medsurg chapter 48, cardiac
Blood flow through the cardiac valves:
"Tissue Paper My Assets" Tricuspid pulmonic Mitral aortic
What are causes of premature ventricular contractions?
Irritability of the ventricular musculature, exercise, stress, electrolyte imbalance, digitalis toxicity, hypoxia, MI
You are caring for a patient with a new pacemaker. Nursing care for this patient would include which of the following?
Monitoring the heart rate and rhythm by apical pulse and ECG patterns
Medication for MI?
Morphine, Oxygen, Nitroglycerine, ASA, Thrombolytic
Discuss the data significant to the diagnosis and management of a patient with a myocardial infarction that can be identified by a complete blood count:
Hemoglobin, WBC, RBC, increase hemoglobin unable to carry oxygen
A 72 years old patient is admitted to the medical floor with a diagnosis of HF. In HF an increase in abdominal girth, increase in total body weight, and pitting edema and indications of:
fluid retention
What are the signs and symptoms of right ventricular failure?
*Distended jugular veins *Anorexia, nausea, abdominal distention *Liver enlargement with right upper quadrant pain *Ascites *Edema in feet, ankles, sacrum, may progress up the legs into thighs, external genitalia, lower trunk.
Signs and symptoms Right side Heart failure?
*Distended jugular veins *Anorexia, nausea, abdominal distention *Liver enlargement with right upper quadrant pain *Ascites *Edema in feet, ankles, sacrum; may progress up the legs into thighs, external genitalia, lower trunk
What symptoms are associated with left ventricular failure?
*Dyspnea *Paroxysmal nocturnal dyspnea *Cough *Frothy, blood tinged sputum *Orthopnea *Pulmonary crackles *Radiographic evidence of pulmonary vascular congestion with pleural effusion
Interventions for Pericarditis?
*Maintain bed rest with head of bed elevated to 45degree *Monitor I & O *Provide planned rest periods.
What interventions would the nurse anticipate implementing for the patient with a diagnosis of myocardial infarction?
*Nitroglycerin *Antiplatelet *IV morphine *Maintain bed rest and reduced patient activity *Administer oxygen as prescribed * Record patient response to pain relief measure *Promote restful sleep pattern.
Signs and symptoms of pulmonary edema?
*Restlessness *Vague uneasiness *Agitation *Disorientation *Diaphoresis *Severe dyspnea *tachycardia *tachypnea *pallor or cyanosis *cough production of large quantities of blood tinged frothy sputum *Audible wheezing, crackles *cold extremities
What discharge teaching would be done for the patient with a new pacemaker?
*Wear medical alert identification *Carry pacemaker information *Avoid hazardous situations *Avoid high output electrical generators *Avoid large magnets such as MRI
Discuss the onset of rheumatic heart disease?
1-5 symptoms free weeks after recovery from pharyngitis or from scarlet fever
Nursing interventions for patients with pulmonary edema?
1. Administer medications as ordered 2. carefully monitor I/O 3. weigh pt at same time each day 4. assess for edema 5. assess for signs of hypoxia, such as restlessness disorientation, irritability
Which of the following is/are true statements regarding angina pectoris?
1. Angina indicates a lack of oxygen and blood supply to the heart 2. Angina may resemble heartburn or indigestion 3. Angina is usually relieved by nitroglycerin 4. Angina may appear as jaw pain
sinus tachycardia
100-150 bpm, causes exercise, anxiety, fever, shock, medications, HF, excessive caffeine, recreational drugs,, tobacco use
supraventricular tachycardia
150-250 bpm, causes drugs, alcohol, mitral valve prolapse, emotional stress, smoking, hormone imbalance
The diagnostic test that allows observation of real time movement via radiography is:
fluoroscopy
Atrial dysrhythmias
350-600 bpm, causes cardiac surgery, long standing hypertension, pulmonary embolism, atherosclerosis, mitral valve disease, HF, cardiomyopathy congenital abnormalities, chronic destruction, pulmonary disease, thyrotoxicosis.
sinus rhythm
60-100bpm, causes dysrhythmia
sinus bradycardia
< 60 bpm, causes endocrine disturbance, increased intracranial pressure, hypothermia, sleep, vomiting, intracranial tumors, MI, drugs, carotid sinus massage, vagal stimulation
Ventricular dysrhythmias
<100 bpm 140-240 bpm, causes hypoxemia, drug toxicity such as digitalis, quinitdine, electrolyte imbalance and bradycardia
tachycardia
>100bpm, rapid irregular rhythm originating in the SA node.
