NSG 210 Test 2 (3/4/21)
confirming HF dx
-BNP (elevates-compensatory mechanism, ventricles release this in response to overload of fluid, 100 and below is NORMAL, elevated is usually in the thousands) -Echocardiogram/ultrasound (blood flow through the heart, stroke volume, EF (how much blood the L ventricle pumps with every beat, 55-65% normal)
normal creatinine level
0.9-1.2
what is the nurse monitoring after a patient gets a cardiac cath?
Monitor pulses, BP, HR, don't sit up more than 30 degrees (low fowler's, puts pressure on artery), use bedpan (don't want to risk getting a CAUTI), frequent assessments (15 min X 4, 30 min X 4)
MONA B
Morphine Oxygen Nitroglycerin Aspirin Beta Blocker
sxs of Digoxin toxicity?
blurred vision, confusion, fast heart rate, irregular pulse, N/V
BUBBLE-EE
breasts, uterus, bladder, bowels, lochia, episiotomy/perineum, extremities, emotional status
when do signs of withdrawal take place in newborns?
can be an hour after birth
stress tests (what are nursing interventions before?)
can inject patient (for older adult) or run on treadmill, no caffeine (NPO), **hold beta-blocker (but you can give it when they come back from test, because it impacts heart rate)
what do ARBs do?
cause venous dilation, lowering preload
stable angina
chest pain that occurs when a person is active or under severe stress
unstable angina
chest pain that occurs while a person is at rest and not exerting him/herself & doesn't go away
cardiac tamponade S&S
**restlessness & confusion, syncope, ,fatigue, SOB, tachy, drop in systolic BP, narrow pulse pressure
If cardiac output is compromised, what do you generally see?
*confusion, fatigue
how much O2 do you start a patient having an MI?
2-4L
What medication do you hold that is non cardiac related when receiving contrast dye?
Metformin-can get lactic acidosis & acute nephropathy/hold 2 days before and 2 days after
Acute pulmonary edema-nursing interventions
***raise HOB (more important than administering O2 for test purposes), administer O2 (may start with face mask/nonrebreather), IV access (2), possibly get on CPAP, possibly intubate, monitor cardiac rhythms, *frequent vital signs, labs-ABG, troponin
babies need to be watched for how many days for signs of withdrawal?
3-5 days
PTT range
46-70
normal EF
55-65 percent
Meds used for HF
ACE & ARBS (lowers BP) Beta-Blockers (lowers HR & BP) Calcium CB (lowers HR & BP) Digoxin (lowers HR) Dilators (vasodilators) Diuretics (lowers BP)
priority interventions for Digoxin
Apical Pulse for a full min Toxicity (over 2.0--vision changes, nausea, dizzy) Potassium level (below 3.5 increases risk)
A patient is brought to the emergency department for unrelieved chest pain for 45 minutes. ECG performed by EMS suspects a non-ST elevation myocardial infarction (NSTEMI). Which of the following interventions is most important?
Apply oxygen, administer morphine, and place the pt on bed rest with cardiac monitoring A patient with a suspected myocardial infarction with non-ST elevation should be placed on bed rest, have oxygen placed, and have morphine administered. Morphine reduces preload and decreases workload of the heart, while bed rest will reduce workload and oxygen needs.
