Chapter 19 Care of Patients with Cardiac Disorder

A nurse answers the call light of a patient admitted with HF. The patient states that they are short of breath and appears to be in distress. Identify the nursing actions in priority order

Raise the head of the bed. Apply supplemental oxygen. Check vital signs. Listen to lung sounds. Notify the health care provider.

effusion

accumulated fluid in pericardium

class D HF

advanced disease needing ongoing tx

cardiac dysrhythmias

alterations in the conduction of cardiac electrical impulses that create heart rate and rhythm, caused by disruption of the normal electrical conduction in the heart resulting in abnormal heart rhythm, may be caused by congenital abnormalities, electrolyte disturbance, too much caffeine, drug use, stress, med side effects, valvular disorders, thyroid problems, infective endocarditis, problems in ANS

factors that can precipitate HF

anemia, systemic infection/sepsis, MI, ischemia, pulm embolism, uncontrolled htn, thyroid disorders, dysrhythmias, pericarditis, myocarditis, endocarditis, chronic pulm disease, physical, emotional or environmental stress

pt teaching with ICDs

avoid exposure to strong magnetic fields, microwaves. generators, electrical transmitters, handheld security devices at airports, arc welding equipment, dont lean over alternator of running car or boat motor

mitral regurgitation/insufficiency

backflow of blood into LA occurs as ventricle contracts, more women then men get this disorder, rheumatic heart disease main cause but also papillary muscle ruptures from ischemic heart disease, congenital anomaly, IE, fibrosis, calcification

takotsubo cardiomyopathy

"broken heart syndrome or stress cardiomyopathy" occur abruptly in pts with no underlying cardiac disease, s/s similar to MI, dx when left heart cath is performed, no coronary blockages found, EF reduced, dysfunction of LV, images obtained from LV show a shape similar to japanese octopus trap, dysfunction believed to be caused by increase in circulating hormones such as adrenalin that are released with stress, most pts recover without long term consequence

What is true about HF in America? Select all that apply. a) Cardiac dysrhythmias can contribute to HF. b) Approximately 1 in 100 people will develop HF. c) African Americans have a higher incidence of HF. d) Most patients diagnosed with HF will die within 3 years. e) HF is defined as a potentially fatal irregular heart rhythm.

a) Cardiac dysrhythmias can contribute to HF. b) Approximately 1 in 100 people will develop HF. c) African Americans have a higher incidence of HF.

A nurse is assessing a patient with right-sided heart failure. What assessment finding is the nurse most likely to find? a) Edema in the lower extremities b) Edema in the upper extremities c) Edema in the face and neck d) Crackling sounds

a) Edema in the lower extremities

systolic failure

caused by anything that interferes with ejection of blood from the ventricles, muscle dysfunction, problems from MI, dilated cardiomyopathy and aortic or pulm stenosis can lead to systolic failure

ventricular fibrillation/VF

chaotic random firing of all ventricular cells, no cardiac output, CPR needed, death may result, no pulse and no bp

heart block

conduction problems, electrical signal is stopped

The patient is being discharged following a mitral valve replacement and will be prescribed the anticoagulant warfarin. Which food should the nurse instruct him to avoid? a) Bananas b) Dairy products c) All meat products d) Green leafy vegetables

d) Green leafy vegetables

class 3 HF

dyspnea and fatigue with short distance walking or climbing 1 flight of stairs

class 4 HF

dyspnea at rest or with very little activity

external pacemaker

electricity passed through chest wall via external pads

cardiac tamponade

excessive fluid in pericardium

pericardiocentesis

fluid extracted

cardiomyopathy

group of diseases that affect the structure or function of the heart, increase risk with htn, chronic excessive alcohol intake, pregnancy, systemic infection -tx: digoxin, antihypertensives, diuretics, antiarrhythmics, anticoagulants, heart transplant

permanent pacemaker

implanted for SA node dysfunction, heart block or tx of chronic HF,

first degree heart block

impulse conduction between the atrium and ventricle is lengthened, often occurs after open heart surgery or MI, use of digoxin, calcium channel blocker and beta blockers,

hypertrophic cardiomyopathy

increased growth of LV muscle, may be hereditary or caused by htn or hypoparathyroidism, sudden death may occur

right sided HF

increased pump pressure is needed to eject blood into pulm arteries, myocardium of RA and RV become thick and contraction weakens. caused by chronic pulm disease, pulm stenosis, pulm htn, severe emphysema, right ventricular MI