What is tachycardia?
>100bpm, rapid regular rhythm SA Node
What is the treatment for sinus bradycardia?
Atropine, pacemaker, management towards primary concern
Causes of pericarditis?
Bacteria, viral, fungal infection assoc with acute pericarditis. occurs as a complication of noninfectious conditions. Fibrosis of the pericardial sac develops in chronic form.
Which drug is most commonly used to treat PVC's?
Beta Adrenergic blockers, lidocaine
Polycythemia
Abnormal increase in the number of RBC in the blood
Pulmonary edema
Accumulation of extravascular fluid in the lung tissues and alveoli most often caused by HF.
What causes of myocardial infarction?
Atherosclerosis or an embolus
What complications of thrombolytic therapy would need to be monitored for the client?
Blood in stool, emesis, urine
what is the old term for heart failure?
CHF
What is the treatment for the patient with ventricular fibrillation?
CPR, defibrillation, lidocaine, procainamide
What interventions apply to the patient with infective endocarditis with the nursing diagnosis of activity intolerance related to general weakness?
Calm, quiet environment
A 67 year old patient has a diagnosis of hypertension. She is being dismissed from the hospital. He teaching should include:
Education on continuing to take antihypertensive medications are prescribed.
Sodium
Fluid balance
What is pericarditis?
Inflammation of the membranous sac surrounding the heart
What causes pericarditis?
Inflammation of the membranous sac surrounding the heart. Bacterial, viral, or fungal infection is associated with acute pericarditis.
What are causes of premature ventricular contractions (PVCs)?
Irritability of the ventricular musculature, exercise, stress, electrolyte imbalance, digitalis toxicity, hypoxia, MI
signs, symptoms, medical management of pericarditis?
Muscle aches, fatigue, dyspnea, excruciating chest pain, elevated temp., non productive cough, anxiety, rapid and forcible pulse, rapid and shallow breathing, pericardial friction rub heart sounds become muffled.
During the care of a patient on anticoagulant therapy, what laboratory values should be monitored?
PT, INR, PTT
What types of evaluations are performed on a potential candidate for cardiac transplant?
Patient most beneficial from new heart. Physical exam and psychological assessment of candidates is valuable.
What is the main goal of treatment for a patient with rheumatic fever?
Preventive antibibiotics "Pencillin"
Medical management or rheumatic heart disease?
Preventive measures, rapid treatment for pharyngeal infection. bed rest, NSAIDS, well balanced diet
In what population may homocysteine screening be beneficial?
Progressive and unexplained atherosclerosis, unusual family history of atherosclerosis, especially at a young age
Valve flaps prevent the backflow of blood from the pulmonary artery into the:
Right Ventricle
Trace the impulse pattern of the cardiac conduction system.
SA node-AV node-Bundle of His-Right and left bundle branches-Purkinje fibers
Your patient was admitted yesterday for a myocardial infarction. Select the following statement that is true regarding treatment for a patient with MI.
The patient with an acute myocardial infarction will be on bedrest with commode privileges for 24-48 hours.
What is the endocardium made up of?
Think layer of connective tissue in heart that lines chambers and valves.
orthopnea
an abnormal condition in which a person must sit or stand to breathe deeply or comfortably
hypoxemia
an abnormal deficiency of oxygen in the arterial blood.
Which cardiac markers is specific to the heart. not influenced by skeletal muscle trauma or renal failure, and rises 3 hours following a myocardial infarction??
Troponin I
____________ is a myocardial muscle protein released into circulation after myocardial injury and is useful in diagnosing a myocardial infarction.
Troponin I
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.