HF precautions (AACE)
Avoid pregnant Angioedema (airway risk) Cough Elevated K+
important indicator for heart failure
B-type natriuretic peptide
BECs triad
Big JVD extreme low BP can't hear heart sounds
R sided HF patho/causes
Left sided HF can cause R sided HF Pulmonary HTN Fibrotic Lungs "stiff lungs" Sleep Apnea COPD
what are some causes of myocardial dysfunction & HF
CAD, HTN, cardiomyopathy, valvular disorders, atherosclerosis, and renal dysfunction w/volume overload
Clinical manifestations that nurses assess for in Right-sided HF (cor pulmonale)
COPD, pulmonary HTN, JVD, edema, most common in diabetes pts
cardiac tamponade diagnostic tests
CXR, echo (swinging on monitor), ECG, and hemodynamic monitoring
STEMI s&s
Chest pain Oxygen Lethargy Anxiety Palpitations SOB Elevated ventricle rate/HR dizziness/syncope
Which food item should the HF patient avoid? SATA Chips Fruits Veggies Grilled chicken & fries Canned beans Bread
Chips, grilled chicken & FRIES, canned beans
CIWA
Clinical Institute Withdrawal Assessment
indications for Heparin
DVT/PE
patient education for HF DRBEDSS
Diet-low sodium & fluid Risk for falls (change positions slowly) BP & BNP (should not be increasing) Elevate legs (w/pillows) high fowlers Daily Weights (3 lbs/day or 5 lbs/7 days=worsening!) Sex (2 flights of stairs with NO SOB) Stockings (decrease blood pooling, remove daily, never massage calves)
what type of medication is used most frequently for acute or worsening HF?
Diuretics
Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant?
During feeding Explanation: Heart failure manifests itself as tachypnea or dyspnea at rest or on exertion. For the infant, this most commonly occurs during feeding.
Heart failure interventions
Echo, High Fowler's position, O2, advanced airway, diuretics, beta blockers, ARBs, ACE inhibitors, Digoxin, or pacemaker
T or F: Heparin busts clots
False. It only thins blood. TPA busts clots
A client with chronic HF took cold medicine for her flu. She presents with a new productive cough w/pink frothy sputum and worsening crackles. What action should the nurse take first? Assess lung sounds Give Bumetanide IVP Notify HCP Clock out for lunch
Give Bumetanide IVP
cardiomyopathy leads to what?
HF and dysrhythmias
nursing interventions for heart failure
HOPE HOB 45-90 degrees Oxygen Push lasix/morphine End sodium & fluids
when do you hold BP meds?
HR below 60 & BP below 100 systolic/big drops
What is a big issue for a patient taking Lasix?
Hypokalemia because Lasix is not potassium sparing
A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for:
Hypotension Explanation: When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension.
top 5 vasodilators
Nitroglycerin Nitroprusside Hydralazine Isosorbide Minoxidil (only for severe HF)
What do calcium channel blockers do?
Open up blood vessels by reducing systemic vascular resistance
2 procedures that can improve myocardial oxygenation & ventricular function
Percutaneous coronary intervention & coronary artery bypass graft
preload & afterload
Preload affects the amount of blood going into Right ventricle. Afterload is the systemic resistance after leaving the heart.
The nurse has received a client into care who was admitted with a heroin overdose. The client has a 5-year history of illicit substance use with cocaine, heroine and oxycodone. The client develops a sudden onset of wheezing, restlessness and a cough that produces a frothy, pink sputum. The nurse suspects the client has most likely developed which complication of opioid overdose?
Pulmonary edema Explanation: The nurse should suspect the client has developed pulmonary edema, which is frequently seen in clients who abuse/overdose on narcotics. Many drugs — ranging from illegal drugs such as heroin and cocaine to aspirin — are known to cause noncardiogenic pulmonary edema. Pneumonia is not the likely cause given the sudden onset of respiratory symptoms accompanied but coughing up the pink frothy sputum. The client's history of illicit substance use and now overdose on these drugs should lead the nurse to suspect pulmonary edema is the cause of the sudden onset of these symptoms over congestive heart failure, in which clients have a more gradual onset of respiratory issues. Although a panic attack can manifest in shortness or breath and restlessness, the client would not be wheezing or producing blood tinged sputum with a cough. Panic attacks do, however, have a sudden onset and can cause the client chest pain and a sense of doom.
Clinical manifestations that nurses assess for in Left sided HF
Pulmonary edema, crackles, dyspnea, Left---L---Lung, auscultate S3 and S4 heart sounds
Cardiac Cath, where do the cardiologists access?
