter
soft, flexible catheter that is inserted through a vein into pulmonary artery. used to provide continuous measurements of pulm artery pressure. can exercise with device but patient should avoid activities that increase pressure on injection site
renew nitro spray and pills every
spray 2 years pills 6 months
left coronary artery occlusion think
sudden death or widow maker
cardiac cath pre procedure -ask if they are allergic to.... -check what function -can give what drug to help protect the kidney - hot shot describe -palpitations... normal or not
- shellfish or iodine -kidney -mucomyst -get hot -normal
S/S of right sided heart failure
-distended neck veins -edema -enlarged organs -weight gain -ascites
normal troponin levels
0-0.4 ng/mL
norm dig level
0.5-2ng/mL more than2 is toxic
40mg of lasix push over
1-2min to prevent hypotension and ototoxicity
The nurse performs a rapid assessment on a client who states, "I feel really sick and my heart is beating so fast." What signs and symptoms would indicate to the nurse that the client's cardiac output is inadequate? Select All That Apply1. CVP 5 mm Hg.2. Moist skin.3. Urinary output 150 mL over 4 hours.4. Weak radial pulses.5. BP 90/50, HR 200, RR 22.6. Mild chest discomfort.
2, 4, 5, & 6. Correct: When cardiac output is inadequate, the vital organs are not being perfused properly. Skin will be cool and clammy (moist) because the skin is not being perfused. Radial pulses will be weak and thready, because less blood is pumping through the arteries. Less volume means less pressure, so BP is low. The heart rate is too fast, so blood does not have time to get in the ventricles before it is contracting again which decreases cardiac output. Less blood is being pumped to the body. Chest pain means oxygenated blood is not reaching the heart muscle. 1. Incorrect: Normal CVP is 2-6 mmHg, so this is a normal finding. 3. Incorrect: Normal urinary output (UOP) should be at least 30 mL per hour. This client's UOP was 150 mL over 4 hours (50 mL per hour). So no concern here.
report a weight gain of _____-____lbs
2-3
A client reports dizziness and weakness while walking down the hall. The nurse notes the client's cardiac rhythm displayed on the telemetry monitor. What actions should the nurse take? Exhibit Correct! Select All That Apply1. Assist client in ambulating back to bed.2. Obtain client's blood pressure.3. Auscultate lung sounds.4. Prepare for cardioversion.5. Initiate 100% oxygen per nonrebreather mask.
2. & 3. Correct: The client is dizzy and weak. This client is at risk for falling, so think safety and get the client back in bed. Use a wheelchair to accomplish this. Then obtain the client's BP. It may be low, indicating poor tissue perfusion to the vital organs. One cause of premature ventricular contractions (PVCs) includes heart failure, so assess the lungs for adventitious sounds. 1. Incorrect: This client is dizzy and weak. Having the client ambulate back to the bed is a safety risk. The client could fall or the condition could deteriorate while ambulating. 4. Incorrect: Cardioversion is not indicated with an underlying rhythm that is normal (NSR) with PVCs. Oxygen may decrease the PVCs. If not, medication can be administered to decrease the rate of the PVCs. 5. Incorrect: Oxygen may abate the PVCs; however, it should be initiated at 2 liters/NC rather than at 100% per nonrebreather mask. Start with the least amount of oxygen that could relieve symptoms.
The nurse is providing teaching to a group of clients newly diagnosed with chronic stable angina. What points should the nurse include? Correct! Select All That Apply1. Wait 1/2-1 hour after eating to exercise.2. Attend classes such as guided imagery to reduce stress.3. Temperature extremes can precipitate an angina attack.4. Gradually increase weightlifting training to improve cardiac output.5. Eat a low fat, low fiber diet to lose weight.6. Medications prescribed to prevent angina work by increasing the workload of the heart.