The blood that is pumped out of the left ventricle contains:
a full supply of oxygen
Pleural effusion
abnormal accumulation of fluid in the thoracic cavity between the visceral and parietal pleurae
List factors that are use to determine donor matching?
body and heart size and ABO type
What are common signs and symptoms of heart failure?
decreased cardiac output; left ventricular failure; right ventricular failure, weight gain, restlessness
dysrhythmia
cardiac rhythm that deviates from normal sinus rhythm
What condition is most commonly the underlying cause for cardiac transplantation?
cardiomyopathy
A 10 year old patient is diagnosed of hypertension. She is being dismissed from the hospital. Her teaching should include:
carditis
heart failure
circulatory congestion as a result of the hearts inability to act as an effective pump.
coronary artery disease
conditions that obstruct blood flow in coronary arteries
What is the endocardium made up of?
connective tissue
Calcium
contract cardiac muscle
ischemia
decreased blood supply to a body organ or part often marked by pain and organ dysfunction
The normal period in the heart cycle during which the muscle fibers lengthen, the heart dilates and the cavities fill with blood, roughly the period of relaxation, is called:
diastole
Risk factors for endocarditis?
endocarditis occurs after intrusive procedures such as dental procedures, minor surgery, gynecologic exam, or insertion of indwelling urinary catheters.
The interior lining of the heart, the valves, and the large vessels of the heart are together called the:
endocardium
Aneurysm
enlarged, dilated portion of an artery that is more than 1 1/2 the artery's circumference.
sign and symptoms of rheumatic heart disease?
fever, increased pulse, epistaxis, anemia, joint involvement, nodules or joints and subcutaneous tissue may be noted. Carditis can develop
Modifiable risk factors for coronary artery disease includes:
high cholesterol, obesity
In evaluating your patients risk factors for cardiovascular disease, you identify that the following is a modifiable risk factor that he possesses:
hyperlipidemia
In the united states, the two beta blocker medications specifically approved for heart failure are carvedilol and:
long acting metoprolol (Toprol X-L)
magnesium
maintain electrical excitability
How is angina pectoris managed?
nitrates, beta blockers, calcium channel blockers, oxygen therapy, ECG monitoring, aspirin for unstable angina
When a patient is receiving heparin therapy, the nurse should:
observe emesis, urine, and stools for blood
occlusion
obstruction or closing off in a canal, vessel, passage of the body
myocardial infarction
occlusion of a major coronary artery or one of its branchea with subsequent necrosis of myocardium caused by atherosclerosis or an embolus
What is the pericardium?
outermost layer of the heart
Medications used in the medical management of heart failure?
oxygen, Morphine, nitro, ASA, ACE inhibitors, diuretics, beta blockers, prevention and treatment of complications, anticoagulant to prevent further clotting
Angina pectoris
paroxysmal thoracic pain and choking feeling caused by decreased oxygen or anoxia of myocardium
peripheral
pertaining to the outside, surface, or surrounding area
bradycardia
rate < 60bpm, slow rhythm originate SA node
cardioversion
restore of normal sinus rhythm by electric shock
What causes rheumatic heart disease?
result of rheumatic fever and the clinical manifestation of carditis resulting from an inadequately treated childhood pharyngeal or upper respiratory tract infection.
Dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein distention, and abdominal distention are signs and symptoms of:
right sided heart failure
What are the modifiable risk factors for cardiovascular disease?
smoking, hyperlipidemia, hypertension, diabetes mellitus, obesity, sedentary lifestyle, stress, psychosocial factors
What are causes of bacterial endocarditis?
strep
What causes of bacterial endocarditis?
strep
The right atrium receives blood from the:
superior and inferior venae canvae and coronary sinus
What does an elevated CK-MB level signify?
surgery, muscular disease, muscle trauma
defibrillation
termination of ventricular fibrillation by delivering a direct electrical counter shock to patients precordium.
endarterectomy
the surgical removal of the intimal lining of an artery
arteriosclerosis
thickening, loss of elasticity and calcification of arterial wall, resulting in a decreased blood supply
Why is Nitroglycerin used to treat angina?
vasodilator, increase blood flow
Of the following, which is the most serious type of dysrhythmia?
ventricular fibrillation
intermittent claudication
weakness of the legs accompanied by cramping like pains in the calves caused by poor circulation of the arterial blood to the leg muscles
Atherosclerosis
yellowish plaques of cholesterol lipids, cellular debris in the inner layers of the walls of large and medium arteries