R femoral artery
biggest S & S of heart failure
SOB, edema, fatigue
Which immediate action by the nurse is the first priority when a patient is on the treadmill doing a stress test?
ST changes
STEMI
ST elevation MI, real-time ongoing death of heart tissue due to ischemia
BECks triad
big JVD extremely low BP cant hear heart sounds (muffled) Pulsus paradoxes-BP gets squished down too
4 T's of postpartum hemorrhage
Tone (uterine atony), Trauma (cervical, vaginal, perineal), Tissue (retained placenta, membranes), Thrombin (coagulopathies)
nursing interventions for neonatal substance abuse syndrome
keep baby swaddled, lights out (decrease stimulation), keep windows closed during the day, if the baby is asleep (leave him alone), be supportive of mom
The nurse is caring for a client with chronic heart failure. Which drug category may be prescribed for acute heart failure to improve heart performance by decreasing preload?
Vasodilator drugs like nitroprusside
The nurse caring for a client with cardiomyopathy plans to have an education session with the client and the client's spouse about ways to improve cardiac output and reduce the workload of the heart. Which of the following instructions would help reduce preload?
When resting, sit up with the legs down to pool blood in the legs. Many clients find that sitting up with their legs down is more comfortable than lying in bed. This position is helpful in pooling venous blood in the periphery and reducing preload. Laying flat in bed impairs respiratory efforts due to abdominal contents pushing against the lungs. This client must be on a low sodium cardiac diet to avoid fluid retention. It is impossible to avoid all physical and emotional stress.
effects on baby for mother addicted to cocaine
abruptio placentae, miscarriage, neural tube defects, poor feedings, irritable
4 things to monitor after contrast dye (Iodine)
allergy (warm flushing is normal) bleeding creatinine kidney can't palpate pedal pulse? call HCP
how do you determine which type of HF a patient has?
an assessment of the EF
med management for ETOH withdrawal
ativan, clonidine, zofran
when should a patient with stable angina take Nitroglycerin?
before any strenuous activity goal is no chest pain when doing ADLs
Priority nursing interventions for HF meds (CCB)
count HR & BP change positions slowly bad headaches
ACE inhibitors
decrease aldosterone
negative inotropics, what do they do?
decrease heart contractility
what does morphine do?
decreases workload on the heart
clinical manifestations of R sided heart failure
dependent edema, weight gain, jugular vein distention, and hepatomegaly
causes of STEMI
deposits of plaque in the arteries Diabetes angina hx vasospasm-sudden constriction or narrowing of blood vessels increased cholesterol over 200 narcotic use CAD inflammation of heart walls
infants with heart failure often display subtle signs such as what?
difficulty feeding and tiring easily
type of cough associated with left ventricular failure
dry and nonproductive but might become moist over time
clinical manifestations of L sided heart failure
dyspnea on exertion, crackles, paroxysmal nocturnal dyspnea, cough, orthopnea, tachycardia, fatigue, muscle weakness, edema/weight gain, irritability, restlessness, and ventricular gallop
Creatinine over 1.3
kidney injury
early signs of low BP
lack of coordination, irritability, sweating, and pallor
nursing interventions for STEMI
get to cath lab within 60 minutes MONA (usually given in the order OANM)
What is digoxin used for?
helps contract the heart, given for HF, slows conduction through AV node
Action of Lasix for acute pulmonary edema & nursing actions?
helps rid the body of fluid, monitor potassium, monitor I&O, reassess lung sounds, monitor BP for hypotension, O2 sat, respirations
diet for ETOH withdrawal
high protein diet, folic acid, potassium, magnesium
A woman at 38 weeks' gestation with a history of heroin use disorder has given birth to a newborn several hours ago. Upon assessment, the nurse determines that the newborn is experiencing withdrawal based on which findings? Select all that apply.