2., & 3. Correct: We want to teach clients who have angina to do whatever they can to decrease the workload of the heart. Stress can increase the workload on the heart, so learning ways to decrease or deal with stess is a positive step. This can be done through guided imagery or music therapy. Temperature extremes can precipitate an attack, so the client should dress warmly in cold weather and be cautious out in extremely hot weather. 1. Incorrect: The client should wait at least 2 hours after eating to exercise. During this time, more blood is going to the digestive system. We don't want the heart to have to compete with the gut. 4. Incorrect: Weightlifting will increase the workload of the heart. We don't want to increase the workload of the heart in a client with a cardiac issue. 5. Incorrect: Losing weight is often beneficial for the cardiac client, so we advise them to decrease calorie consumption and maintain a low fat, high fiber diet. 6. Incorrect: We want to decrease the workload of the heart, not increase it. Medications prescribed to prevent angina work to decrease the workload of the heart.
troponin elevates within how many hours after the onset of pain and remains this way for how many weeks
3-4hours 3 weeks
The nurse is teaching a group of clients in cardiac rehabilitation how blood flows through the heart. What information should the nurse include? Correct! Select All That Apply1. Deoxygenated blood enters the heart through the pulmonary vein.2. Blood flows from the right atrium through the mitral valve to the right ventricle.3. The right ventricle pumps the blood to the lungs via the pulmonary artery where the blood becomes oxygenated.4. From the lungs, oxygenated blood goes to the left atrium via the pulmonary vein, then to the left ventricle.5. The right ventricle pumps the blood out through the aorta to the body.
3., & 4. Correct: These are true statements. The right ventricle pumps the blood to the lungs via the pulmonary artery where the blood becomes oxygenated. From the lungs, oxygenated blood goes to the left atrium via the pulmonary vein, then to the left ventricle. 1. Incorrect: Deoxygenated blood comes from the body to the heart via the superior and inferior vena cava. 2. Incorrect: Blood flows from the right atrium through the tricuspid valve to the right ventricle. 5. Incorrect: The left ventricle pumps the blood out through the aorta to the body.
how long after post cath do pts need to lay flat for
4-6 hours
where to check for an apical pulse
5th intercostal space, 3rd midclavicular line
how long do you hold glucophage after a card cath
48hr
medications to decrease afterload
ACE ARBS hydralazine nitrates
how do you know dig is working
CO will go up
BNP can indicate
HF
CO=
HRxSV
S/S of left sided heart failure
L=Lungs -Pulmonary congestion -dyspnea -cough -blood-tinged frothy sputum!!!! -restlessness -tachycardia -S-3 -Orthopnea -nocturnal dyspnea
mitral valve located betwween
LA and LV
myoglobin is not a good indicator for a ______ it increases within ____ hour and peaks within ______
MI 1 12
new MONA
OANM
loss of capture
Pacing activity occurs but is not captured by the myocardium
tricuspid valve located between
RA and RV
#1 sign of MI in elderly
SOB
pulm edema occurs ____ _____ due to
at night blood pulling in legs
common medications requiring bleeding precautions
abciximab tylenol aspirin apixaban (eliqus) plavix xarelto lovenox coumadin
standard therapy for HF is
ace and arbs
ACE and ARBS both block
aldosterone so you lose NA and H2O and retain K+
preload
amount of blood returning to the right side of the heart
stroke volume
amt of blood pumped out of the ventricles with each beat
percutaneous coronary intervention
angioplasty and stent
how do you take nitro SL
one every 5 min x 3 doses
when can sex be resumed after a CABG
one week to 10 days or walk up a flight of stair w/ no discomfort
what medications does a pt get when coming to the ED with chest pain
oxygen aspirin nitro morphine
failure to sense
pacemaker fires at inappropriate times
nitro with cause decrease _______ and _____
preload afterload
afterload
pressure in the aorta adn peripheral arteries that the left vent has to pump against to get the blood out
3 rhtyhms that are a big deal
pulseless vtach vfib asytole
check 5 p's
pulselssness pallor pain paresthesia paralysis
Echocardiogram can look at
pumping action or ejection fraction
diastolic think
relax/fill
chest pain after a percutaneous coronary intervention means
reocclusion
what releives angina
rest nitro SL
s/s of pulm edema
restlessness anxious serve hypoxia prductive cough that is pink frothy sputum
