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Hurst Review > Cardiac > Flashcards

Cardiac Flashcards

1
Q

DVT 4 SIGNS AND SYMPTOMS

A
  1. ) Red
  2. ) Warm
  3. ) Tenderness
  4. ) Edema
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2
Q

DVT 7 TX??

Big bird and Elmo With Sesame Street

A

Tx:

1) Bed rest
2. ) bleed precautions

3.) Anticoagulant drugs: Heparin, Warfarin (Coumadin®), Enoxaparin (Lovenox®),
Pradaxa

These prevent aggregation or prevent the clot from getting bigger.

4)Elevate- to increase blood return; _decrease pooling in The extremity

5.) Warm , moist heat-__to decrease _inflammation! Hot causes vasodilation and make just dislodge the clot
!!

6) surgery
•
7.)SCD/TED hose- to increase venous return; decrease pooling !
You remove the Ted hose once a shift or twice a day
Used with SCD’s many times

With a known clot TEDs or SCD may not be used on the unaffected extremity
or not at all

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3
Q

Never put cold on a vein=

A

excessive vasoconstriction

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4
Q

Never put hot on a vein=

A

excessive vasodilation

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5
Q

For DVT Prevention is the key!

We ____ and ______ the client.

Also for prevention we put on____ and get the client to do_____ exercises

A

ambulate Prevention is the key!

We ____ ambulate and ____ hydrate__ the client.

  1. ) ambulated
  2. ) hydrate
  3. ) SCD
  4. ) isometric exercises
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6
Q

Cardiac Tamponade:

Pathology

A

Pathophysiology:

• ____________________BLOOD_, fluid, or exudates have leaked into pericardial sac
resulting in compression of the heart.

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7
Q

Cardiac Tamponade:

can happen if the client has had one of the 5 things happen

Men Require Appropriate Personal Hygiene

A
  1. )motor vehicle collision,
  2. ), an _MI
  3. ) right ventricular biopsy
  4. )pericarditis, or
  5. )hemorrhage post CABG.
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8
Q

Cardiac Tamponade THIS CAN OCCUR WITH A as LITTLE IS

A

20-50 ML OF BLOOD Accumulating in the sack

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9
Q

Hallmark signs of Cardiac Tamponade

A
  1. ) decrees BP

2. ) increase CVP

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10
Q

7 signs and symptoms of Cardiac Tamponade

A
  1. decreasing BP
    2.increase CVP
  2. Heart sounds will be muffled or distant.
  3. Neck veins _ distended but clear lung sounds
  4. Pressures in all 4 chambers are the same
    because fluid is acumulating around the heart squeezing the heart muscle
  5. Shock -due to the decrease cardiac output
  6. Narrowed pulse pressure (from the baseline)
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11
Q

Tx for Cardiac Tamponade

Name the treatment ?

Describe the treatment ?

You might have what in place ?so what do you Monitor?

A

Pericardiocentesis to remove ____________blood_ from around the
heart. The Physician we will insert a needle in the pericardial space and remove the fluid.
• Surgery
- might have a drain in place so you want to monitor the fluid output

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12
Q

Describe A. Normal blood flow through the heart:

A

• The two major veins that bring blood to the right side of the heart are the superior
and inferior vena cava (This blood is deoxygenated)→The blood enters the right
atrium→ Then the right ventricle→ From the RV the blood is pumped into the
pulmonary artery (this artery carries deoxygenated blood) → Then the blood goes to
the lungs where it is oxygenated→ Next through the pulmonary veins (they carry
oxygenated blood)→ It then goes to the left atrium → to the left ventricle (the big
bad pump)→ It is then pumped into the aorta→ And finally this oxygenated blood is
delivered throughout the body through the arterial system where it eventually ties
back into the venous system.

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13
Q

Preload

A

Preload is the amount of blood ___returning to the right side of the heart and the
muscle stretch that the volume causes . _ANP is released when
we have this stretch. The more volume u have the more stretch u have! Stretch to a certain point is good more stretch more strength ! But the heart can stretch to much and become weak

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14
Q

Afterload

A

Afterload is the _PRESSURE in the aorta and (peripheral arteries)–( this causes the most Resistance) that the left
ventricle has to pump against to get the blood out)

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15
Q

Stroke volume

A

Stroke volume is the ___AMOUNT of blood pumped out of the ventricles with each
beat.

