9 - Cardiovascular Emergencies

Question 1

The electrical stimulus for the healthy heart to beat originated where? In which part of the heart is this electrical stimulus located?

Answer 1

Sinoatrial node (SA Node)

Right atrium

Question 2

List two ways cardiac output can be increased.

Answer 2

Increasing heart rate

Increasing stroke volume

HR x SV = Cardiac Output

Question 3

A thrombus in a coronary artery can lead to what complication?

Answer 3

AMI
(Acute Myocardial Infarction)

Question 4

A 56-year-old patient is complaining of chest pain. Your working diagnosis is angina and you are using OPQRST to assess the patient’s chief complaint. List an answer would you expect to hear from asking the “Q” question?

Answer 4

Heavy pressure on chest

Question 5

Briefly explain the three differences between an AMI and angina pectoris.

Answer 5

Duration: Angina pain typically is short lived while AMI pain is long term

Provocation/palliation: Angina pain typically is brought on by stress and stops shortly after stress ceases; AMI is sudden and needs treatment to relieve pain

Severity: Angina usually doesn’t lead to long term damages and AMI causes permanent damage.

Question 6

What is the function of the right atrium?

Answer 6

Receiving deoxygenated blood from systemic circulation, via the Superior Vena Cava

Question 7

What is preload?

Answer 7

The amount of blood that fills the heart before the contraction

Question 8

What is the function of the coronary arteries?

Answer 8

Provide myocardial tissue (heart muscle) with O2 rich blood

Question 9

An AMI is more likely to occur in which part of the heart? Explain why.

Answer 9

Left ventricle.

It’s the part of the heart that works the hardest.
(High pressure pump)

Question 10

Not all patients experiencing an AMI will complain of chest pain. Which types of patients would fall under this category?

Answer 10

Women, geriatrics, diabetics

Question 11

The text lists 5 common cardiac arrhythmias. List the arrhythmias that do not generate a pulse.

Answer 11

Tachycardia

Bradycardia

Ventricular fibrillation (pulseless) (VF)

Ventricular tachycardia (VT)

Asystole

(688)

Question 12

Answer the following for Aspirin: What is the indication, the recommended dose and the action?

Answer 12

Indication: Chest pain (cardiac related)

Dose: 162–324 mg

Action: Decreases clotting

Question 13

During your assessment of a 65-year-old female patient ℅ general fatigue, you notice JVD and pedal edema. The patient denies any chest pain but states that she does take “Heart pills” . Explain what may be causing these S/S.

Answer 13

Right-side heart failure

JVD - increased pressure in the jugular veins causing them to protrude

Pedal edema - heart cannot maintain adequate circulation, blood and fluids build up in lower extremities

(690)

Question 14

A 53-year-old patient who is complaining of chest pain and difficulty breathing. Vitals signs are RR 20, HR 94, BP 98/78 and an Sp02 of 93%. During the secondary assessment you find that the patient has a heavy pressure type of chest pain. Outline your treatment for this patient?

Answer 14

Provide O2 therapy to maintain 94% SPO2 levels, using NRM. Have the patient sit in Fowler’s position to ease breathing.

Administer 324mg Aspirin.

NOTE: (not NTG: Systolic BP needs to increase to above 100 before giving Nitroglycerin)

Promptly transport the patient to a cardiac center. (686) / (697)

Question 15

You are treating a 62-year-old patient is ℅ difficulty breathing. Your assessment reveals an irregular HR of 108, BP of 188/114, a RR of 26, with wheezing and crackles. You are unable to obtain a pulse oximeter reading. During the history taking part of your assessment you find that the patient has a heart condition and hypertension. What is the treatment for this patient?

Answer 15

Administer high flow O2 using a NRM while patient is sitting in a Fowlers position or position of comfort.

Consider inhaler or nebulizer for bronchodilation and give 0.4mg Nitroglycerin as sublingual treatment if no other contraindications are present.

Continue to monitor vitals and promptly transport patient to a hospital with a respiratory center.

Question 16

You are treating a 74-year-old female patient who is complaining of general weakness. Your assessment reveals pale, cool skin, a RR of 18, HR of 90 that is weak and thready, BP of 94/62 and an SP02 of 95%. During the history taking part of your assessment, you find that the patient takes Glucophage, nitroglycerin, aspirin and Lipitor. What is the treatment for this patient?

Answer 16

Possible Silent MI

Lay the patient in a supine position to improve venous return.

Continuously monitor vital signs and for changes in the patient’s mental status.

No NTG due to BP, check patient glucose levels, administer aspirin and high flow 02 via NRM.

Immediately transport the patient to the cardiac center at hospital while monitoring patients vitals every 5 minutes.

(687)

Question 17

You are treating an altered 88-year-old patient who is complaining of nausea. Your assessment reveals a RR of 26, HR od 102 that is weak and thready, BP of 86/62 and bilateral crackles noted with an SP02 of 92%. These S/S are MOST likely caused by what condition? What is your treatment for this patient?

Answer 17

CHF or pulmonary edema

Treatment: Immediately provide high flow O2 usinG NRM.

Position the patient in Fowler’s position to maximize airflow.

Monitor patients vital signs every 5 minutes as well as mental status.

Immediately transport to the cardiac facility.

