Medsurg 2 Test 1

PAD: Intermittent Claudication

Ischemic muscle ache or pain that is precipitated by a constant level of exercise Resolves within 10 minutes or less with rest Reproducible

Pulonary Edema TX

LMNOP Lasix Morphine Nitrates O2 Position( upright)

HTT cardio

LOC, mucus membranes, PEERLA, JVD, Carotid (bilateral, bruit) Resp effort, Pulses, cap refill

LEFT SIDED HEART FAILURE

Left =Lung -most common -blood backs up into left atrium and pulmonary veins -Pulmonary congestion and edema

Aortic dissection CM: PAIN

Pain characterized as: Sudden, severe pain in anterior part of chest, or scapular pain radiating down spine to abdomen or legs, Described as "sharp" and "worst ever", May mimic that of MI

5 P's of assessment

Pain... Pulselessness... Paresthesia... Pallor... and. Paralysis

A client has been admitted to the coronary care unit. The nurse observes third-degree heart block at a rate of 35 bpm on the client's cardiac monitor. The client has a blood pressure of 90/60 mm Hg. What should the nurse do first?

Prepare for transcutaneous pacing.

A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation?

Rehabilitation will help me function as well as I physically can."

RIGHT SIDED HEART FAILURE

Right=REST OF BODY -blood backs up in right atrium and rest of body circulation -fatigue -ascites -enlarged liver and spleen -JVD -secondary pulmonary problems -weight gain

Atrial Flutter -increased risk of -tx

Saw tooth like - increased risk of stroke -Ca channel blocker or beta blocker, cardioversion, ablation

serum cardiac markers after MI

Troponin, CK-MB, Myoglobin

True vs false Aneurysm

True aneurysm: Wall of artery forms the aneurysm, At least one vessel layer still intact, False aneurysm-Disruption of all layers of arterial wall, Results in bleeding contained by surrounding structures

Treating congestive heart failure: UNLOAD FAST

Upright position Nitrates Lasix Oxygen ACE inhibitors Digoxin Fluids (decrease) Afterload (decrease) Sodium restriction Test (Dig level, ABGs, potassium level)

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as

a third heart sound (S3).

Two risk factors for coronary artery disease that increase the workload of the heart and increase myocardial oxygen demand are

a.Hypertension and cigarette smoking.

PAD risk in diabetic

a1c above 7.0

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of

acute pulmonary edema.

Stroke volume

amount of blood ejected with each contraction

Ascending aorta/aortic arch aneurysms CM

angina, hoarseness, if presses on Superior vena cava causes decreased venous return and distended neck veins with edema of face and arms

During a shift report for a client with heart failure, the nurse going off shift reports that the client had sinus bradycardia during the shift and a creatinine of 3.5 mg/dL. Which action does the nurse perform when administering digoxin to this client?

assess digoxin level

A client is admitted to the hospital through the emergency department with chest pain. Which intervention is the priority?

assessing troponin 1 levels

Normal BNP

below 100

AORTIC DISSECTION W NO SYMPTOMS

can be treated conservatoively for a period of time: pain relief and BP control

Stable angina further tx Key to localize cad

cardiac catheter, angiography

Aortic dissection complications

cardiac tamponade, aorta rupture

A client has atrial fibrillation. The nurse should monitor the client for which condition?

cerebrovascular accident

Systole Diastole

contraction relaxation

Vagus nerve stimulation

decreases heart rate

MAnagement of CAD

diet, excersice to lower lipid, if ineffective, pharm amanagement: STATINS and ANTIPLATELET

An older adult is admitted to the hospital with nausea and vomiting. The client has a history of heart failure and is being treated with digoxin. The client has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for:

dig toxicity

A nurse is awaiting the arrival of a client from the emergency department with a diagnosis of anterior wall myocardial infarction. In caring for this client, the nurse would be alert for which signs and symptoms of left-sided heart failure? Select all that apply.

dyspnea, crackles, tachycardia

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?

elevated ST segment

MYOCARDITIS cm

fever, fatigue, malaise, pericardial friction rub -late S/S HF (s3, crackles, JVD, peripheral edema, angina)

Chronica heart failure edema weight gain to watch for

gain of more than 3lb in 2 days

Prior to administering tissue plasminogen activator (t-PA), the nurse should assess the client for which contradiction to administering the drug?

history of cerebral hemorrhage

Assessment of Cardiovascular System- subjective

hx, medications, surgery hx, functional health patterns

postprandial hypotension

hypotension after eating by 20 mmhg

Surgical therapy for aortic aneurysm

if ruptures, emergent intervention required -in AAA ruptures, 90% mortality

The nurse is caring for a client in the coronary care unit when the cardiac monitor reveals ventricular fibrillation. The nurse should anticipate which intervention?