supraventricular tachycardia/SVT

rhythm that originates in or above the bundle of his, causes atrial flutter, afib, atrial tachycardia, junctional tachycardia, HR >150

restrictive cardiomyopathy

stiffened ventricles prevent relaxation after systole affecting ventricular filling, caused by amyloidosis, sarcoidosis, progresses to right sided HF, least common

stage B HF

structural heart disease present, no HF symptoms

left sided HF

typically occurs first. weakness of the LV resulting in reduced cardiac output with backup of blood into the atrium and pulm system. caused by htn, CAD, MI, mitral or aortic valvular disease

temporary transvenous pacemaker

used if theres heart block after MI or drug toxicity, inserted local anesthesia via fluoroscopy, pt consent required, sedative given

pacemakers

used to treat bradycardia, postop monitor heart rhythm, bp and temp, monitor for hematoma formation at site insertion, battery should last 6-9 years

mitral stenosis

valve leaflet thickening and calcification causes stiffening, causes backup pressure in lungs and right sided HF, caused by rheumatic fever, lupus, RA,

mitral valve prolapse/MVP

valve leaflets and tendonlike cords supporting the valve weaken and prolapse into the LA during systole, benign condition

right sided heart failure s/s

weight gain, dependent pitting edema, liver enlargement, jugular venous distention, reduced urinary output, fatigue, sacrum, feet, legs, ankle edema, abdominal distention, dyspnea, loss of appetite, nausea, increased bp

pericardiotomy

window created in pericardium

tx of valve disorders

yearly monitoring, drug therapy, heart surgery, valve replacement, diuretics, beta blockers, digoxin, oxygen, rest, surgery (reparative procedures, balloon valvuloplasty, valve replacement)

guidelines for a heart healthy diet

reduce foods high in saturated fat, trans fat and cholesterol, limit meat intake, eat pasta, rice, beans, veggies, lean meat, poultry, fish, reduce intake of liver, brains, chitterlings, kidney, gizzards and sweetbreads, cook using broil, bake, roast, poach, stir fry, microwave or steaming, trim fat off meat nd after browning meat drain off fat, chill soups or stews, use olive, canola, corn or safflower oil, eat fish 2x/wk (salmon, mackerel, tuna), eat 5-7 servings of fruits and veggies per day, increase fiber and carbs (whole grains, cereals, breads), use skim or 1% fat milk or nonfat or low fat yogurt, cheese or ice cream, limit consumption of egg yolk to 3-4/wk, eat less then 1500mg of salt per day, limit alcohol consumption to 1 drink per day for women and 2 per day for men

The delivery of a mild electrical shock at a specific time of the cardiac cycle to interrupt an abnormal rhythm and to possibly initiate a normal rhythm is which of the following? 1. Synchronized cardioversion 2. Defibrillation 3. Pacemaker initiation 4. Electrophysiology study

1. Synchronized cardioversion

The nurse is about to administer the first dose of torsemide (Demadex) to a patient diagnosed with congestive heart failure. Common drug reactions include: (Select all that apply.) 1. shortness of breath. 2. chest pain. 3. hypoglycemia. 4. lightheadedness. 5. hypertension.

1. shortness of breath. 2. chest pain. 4. lightheadedness.

After pacemaker implantation, it is important to teach the patient to: 1. stay away from microwave ovens. 2. count their pulse regularly. 3. refrain from swimming. 4. use a safety razor to shave.

2. count their pulse regularly.

mitral stenosis s/s

pulm pressure, pulm congestion, RV hypertrophy, dyspnea on exertion, paroxysmal nocturnal dyspnea, palpitation of afib, dry cough, murmur

heart failure dx

ECG, chest xray, MRI, electrolyte/CBC, BNP

cardiac dysrhythmia tx & dx

ECG, pt hx, drug therapy, synchronized cardioversion, pacemakers, implantable cardiac defibrillators/ICDs, radiofrequency catheter ablation

pt teaching with pacemaker

avoid lifting arm away from the body on the pacemaker side until provider says you can progress to normal activity, keep incision dry for 4 days postop, check for redness, swelling, drainage or fever and report immediately, refrain from activity that may cause direct blow to pacemaker, stay away from high output electrical generators or large magnets, monitor pulse daily, wear medical alert bracelet, keep follow up appts, microwaves are safe to use, airport security screening doesnt cause problems, use cellular or cordless phones on opposite ear of pacemaker

