cadiovascular Flashcards
which sided HF usually occurs first?
Left sided (and can trigger right)
What are manifestations of R sided HF?
peripheral edema, JVD, ascites, weight gain
What are manifestations of L sided HF?
fatigue, anxiety, PE, crackles, dyspnea
Risk factors for HF?
Hypertension, previous MI (biggest one), CAD, ischemic heart disease, male gender
Which disrhythmia is commonly associated with HF?
atrial fibrillation
Description of a fib on an ECG
no discernible p waves, rapid, irregular QRS complexes (ventricular response)
description of a fib (whats happening in the heart)
multiple areas in the atria elicit irregular electrical impulses some of which get through to the ventricle
What drug could be given to a HF pt who is experiencing a fib?
digoxin
Which diagnostic test is used to measure the pressure in the R atrium?
pulmonary artery catheterization
What is an echocardiography used to determine?
cardiac valvular defects, chamber enlargement, pericardial effusions
What is an ECG used to determine?
arrhythmias, underlying miocardial ischemia
Vagal stimulation (valsalva maneuver) amy cause what? (rhythm)
bradycardia
Possible HF nursing diagnoses?
- fluid volume excess (heart not pumping effectively and fluid builds up in tissues and lungs)
- impaired gas exchange (lung tissues become congested with fluid, less O2 available for exchange, resulting in decreased tissue oxygenation)
- decreased cardiac output
- activity intolerance
possible nursing interventions for HF?
- monitor weights
- degree of peripheral edema
- ECG
- VS
- oral and IV intake
- monitor labs (particularly potassium)
- monitor inr/ptt
- fall precautions
manifestations of pulmonary edema?
confusion, restlessness, frothy/productive/blood tinged cough, tachycardia, dyspnea, blue/cold skin, crackles in the lungs
foods high in potassium?
AVOCADOS, BANANAS, CANTALOUPES, RAISINS, SPINACH, fish, tomatoes, mushrooms, veal, beef, carrots
Which enzyme test is best post MI or unstable angina?
Triponin - it is specific to the heart. Creatinine kinase MB and myoglobin are good to test for if it has been a longer amount of time. they are also not specific to cardio.
Within the scope of an LPN?
- administering meds PO
- attaching cardiac monitor leads
- obtaining an ECG
- data/assessment collection (listening to lung sounds and assessing peripheral edema for stable pt’s)
- observing a previously taught action for accuracy
- wound care
- reinforcing previously taught material
- foley insertion
- IV insertions ONLY IF TRAINED AND ONLY IN SOME STATES!
- SQ administrations/infusions
Not in the cope of an LPN?
- administering high alert meds (anticoagulants, narcotics)
- administering meds to unstable pt
- obtaining pt history
- reviewing meds with pt
- planning activity levels
- planning for client care or teaching
- IV insertion (unless properly trained or in some states)
- Pt education
What is the cough that is sometimes seen in pt’s taking ACE inhibitors caused by?
caused by a build-up of bradykinin
goal of hypertension meds
reduced pt BP to < 140/90
What is altaplase?
What is the time limit for administering it?
Thrombolytic
6 hours
MONA order
Oxygen
Aspirin
Nitroglycerin
Morphine
coronary arteriography?
Biggest risk?
diagnostic cathlab procedure
Risk: bleeding (you would see an elevated HR)
PVC’s in an acute MI pt…
…Can quickly lead to v tach or v fib. Immediate attention is warranted.
PRIORITIZATION: what is the first treatment for Vfib?
SHOCK!
type of pulse expected with afib?
irregularly irregular
Crackles in the lungs…?
indicate L sided heart failure. May not be life threatening in chronic HF pt, but in other pts it is.
how should morphine sulfate be written in a doctor’s order?
“morphine” or “morphine sulfate” NOT ms
What is morphine used for in pulmonary edema?
effect as a venodilator which decreases venous return to the heart and reduces ventricular preload.
What should a HF pt who was started on a beta blocker be taught?
At first symptoms will get worse, but then they will get better…
What duties can a nursing assistant perform (without extra training)?
- monitor and record intake and output
- measuring vital signs
- remind pt of something previously taught by the RN
What duties can a nursing assistant not perform (non-obvious ones…)
- initiate telemetry
- perform venipuncture
- obtaining ECG
Triponin level that indicates myocardial injury or infarction?
A level of more than 0.20 ng/mL
Pt discharge instructions after a cardiac cath?
- leave dressing in place for at least one day
- heavy lifting and exercise should be avoided for several days
- a small hematoma or bruise is normal
- it is not necessary to keep the extremity straight after leaving the hospital
Raynauds:
What is it?
Pt teaching?
- vasospasms of the arterioles and arteries of the upper and lower extremities, compromising blood flow to the hands and feet (usually unilaterally).
- avoid exposure to cold by wearing warm clothes
- nifedipine (procardia) helps relieve symptoms
- keep your home at comfortably warm tempurature
- stress reduction techniques can help prevent s/s
desirable HDL cholesterol level?
> 40 for women, >50 for men
desirable LDL cholesterol level?
<100 (for people with a risk for heart disease)
desirable total cholesterol level?
240 is considered HIGH RISK for heart disease
normal sinus rhythm ECG measurements…
- Atrial and ventricular rate:
- PR interval:
- QRS complex:
Atrial and ventricular rate: 60-100 beat per minute
PR interval: 0.12 - 2.0 seconds
QRS complex: 0.06 - 0.12 seconds
- each of the little boxes on the ECG strip represent how much time?
- each of the TINY boxes inside the little boxes, represent how much time?
1) 0.2 seconds
2) 0.04 seconds
What does a VVI pacemaker do?
- it is a ventricular rhythm pace maker that senses when the ventricle is not going to fire and provides pacing at that time. Only picks up slack from the ventricle. Does not fire before every QRS complex
BP and HR in a hypothermic pt?
decreased HR and decreased BP
pt teaching for cath procedure?
- taught to report chest pain or any unusual sensations immediately.
- may be asked to cough or breathe deeply from time to time during the procedure.
- informed that a warm, flushed feeling may accompany dye injection and is normal.
- Because a local anesthetic is used, the client is expected to feel pressure at the insertion site.
Sinus dysrhythmia?
Is cardiac output affected?
- normal sinus rhythm except the PP interval is irregular
- CO is not affected
long term pt care for a pt with peripheral artery disease
- warmth is contraindicated (d/t possibility of burns)
- focuses on pain management, maintain tissue integrity (nutrition and foot care), peripheral circulation (exercise)
