chapter 38
Which statement by a client scheduled for a percutaneous transluminal coronary angioplasty (PTCA) indicates a need for further preoperative teaching?
"My angina will be gone for good."
A client undergoing coronary artery bypass grafting asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct?
"These arteries remain open longer."
A client with unstable angina has received education about acute coronary syndrome. Which statement indicates that the client has understood the teaching?
"This is a big warning; I must modify my lifestyle or I am at risk for having a heart attack."
During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response?
"Where might you be able to walk?"
critical rescue
- if pt experiences MI, prepare them for transfer to specialized unit where close monitoring and management can be provided. If the pt is at home or in community call 911 for transfer - monitor or report and document signs of organ perfusion that result from decreased CO: change in orientation, UO less than 0.5-1 ml, cool/clammy extremity , unusual fatigue, chest pain - monitor for cardiogenic shock: tachy, hypotension, systolic less than 90, uo less than 0.5-1, weak pulses and cold skin, agitation or confusion, pulmonary congestion, tahcypnea, chest discomfort - after pci monitor potential problems includeing acute closure of the vessel leading to st elevation, bleeding at insertion site, and reaction to contrast medium. Monitor hypotension, hypokalemia, dysrhythmias. cardiac tamponade: sudden cessation of mediastinal drainage, becks triad (JVD with clear lung sounds, distant/muffled heart sounds, hypotension), pulsus paradoxus (BP more than 10mmhg higher on expiration) , an equalizing of PAWP and right arterial P, cardiovascular collapse
An LPN/LVN is scheduled to work on the inclient "stepdown" cardiac unit. Which client does the charge nurse assign to the LPN/LVN?
A stable 66-year-old who has a prescription for a nitroglycerin (Nitro-Dur) patch and is stable and scheduled for discharge to a group home later today.
The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure?
Anterior wall
An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take?
Assess pulmonary artery wedge pressure (PAWP).
A client has just returned from coronary artery bypass graft surgery. For which finding does the nurse contact the surgeon?
Chest tube drainage 175 mL last hour
The nurse in the coronary care unit is caring for a group of clients who have had a myocardial infarction. Which client does the nurse see first?
Client with third-degree heart block on the monitor
The nurse is concerned that a client who had myocardial infarction (MI) has developed cardiogenic shock. Which findings indicate shock?
Cool, diaphoretic skin Crackles in the lung fields Anxiety and restlessness
The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure?
Crackles in the lung fields
The nurse is teaching a group of teens about prevention of heart disease. Which point is most important for the nurse to emphasize?
Do not smoke or chew tobacco.
after thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign?
Facial drooping
when giving ... assess pt for hypersensitivity rxn and bleeding. monitor platelets 4 hrs after giving the drug
GP 11b/11a
Which characteristics place women at high risk for myocardial infarction (MI)?
Increasing age Family history Abdominal obesity
The visiting nurse is seeing a client postoperative for coronary artery bypass graft. Which nursing action would be performed first?
Monitor the heart rate for dysrhythmias.
A client comes to the emergency department with chest discomfort. Which action does the nurse perform first?
Obtains the client's description of the chest discomfort
Prompt pain management with myocardial infarction is essential for which reason?
Pain relief improves oxygen supply and decreases oxygen demand.
The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity does the nurse suggest?
Placing a chair in the shower for independent hygiene
The nurse is caring for a client 36 hours after coronary artery bypass grafting, with a priority problem of intolerance for activity related to imbalance of myocardial oxygen supply and demand. Which finding causes the nurse to terminate an activity and return the client to bed?
Respiratory rate 28 breaths/min
The nurse is assessing a client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI?
Substernal chest pressure relieved only by opioids
After receiving change-of-shift report in the coronary care unit, which client does the nurse assess first?
The client with acute coronary syndrome who has a 3-pound (1.4 kg) weight gain and dyspnea
To validate that a client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests?
Troponin
The nurse is preparing to teach a client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion?
Truncal obesity Hypercholesterolemia Glucose intolerance Client taking losartan (Cozaar)
.. is the most important risk factor in women
age, if older than 40 they are more likely to die within 1 year of their MI, women postmenopause (70+) have the same incidence of MI to men smoking and lesbian = higher risk
dual antiplatelet therapy is suggested for all ACS patients incorporating ...
aspirin, or clopridogrel or tricagrelor -- observe for nose bleeds or bleeding in stool
women experience .. angina
atypical (pain in shoulder, aching jaw, choking feeling on exertion)
do not give ... if pulse under 55 or systolic is below 100 w/o checking with the doctor
beta blocker
if using sublingual NGT spray, the pt must...
carry it at all times
nurse assesses a client with chest pain. What symptoms are most indicative of MI?
chest pain with ekg change chest pain relieved by opioids chest pain with SOB
after thrombolytic therapy observe signs of bleeding by..
document neuro stat observe all iv sites for patency or bleeds monitor clotting study observe signs of internal bleed test stool, urine, emesis for blood
Which atypical symptoms may be present in a female client experiencing myocardial infarction (MI)?
dyspnea dizziness fatigue
NTG + phoshpodiestrase inhibitors (erectile dysfunction, PAH) = ..
hypotension, cannot take within 24-48 hrs of each other
the nurse assesses a client who had coronary artery bypass graft yesterday. What assessment finding will cause the nurse to suspect cardiac tamponade?
muffled heart sounds with JVD
use of .. can increase stroke and heart attack. can occur in early tx, those with cvd are at a greater risk
nsaids
When planning care for a client in the emergency department, which interventions are needed in the acute phase of myocardial infarction (MI)?
oxygen morphine sulfate
use caution when giving .... bc potential risk of increase myocardial o2 consumption - monitor chest pain
positive inotrope
which modifiable factors does the nurse teach about MI risk?
tobacco high fat diet obesity
hold the ntg tablet ... and drink 5 ml. Spray can be given and is more quickly absorbed. If bp is lower than last reading raise the bed and call provider.
under the tongue
gender consideration
women with ischemic heart disease or stress testing dont have abnormal cardioangiography, microvascular disease or endothelial dysfunction are the cause of CAD in women, women usually have smaller arteries and clots break off and can be missed on angiography