immediate defibrillation

How common are dysrhythmias in MI pt?

in 80%

A nurse is performing a cardiac assessment on an elderly client. Which finding warrants further investigation?

irregularly irregular heart rate

Pulonary Edema

life threatening situation, alveoli filled with fluid

Ventricular failure leads to

low BP, poor perfusion, decreased ejection fraction

CM Infective endocarditis

low grade fever, chills, weakness, malaise, fatigue, anorexia, myalgias, back pain, abdominal discomfort, headache, clubbing, splinter hemorrhages in nail bed, petechiael oldernodes, janeways lesions, roth spots, murmur, heart failure

Pt teaching with chronic heart failure

meds, daily weights, watch vitals, heart healthy diet and low salt, no smoking, weight management

ACUTE CORONARY SYNDROME continuued tv

monitor close for bleeding if on thrombolytics, assess reperfusion and return of ST segment to baseline, IV hep to prevent reocclusion

PAD complications

nonhealing arterial ulcers and ganegrean, can lead to sepsis and amputation

A client is diagnosed with myocardial infarction. Which data collection findings indicate that the client has developed left-sided heart failure? Select all that apply.

orthopnea, crackles, cough

MYOCARDIAL INFARCTION CM: PAIN

pain -severe, not alleviated with rest, more common in morning, substernal, retrosternal, epigastric, atypical in women and elderly, _NO PAIN IF DIABETIC NEUROPATHIC

PAD: CM

pain at rest, atrophy of skin and muscles, ulcers, tissue necrosis, wound infection

afterload

periph resistance the left ventricle must pump against

MAP

pressure/perfusion the organs actually feel (NORMAL GREATER THAN 60)

Baroreceptors

regulate cardiovascular system, sensitive to pressure, in aortic arch, carotid sinus

Aortic Anneurysm Rupture

serious complication -bleeding into retroperitoneal space, severe back pain, MAY OR MAY NOT HAVE BACK ECCHYMOSIS

AAA

spontaneous embolize plaque causes blue toe syndrome

After receiving the shift report, a registered nurse in the cardiac step-down unit must prioritize the client care assignment. The nurse has an ancillary staff member available to help care for the clients. Which of these clients should the registered nurse assess first?

the client with heart failure who is having some difficulty breathing

Serum lipids

triglycerides

A client is to have a treadmill stress test. Prior to the stress test, the nurse reviews the results of the laboratory reports. The nurse should report which elevated laboratory value to the health care provider (HCP) before the stress test?

troponin level

The nurse is admitting a client with substernal chest pain. Which diagnostic tests does the nurse anticipate the client will receive to confirm or rule out a diagnosis of myocardial infarction (MI)? Select all that apply.

troponin, myglobin

Assessment of Cardiovascular System- Objective data

vital signs, physical exam, PULSES, bruit, PETM, thorax,

Preload

volume of blood in ventricle at the end of diastole

Excercise therapy with PAD

walking 30-60 min daily 3x/week

The nurse is teaching a client with a demand pacemaker. What should the nurse tell the client about how the device functions by providing stimuli to the heart muscle:? The pacemaker will provide a stimulus:

when the heart rate falls below a specified level.

aortic aneurysm risk factors

§Age §Male gender §High blood pressure (BP) §Coronary artery disease §Family history §High cholesterol §Lower extremity PAD §Carotid artery disease §Previous stroke -tobacco use -obesity -white and native american

Arteries PAD affects

§Iliac artery §Femoral artery §Popliteal artery §Tibial artery §Peroneal artery HArd time for blood to get to leg

PAD risk factors

§Tobacco use §Hyperlipidemia §Hypertension §Diabetes mellitus

H & T s

•Hypovolemia •Hypoxia •Hydrogen ion (acidosis) •Hyper-/hypokalemia •Hypoglycemia •Hypothermia •Toxins •Tamponade (cardiac) •Thrombosis (MI and pulmonary) •Tension pneumothorax •Trauma

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement?

"I sleep on three pillows each night."

An obese male client with history of heart failure is prescribed a beta blocker. Which of the following is important to teach regarding home drug therapy? Select all that apply.

"Take your medication at the same time daily." "Contact the health care provider if you have difficulty getting or maintaining an erection." "Change positions between sitting and standing carefully. "Check your pulse for a full minute before administering your medication."

Which client statement should the nurse evaluate as indicating the client's correct understanding of the causes of coronary artery disease (CAD)?

"The leading cause of CAD is atherosclerosis.