high-pitched shrill cry almost constant sneezing nasal stuffiness poor sucking reflex
action of Dobutamine
increase cardiac contractility and renal perfusion to enhance urine output
positive inotropics, what do they do?
increase heart muscle contraction
what do cardiac glycosides do?
increase the force of myocardial contraction
An expected outcome for a patient who has just taken sublingual nitroglycerin should be
increased heart rate and decreased blood pressure.
signs of withdrawal in newborn
jitteriness/shaking, nasal stuffiness, high pitched cry
withdrawal agent for opioid withdrawal
methadone (N/V, frequent emesis)
Which medication would be included in the plan of care for a newborn with acute neonatal abstinence syndrome who is not responding to conservative nursing approaches?
morphine sulphate Explanation: Pharmacologic treatment is warranted for NAS if conservative measures are not adequate. For newborns with confirmed drug exposure, drug therapy is indicated if the newborn has acute NAS. Common medications used in the management of newborn withdrawal include an opioid (morphine or methadone), and phenobarbital is the second drug if the opiate does not adequately control symptoms.
NAS
neonatal abstinence syndrome
substance abuse during pregnancy causes what to newborns?
neuro impacts, premature, growth restriction, increases risk of SIDS
post-op cath lab education
no heavy lifting, no baths, prevent infection
NSTEMI
non-ST elevation myocardial infarction
when should a patient with stable angina call 911?
pain 5 minutes after 1st dose but ONLY if they have pain (3 doses max X 5 min apart)
what is Acetylcysteine used for?
patients who need dye contrast who have renal issues
what does an ECG look like with a patient who has high potassium?
peaked T waves, ST elevation
cardiac tamponade treatments
pericardiocentesis (drain fluid) 1. cardiac monitor 2. catheter attached to drainage system 3. assess drainage Digoxin
Antidote for Heparin
protamine sulfate
first priority intervention for a patient with abnormal potassium levels
put them on a cardiac monitor
what do beta blockers do?
reduce adverse effects from constant stimulation of the sympathetic nervous system
Based on the cardiac cath & how its performed, what should we keep an eye on on the patient as a nurse (noncardiac)?
renal function because of contrast dye being nephrotoxic (BUN, creatinine, output), PO/IV fluids
ETOH addiction & withdrawal for adult pts, what sxs do you usually see?
seizures, hallucinations, tremors, N/V, anxiety, headache, tachycardia, fever, jaundice, ascites
what should we ask patients before giving dye?
shellfish allergy, look at BUN, creatinine also, acetylcysteine
what do ACE inhibitors do?
slow the progression of heart failure
Coreg (Carvedilol)
slows heart rate down, lower BP, decreases workload on heart but improves effectiveness
chest pain, no evidence of MI, what would a doctor give?
stress test
causes & risk factors of MI
stress/stimulants, obesity, diabetes/HTN, diet high in cholesterol, and African American males/age over 50, more common in males
cardiac output
stroke volume X heart rate
2 major types of HF
systolic HF, diastolic HF
Diuretic NCLEX tips
take in the AM not at night slow position changes daily weights (report 2-3 lbs) sunburn risk low sodium diet Avoid OTC meds (cough & flu, antacids, tylenol, and nsaids because they contain high amts of sodium)
pulmonary edema
the abnormal accumulation of fluid in the interstitial spaces and alveoli of the lungs. It is a diagnosis associated with acute decompensated HF that can lead to acute respiratory failure and death.
patho of a STEMI
tissue death due to clogged arteries--pumping problem--leading to cardiac arrest Ventricles are not squeezing oxygen to the rest of the body
causes of cardiac tamponade
trauma (gun shot wound, stabbing) & disease (cancer, renal filure)
diagnostic tests for STEMI
troponin I, troponin T, CPK, myoglobin
Patient with HF is constipated. What would the nurse recommend? Walking Increase Fiber Stool Softeners Fluids
walking, increase fiber, stool softeners
L sided HF patho/causes
weak heart=weak pump MI CAD