(688-690)

Question 18

You are treating a 57-year-old patient who is complaining of chest tightness. Your assessment reveals a RR of 28, HR of 96, BP of 168/102, with wheezing noted and an SP02 of 93%. During the history taking part of your assessment you find that the patient has a heart condition and hypertension. These S/S are MOST likely caused by what condition. What is the treatment for this patient?

Answer 18

Asthma exacerbation

Treatment: Administer high-flow O2 via nasal cannula to keep SPO2 above 94%.

Give the patient Albuterol using an inhaler or nebulizer

Monitor response to bronchodilator as well as vital signs and mental status during transport to hospital.

Question 19

Myocardial cells have a special characteristic called automaticity, explain this trait of heart cells.

Answer 19

Automaticity is the myocardial cells ability to pump the heart without stimulation from the nervous system. The heart is the only muscle to have automaticity

Question 20

What is stroke volume

Answer 20

The amount of blood pumped with each ventricular contraction

(pg. 682)

Question 21

A 71-year-old patient is complaining of chest pain. Your working diagnosis is angina and you are using OPQRST to assess the patient’s chief complaint. List two answers would you expect to hear from asking the “R” question?

Answer 21

The arm (usually left arm), mid portion of the back, epigastrium, jaw

686)

Question 22

What is afterload?

Answer 22

The force or resistance against which the heart pumps during the systolic phase

As afterload increases cardiac output decreases.

(536)

Question 23

List two vessels that carry oxygenated blood to the heart.

Answer 23

Left and right pulmonary veins

Question 24

What are three differences between stable angina and unstable angina?

Answer 24

Stable Angina: Take nitro and rest, goes away with rest, caused by exercise or exertion

Unstable Angina: Constant pain, leads to AMI, can happen anytime, O2 demand exceeds pump

Question 25

There are several patients who, when suffering from an AMI, may not complain of chest pain. List the patients that would fall into this category?

Answer 25

Women
Geriatrics
Diabetics

Question 26

A 74-year-old male is c/o fatigue. Your assessment reveals a normal LOC and skin signs, a HR of 88, BP of 138/98, RR of 22 and an SpO2 reading of 96%. The patient has a hx of CHF and had a stroke three years ago. Upon further exam, you notice swelling in both feet. What is the medical term for this physical finding? What is your working diagnosis?

Answer 26

Dependent edema or pedal edema

Right side heart failure / cardiogenic shock.

Question 27

Explain how a CHF patient develops pulmonary edema.

Answer 27

CHF is when the left side of the heart is not pumping properly or quick enough which leads to blood backing up into the lungs which is known as pulmonary edema

Question 28

Your treatment of a chest pain patient calls for the administration of aspirin. What is the recommended dose for aspirin? What is the action of aspirin?

Answer 28

Action: Prevents platelets from clumping
Dosage: 162-324 mg (2-4 pills)

Question 29

You are treating an 84-year-old female patient whose chief complaint is indigestion Your assessment reveals a HR of 90, BP of 148/92, a RR of 24 with clear lung sounds and an SpO2 of 96%. During the history taking part of your assessment, you find that the patient has diabetes and hypertension. What is the treatment for this patient?

Answer 29

Silent MI

S/S: Complaint of indigestion, geriatric female

Treatment is aspirin, nitroglycerin, and rapid transport to a cardiac center

Answer 30

Cardiac asthma: the alveoli are so full of fluid that bubbles cannot form, the bronchi also become constricted, which produces wheezing.

Typically occurs with left side heart failure.

Treatment is CPAP

(640)

Question 31

You are treating a 60-year-old patient who is A&0x3 and complaining of chest pain. Your assessment reveals a RR of 28, HR of 94, BP of 168/112 and an Sp02 of 90%. During the history taking part of your assessment, you find that the patient has a heart condition and type-2 diabetes. What is the treatment for this patient?

Answer 31

MI

Treatment: Aspirin, nitroglycerin, and NRM

Question 32

You are treating an altered 58-year-old patient who is complaining of chest pain. Your assessment reveals a RR of 22 with poor tidal volume, HR of 88 that is weak and thready, BP of 76/52 and bilateral crackles noted with an SpOz of 90%. These S/S are MOST likely caused by what condition? What is your treatment for this patient?

Answer 32

Cardiogenic shock

Treatment: Oxygen, positioning, blanket, rapid transport (540, 545)

Question 33

You are treating an altered 74-year-old female patient who is c/o of fatigue and SOB. Your primary assessment reveals a weak pulse with pale, cool skin. Her vitals are: RR of 28, HR of SO, BP of 108/62 with an SpO of 95%. During the history taking part of your assessment, you find that the patient takes insulin and Lipitor. What is your working diagnosis for this patient?

Answer 33

Silent MI

(687)

Question 34

In the scenario above, what is your treatment for this patient?

Answer 34

Positioning and rapid transport

Question 35

A 75-year-old patient with a hx of AMI is unconscious. Your assessment reveals a carotid HR of 46, BP of 66/48, a RR of 10 and shallow, with an SpO2 of 86%. What is the treatment for this patient?

Answer 35

Cardiogenic Shock

Treatment: place patient in supine position, administer oxygen appropriately, keep warm with a blanket, and rapid transport to cardiac center.

(543)