A FIB -what is it, common? increased in? -what does it cause? -Most at risk for -Treatment

- no p wave with erratic fibrillation waves, most common, increased prevalence with age -causes decreased CO -STROKE!!!!!!!! STROKE ALERT -Medication to revert to correct ventricular rate (Beta blockers, digoxin, ca channel block, amiodarone -anticoagulation

Acute coronary syndrome protocol

-12 lead ecg -semi fowlers -O2 -IV access -Nitroglycerin SL and ASA chewable -morphine -statin

MYOCARDITIS TX

-ACEI, Beta blockers, digoxin, immunosuppresants, bed rest, IVABP, VAD, - most recover spontaneously, some develop cardiomyopathy

Pulmonary Edema CM

-Anxious, pale, cyanotic -Cool and clammy skin -Dyspnea -Orthopnea -Tachypnea -Use of accessory muscles -Cough with frothy, blood-tinged sputum -Crackles, wheezes, rhonchi -Tachycardia

Aortic Dissection initial goal

-Decrease BP and myocardial contractibility to diminish pulsatile forces within aorta **HR LESS THAN 60 **SBP BELOW 100-110

Unstable andgina and MI Diagnostic

-EKG: Q wave damage d/t necrosis

HF and endocarditis

-HF occurs in up to 80% of patients with aortic valve endocarditis and in approximately 50% of patients with mitral valve endocarditis

Cardiac Tamponade

-Heart in a sac of fluid -muffles heart sounds - dec CO

ACUTE CORONARY SYNDROME tx

-MONA -EMERGENT PCI (90 min from doorway to cath lab)

Sinus Bradycardia -what is it -CM -TX

-Normal rhythm below 60 bpm -hypotension, pale, cool, weakness, angina, dizzy, confusion, SOB - check O2, ATROPINE, transcutaneous pacemaker, stop offending drugs

SINUS Tachycardia -What is it -CM - Tx

-Normal rhythm, above 100 bpm -dizzy, dyspnea, hypotension, angina -treat cause, VAGAL maneuver, Beta blockers

Premature Ventricular Complex

-PVC interrupts regularity - ASSESS APICAL RADIAL PULSE DEFICIT

STABLE ANGINA -EKG results -goal of tx -tx(Process of admin, when to call ems)

-ST segment depression of T wave inversion -decrease o2 demand or increase o2 supply -short acting nitrates to dilate blood vessels, if no relief in 5 min call EMS, can be taken prophylactic -long acting nitrates, ACE , Bblockers, ca channel blockers

ACUTE PERICARDITIS

-Severe sharp chest pain -Worse with deep inspiration or supine -Referred to shoulder/upper back -Phrenic nerve -Hallmark-pericardial friction rub

pt teaching infective endocarditis

-Teach importance of adherence to treatment regimen - avoid infectious people, rest, hygiene, prophylactic antibiotics -s/s infection, monitor temp, follow up

Defibrillation -choice tx for -when most effective -Biphasic

-VFIB and pulseless VTACH -completed within 2 min of dysrhythmia onset -BETTER: shock in 2 areas, fewer postschock abnormalities

Synchronized Cardioversion -choice treatment for - what happens -Sync on or off? -what if pt becomes pulseless

-Vtach with a pulse or SVT -Synchronized circuit delivers a countershock on the R wave of the QRS complex of the ECG -Sync on Turn off sync and defibrillate

Ejection Fraction -normal -What is it measured by

-above 50% -echocardiogram

Risk factors for CAD -Lipid number

-age, gender, ethnicity, fam hx, -triglycerides above 150 -Cholestrol above 200 -HYPERTENSION

Acute pericarditis treatment

-antibiotic if bacterial -NSAID Pericardiocentesis *Monitor kidney and bleeding

Paroxysmal Supraventricular Tachycardia -causes -treatment

-associated with over exertion, deep inspiration, stimulants and dig toxicity -Vagal stim, Adenosine, Beta blocker, calcium Channel blocker, Amiodarone, Cardioversion, ablation

interventional radiology/surgical PAD

-atherectomy: removal of obstructing plaque -peripheral artery bypass with autogenous vein

ACUTE PERICARDITIS -common cause -after MI

-coxsackie virus -common after MI: Dressler syndrome

Third degree AV heart block

-decreased CO, can lead to HF and shock -Pacemaker, meds to increase HR while awaiting pacemaker

VFIB -what is it -can lead to -CM -TX

-derangement of rhythm,, no CO -MI, ischemia, disease -Unresponsive, pulseless, apneic -CPR and ACLS Defib, drugs

Diastolic failure Systolic Failure

-doesn't relax -doesn't contract

PEA -WHAT IS IT -PROGNOSIS -TX

-electrical activity on ECG but no pulse -poor, unless underlying cause can quickly be treated -CPR, epi, intubation

infective endocarditis vegetation

-embolization when part of vegetation breaks off and enters circulation

Surgical therapy for aortic dissection

-endocascular dissection repair, resection or aortic segment replaced with synthetic graft material