A patient reports a history of severe mitral valve disorder. What sign or symptom does the nurse expect to find? a) Hypotension b) Exertional dyspnea c) Digestive problems d) A widening pulse pressure

b) Exertional dyspnea

The nurse is caring for a patient with cardiomyopathy. Which assessment finding should alert the nurse to worsening of the condition? a) Hypotension b) Increasing dyspnea c) An audible heart murmur d) Signs and symptoms of infection

b) Increasing dyspnea

The _______________ is the heart's natural pacemaker. a) Purkinje fibers b) SA node c) bundle of His d) AV node

b) SA node

Which dysrhythmia will definitely result in death without cardiopulmonary resuscitation (CPR)? a) Atrial fibrillation b) Ventricular fibrillation c) Ventricular tachycardia d) Premature ventricular contractions (PVC)

b) Ventricular fibrillation

A patient was recently diagnosed with atrial fibrillation. What medication would the nurse expect the patient to be prescribed? a) Furosemide (Lasix) b) Warfarin (Coumadin) c) Aspirin d) Nitroglycerin

b) Warfarin (Coumadin)

infective endocarditis

infection of the endocardial surface of heart, inflamed tissue becomes rough and swollen and traps organisms which may cause damage to valves and arterial emboli, caused by bacteria, viruses, fungi, dental procedures, skin, surgery or invasive procedures, infections in body, IV drug use (bacteria found in mouth responsible for up to 50% of cases, regular dental care important) -tx: antibiotics for 4-6wks, pain meds, NSAIDs

pericarditis

inflammation of pericardium, caused by cancer and cancer tx, systemic connective tissue disease, infectious organisms, renal failure, trauma, tissue damage from MI. may cause effusion, cardiac tamponade, friction rub, dresslers syndrome, pulsus paradoxus (drop in systolic bp) -dx: pericardiocentesis, pericardiotomy, h&p, ECG, echo, MRI, CT scan, CBC

atrial fibrillation/Afib

irregular HR, tachycardia, causes lightheadedness, decreased bp, clammy skin, can occur with HF, CAD, hyperthyroidism or COPD

ventricular tachycardia/VT

life threatening dysrhythmia, generated from one or more focal points in the ventricle (120-200bpm), pt may be pulseless, caused by ischemia

synchronized cardioversion

mild electrical shock delivered to heart to interrupt abnormal rhythm, pt given sedative, signed consent required

cardiac valve disorders

mitral and aortic are most common, tricuspid problems usually from IV drug use and rheumatic fever, pulmonic stenosis is congenital. untreated htn, congenital abnormalities, MI and IE can cause valve disorders

implantable cardioverter defibrillators/ICD

monitor heart beat and provide electrical shock, used for pts who have an episode of life threatening dysrhythmia, cardiomyopathy, decreased EF

heart failure

most common cause is CAD and uncontrolled htn, congestion develops because the heart is unable to move the amount of blood it receives efficiently through the system, vessels cant accommodate a normal supply of blood causing the heart muscle to become exhausted trying to overcome the resistance/pressure in the vessels, african americans more prone, also caused by weakness of heart from cocaine, alcohol, chemo drugs, NSAIDs, cardiac dysrhythmias, infection, anemia, myocarditis, damage from MI, dilation from blook backup behind diseased valves

class 1 HF

ordinary physical activity with no symptoms

aortic regurgitation s/s

dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturnal angina, diaphoresis, palpitations when lying on left side, bounding pulse, murmur

class 2 HF

dyspnea with long distance walking, climbing 2 flights of stairs or strenuous activity

cardiomyopathy s/s

dyspnea, activity intolerance, angina, dizziness, htn, palpitations

premature junctional contractions/PJC

early junctional beats, caused by irritability of tissue

infective endocarditis s/s

elevated leukocytes, low grade fever, enlarged spleen, thin black lines/splinter hemorrhages under nails, petechiae inside mouth, conjunctivae and above clavicles, fatigue, chills and sweats, malaise, anorexia, muscle aches, headache, cardiac dysrhythmia, murmur, sharp stabbing chest pain, stenosis of valve leaflets, mitral and aortic valves affected

dilated cardiomyopathy

extensive enlargement of ventricles with impairment in contractions, caused by chemotherapy, alcohol abuse, infection, inflammation, poor nutrition, connective tissue disorders, advances to HF

left sided heart failure s/s

fatigue and sob with activity when lying down, dyspnea, wheezing, orthopnea, sleep apnea, pulm edema, pink frothy sputum, pallor, clammy skin, dry hacking cough, crackles in lungs, diminished peripheral pulses, dizziness, confusion, restlessness, difficulty concentrating and remembering, tachycardia, extra heart sounds, decreased bp

mitral regurgitation s/s

fatigue, weakness, reduced cardiac output, dyspnea on exertion, orthopnea, palpitations, anxiety, atypical chest pain, afib, murmur, third heart sound

pericarditis s/s

fever, tachycardia, chest pain, dyspnea, friction rub, malaise, fatigue, restlessness, muffled heart sounds, anxiety, confusion, distended neck veins,

premature atrial contractions/PAC

happens when ectopic electrical focus fires before next SA node impulse is due, depolarizes the atria, common, no symptoms, results from SNS stimulation (anxiety, hypoxia, ischemia)

A patient has HF and atherosclerosis. Which patient statement regarding healthy food choices demonstrates a need for further teaching? 1. "I can have an egg two to three times per week." 2. "I need to watch my red meat intake but can have all the cheese I want." 3. "I should read labels to see how much sodium and fat a serving contains." 4. "Canned goods are often high in sodium."

2. "I need to watch my red meat intake but can have all the cheese I want."

A 48-year-old patient is admitted for tachycardia, shortness of breath, and chest pain eased by sitting up and leaning forward. You auscultate a high-pitched scratchy sound at the left sternal border of the chest. The patient most likely has: 1. heart failure. 2. pericarditis. 3. pneumonia. 4. aortic stenosis.

2. pericarditis.

The patient asks you, "Why am I taking lisinopril (Zestril)?" An accurate response would be: 1. "The medication increases the force of contraction of the heart." 2. "The medication increases the heart rate." 3. "The medication helps prevent vasoconstriction." 4. "The medication causes excretion of extra fluid."

3. "The medication helps prevent vasoconstriction."

While discussing HF with a student, a nurse explains that the underlying weakness of the left ventricle results in reduced cardiac output and backup of fluid in the pulmonary system. The student nurse anticipates which sign or symptom? 1. Edema in the sacrum, legs, feet, and ankles 2. Hepatomegaly 3. Crackles in the lungs 4. Ascites

3. Crackles in the lungs

You explain the importance of reducing salt in the diet to a Hispanic man who was recently diagnosed with HF. The relatives are at the bedside with the patient. An appropriate nursing action would be to: 1. involve the youngest male in the family to translate. 2. ensure patient privacy by directing the relatives out of the patient's room. 3. determine who does the cooking in the family. 4. include all relatives in the diet teaching.

3. determine who does the cooking in the family.

Which assigned patient would take priority for immediate attention? 1. A patient with infective endocarditis who has an antibiotic dose due 2. A patient awaiting aortic stenosis surgery who is complaining of pain 3. A patient with systolic HF whose weight is up 1.5 lb today 4. A patient with dysrhythmia whose heart rate has dropped to 42 bpm and who is dizzy

4. A patient with dysrhythmia whose heart rate has dropped to 42 bpm and who is dizzy

A patient is admitted with a cardiac dysrhythmia. The morning laboratory values show potassium as 6.1 mg/dL. What action is most important to take first? 1. Encourage intake of extra fluid. 2. Notify the health care provider immediately. 3. Check the breakfast tray for sodium-containing foods before serving. 4. Check the patient's vital signs.

4. Check the patient's vital signs.

aortic stenosis s/s

LV hypertrophy, cardiac output decreases, systolic HF, pulm congestion, dyspnea, angina, syncope on exertion, severe fatigue, weakness, peripheral cyanosis, murmur

The LPN/LVN is evaluating the patient's electrocardiogram (ECG) rhythm strip and notes the distance between the P waves are the same. Which interpretation by the nurse of this ECG is correct? a) The heart rate is regular. b) There are premature atrial beats. c) The rhythm of the heart is regular. d) There are premature ventricular beats.

a) The heart rate is regular.

Any patient experiencing chest pain is started on ________________. a) low-dose oxygen b) furosemide (Lasix) c) calcium-channel blocker d) digitalis

a) low-dose oxygen

Automatic implantable cardiac defibrillators (AICDs) are used for patients who have repeated episodes of a) ventricular fibrillation. b) atrial fibrillation. c) sinus bradycardia. d) sinus tachycardia.

a) ventricular fibrillation.