Asystole

-ends stage HF -immediate CPR, epi, intubation, poor prognosis

Chronic heart failure CM

-fatigue -dyspnea -orthopnea -Paroxysmal Nocturnal Dyspnea -Tachycardia `

myocardial infarction cm -cardiovascular

-increased hr and bp initiallu, then decreased, crackles, JVD, abnormal heart sounds (s3 and S4), murmur

infective endocarditis -what is it -cause -HACEK

-infection of inner layer of heart -bacterial most common, sometimes viral or fungi -in IVDA with needle saliva contamination

VTACH -why is it life threatening -H&T -PULSELESS tx -W PULSE tx

-life threatening d/t decreased CO and possible lead to VFIB -Identify precipitating cause -CPR AND DEFIB -Magnesium and cardioversion

ADHF tx

-monitor VS, o2, lung sounds, admin o2, high fowlers

myocardial infarction cm gastric

-nausea, vomiting, fever,

UNSTABLE ANGINA info

-new onset, occurs at rest, worsens, increased frequency, unpredictable, symptoms in women more vague -lead to MI

Thoracic aorta aneurysms CM

-often asymptomatic, deep diffuse chest pain, pain may extend to scapular area

AORTIC DISSECTION

-often misnamed dissecting aneurysm -not a type of aneurysm -torn intima causes blood flow up and normal blood flow occur at same time

Aortic Aneurysms -what is it -increased in

-outpouching or dilation of arterial wall -more common in men -increase with age

LEFT SIDED HEART FAILURE S/S

-paroxysmal nocturnal dyspnea -cough -crackles -wheezes -blood dinged sputum - restless -confusion -exertional dyspnea -cyanosis

CM of ANGINA

-squeezing, heavy, choking, suffocating, indegestion, burning (rarely sharp) pain in chest

Rheumatic Heart failure -caused by -treatment

-step infection -NSAID, antipyretic, antibiotics

PAD CM: ARTERIAL

-thin shiny skin -loss of hair in lower legs -diminished lower pulses -reactive hyperemia of foot with dependent positon -pallor of foot with elevation

ACUTE CORONARY SYNDROME thrombolytics

-when PCI unavailable -stops infarct by dissolving thrombus -ideally given in 30 min

Left ventricular wall is how many times thicker than right?

2-3x thicker

MI: how long does it take for entire myocardium wall thickness to necrotize

4-6 hours

Sinus node rate AV Junction rate ventricular rate

60-100 40-60 20-40

Normal Sinus Rhythm

60-100 bpm, regular rhythm

Drug therapy for PAD

ACEI Antiplatelet (aspirin or plavix)

A client admitted to the emergency department with atrial fibrillation has a heart rate of 160 bpm. The nurse should implement which prescription first?

Administer oxygen via nasal cannula.

Risk factors for heart failure

Age, Diabetes, TOBACCO USE, obesity, cholesterol

CO

Amount of blood pumped by each ventricle in 1 min CO=HRxSV normal 4-8L/min

Leading cause of CAD

Atherosclerosis

BP equals

BP=COxSystemic vascular resistance

BEFAST STROKE

Balance Eyes Facial symmetry Arms Speech Time

A client comes to the emergency department reporting severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit with a diagnosis of myocardial infarction (MI). Which should the nurse do first when the client is admitted to the coronary care unit?

Begin telemetry monitoring.

Test used to identify aortic aneurysm

CT/CAT SCAN Mri, echocardio, ultrasound, ecg, etc

The nurse observes the cardiac rhythm (see ECG strip) for a client who is being admitted with a myocardial infarction. What should the nurse do first?

Check for a pulse

-Stable angina diagnostic

Chest x-ray Cardiac biomarkers, lipids, CRP 12-lead ECG Echocardiogram Exercise stress test

Hypertrophy

Compensatory, overtime leads to less efficient heart contraction risk for cardiac dysrhythmias

A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which is the priority intervention?

Control the pain and support breathing and oxygenation

A client has been diagnosed with right-sided heart failure. The nurse should assess the client further for:

Dependent edema.

Indications of ortic aneurysm rupture

Diaphoresis, pallor, weakness, tachycardia, hypotension, abdominal back or groin pain, change in LOC and pulsating abdominal mass

infective endocarditis diagnostic studies

EKG, Echo, xray, blood culture

COmplications of MI

Heart failure, cardiogenic shock

Infective endocarditis tx:

IV antibiotics long term, antipyretic, supportive care antibiotic therapy for 4-6 weeks

AORTIC DISSECTION drug tx

IV beta blocker, antihypertensive drugs, morphine