When providing education to a patient diagnosed with heart failure, the nurse should instruct the patient to a) weigh him- or herself daily on the same scale at the same time of day. b) weigh him- or herself weekly on the same scale at the same time of day. c) weigh him- or herself monthly on the same scale at the same time of day. d) not weigh him- or herself.

a) weigh him- or herself daily on the same scale at the same time of day.

aortic stenosis

aortic valve opening narrows and obstructs LV outflow during systole, most common valve disorder in U.S., congenital valve malformations and rheumatic fever are causes in younger pts,

MVP s/s

asymptomatic, chest pain, palpitations, exercise intolerance, fainting

stage A HF

at risk for heart failure but no heart damage

cardiac dysrhythmia s/s

bradycardia, tachycardia, dizziness, palpitations, chest pain, hypotension, LOC, death, fatigue

What makes a person most susceptible to infective endocarditis? a) Antineoplastic therapy b) Untreated tuberculosis (TB) c) Untreated group A Streptococcus d) Premature ventricular contractions

c) Untreated group A Streptococcus

A heart rate greater than 120 beats per minute is called a) bradycardia. b) premature ventricular contractions. c) tachycardia. d) ventricular fibrillation.

c) tachycardia.

third degree heart block

complete heart block, AV node doesnt conduct atrial impulses to ventricles, cardiac output decreases drastically, life threatening

second degree heart block

considered benign, impulses not conducted to the ventricles, causes a pause in rhythm, occurs from use of digoxin, calcium channel blockers, beta blockers, electrolyte imbalance, addison disease, endocarditis, ischemia

A patient who has heart failure (HF) has been prescribed a digitalis preparation. The patient asks the nurse how this medication will help his HF. Which response by the nurse is correct? a) "The medication increases the heart rate." b) "The medication decreases cardiac output." c) "The medication decreases the diameters of the arteries." d) "The medication increases the force of the heart contraction."

d) "The medication increases the force of the heart contraction."

The nurse is caring for a patient who was diagnosed with aortic valve stenosis. What would indicate that the patient's stenosis is worsening? a) Angina b) Syncope c) Dyspnea d) Peripheral cyanosis

d) Peripheral cyanosis

The nurse is assessing the patient who has been taking digoxin for the past 2 months. Which assessment finding would alert the nurse that the patient may be experiencing digitalis toxicity? a) The patient reports feeling fatigued. b) The patient's heart rate is 54 beats/min. c) The patient has edema in the feet and ankles. d) The patient reports frequent nausea and diarrhea.

d) The patient reports frequent nausea and diarrhea.

Which of the following dysrhythmias is considered life threatening? a) Atrial fibrillation b) Sinus bradycardia c) Sinus tachycardia d) Ventricular fibrillation

d) Ventricular fibrillation

When a nurse auscultates the lungs of a patient with left-sided heart failure, she will most likely hear a) clear breath sounds. b) diminished breath sounds. c) wheezing sounds. d) crackling sounds.

d) crackling sounds.

heart failure tx

identify and treat underlying cause, surgery, ACE inhibitors. goals are reduce demand for o2 and workload of heart, strengthen pumping action, relieve venous congestion in lungs, minimize sodium and water retention in tissues

premature ventricular contraction/PVC

no P wave and wide QRS complex, apical and radial pulse deficit may be detected, caused by caffeine, drug use, increased emotional stress, hypoxia, hypokalemia and myocardial ischemia

diastolic failure

occurs when conditions prevent the filling of the heart with blood, tricuspid and mitral stenosis, cardiac tamponade or constrictive cardiomyopathy can cause diastolic failure

class C HF

past or present HF symptoms

radiofrequency catheter ablation

pinpoints irritable focus, destroys irritable focus via heat and subsequent scarring, may affect normal conduction system resulting in permanent pacemaker

systolic and diastolic failure

problems occur in either the filling or ejection phase of the cycle, determine EF with echo or left heart cath and is a key feature in determining the correct tx

teaching for pt taking warfarin/coumadin

take med same time each day, keep appts for INR tests, take missed dose as soon as you remember, dont double up on dose, check all meds (OTC, herbs) for interactions, wear a medical alert bracelet, tell all medical personnel you take warfarin, eat foods with vitamin K (asparagus, beans, broccoli, brussel sprouts, cabbage, spinach, cauliflower, kale, mustard greens, fish, rice, yogurt), avoid alcohol more then 1-2 drinks/per day, use electric razor, use soft toothbrush, blow nose gently, report unusual bleeding or bruising, report signs of intestinal bleeding or urine in blood

aortic regurgitation/insufficiency

valve leaflets dont close properly during diastole allowing backflow of blood from aorta into LV. IE, congenital abnormalities, long term htn, marfan syndrome are factors in this disorder,