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16
Q

CO =

  • Tissue perfusion is dependent on
  • Cardiac output changes according to the body’s __
A

CO = LV,HR x SV

  • Tissue perfusion is dependent on an adequate cardiac output.
  • Cardiac output changes according to the body’s __NEEDS
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17
Q

3 Factors that affect cardiac output:

A

Factors that affect cardiac output:

a. Heart rate and certain arrhythmias
b. Blood volume
1) Less volume = __decrease CO
2) More volume = ____Increase__CO
c. ___Decrease contractility

• MI, medication, muscle disease

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18
Q

Pathophysiology of decreased CO:
6

a. Brain:
b. Heart:
c. Lungs:
d. Skin:
e. Kidneys:
f. Peripheral pulses:

A

a. Brain: LOC will go_down
b. Heart: Client complains of __chest pain
c. Lungs: Short of breath? _yes lungs sound WET
d. Skin: _cold and clammy
e. Kidneys: UO goes _down
f. Peripheral pulses: __weak

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19
Q

When are Arrhythmias consider a big deal ???

3 Arrhythmias that are always a big deal: because you have no CO

A

When they affect your cardiac output.

3 Arrhythmias that are always a big deal: because you have no CO

  1. Pulseless V tach
  2. V fib
  3. Asystole
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20
Q

Coronary Artery Disease:
•

What the most common type of cardiovascular disease?

What is the single largest killer of Americans?

A

Coronary Artery Disease:
• Coronary artery disease is the most common type of cardiovascular disease and the
single largest killer of Americans.

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21
Q

Coronary artery disease is a broad term that includes

A

Coronary artery disease is a broad term that includes
chronic stable angina and
acute coronary syndrome

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22
Q

Pathophysiology: chronic stable angina

Decreased blood flow to the myocardium→ ischemia or necrosis? →

What brings the pain on?

What relieves the pain?

A

Decreased blood flow to the myocardium→ ischemia or necrosis? → temporary
pain/pressure in chest.

What brings this pain on? Low ___O2 usually due to__exertion.

What relieves the pain? Rest and/or nitroglycerin sublingual

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23
Q

What is the treatment for chronic stable angina ???

A
  1. )Nitroglycerin
    2) beta blockers or calcium channel blocker
  2. ) aspirin
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24
Q

Nitroglycerin (Nitrostat®

Okay to swallow?

• what do you Keep in ?

Will it burn or fizz?

Will the client get a headache?

Renew how often?

Spray?

• After Nitroglycerin (Nitrostat®), what do you expect the BP to do?

A

Okay to swallow? __no
• Keep in dark, glass bottle; dry, cool
• May or may not burn or fizz
• The client will get a _______ headache.
• Renew how often? An average of every__3-5 months

Spray? _2 years
• After Nitroglycerin (Nitrostat®), what do you expect the BP to do? _drop

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25
Q
  1. )Beta blockers block what?
  2. )beta decrease do what 3 things ?
  3. )When you decrease the contractility what else also decrease ? Then what goes down after that ?
  4. )When you decrease the work on the heart the need what decreases? And that decrease what ?
  5. )Be careful because this could do what ?
A
  1. )beta cells… these are the receptor sites for catecholamines- the epi and norep
  2. ) BP, P, and myocardial contractility
  3. ) CO, workload of the heart
  4. ) decrease the work on the heart the need for oxygen is decreased and that decreases angina.
  5. ) decrease the client’s cardiac output (HR and BP) too much with these drug
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26
Q
  1. )What aspirin dose is normally given by physicians?
  2. ) is aspirin given to treat the pain ?
  3. ) why is given ?
  4. ) as a results of #3 what happens?
A
  1. ) 81 mg-325 mg
  2. ) No
  3. ) use to keep the platelets from sticking together .
  4. ) keep the blood flowing because the platelets dont stick together. More bloddflow eqaul more oxygen and less pain
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27
Q

What is the 10 Client Education/Teaching for chronic stable angina:

You are doing everything you can to do what ?

A

Do everything you can to decrease the workload on the heart

Client Education/Teaching for chronic stable angina:

  1. ) Rest frequently
  2. ) Avoid overeating
  3. )Avoid excess caffeine or any drugs that increase HR.
  4. )Wait 2 hours after eating to exercise.
  5. ) Dress warmly in cold weather (any temperature extreme can precipitate an
    attack) .
  6. )Take nitroglycerin prophylactically.
  7. )Smoking cessation
  8. ) Lose weight.
  9. )Avoid isometric exercise
  10. )Reduce stress
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28
Q

What is the Pre-procedure: for Cardiac Catheterization:

A
  1. Assess for iodine or shellfire allergies
  2. Warn of Hot shot
  3. Palpitations are normal
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29
Q

What is the 5 post procedure: for Cardiac Catheterization:

A
  1. ) Monitor VS.
  2. )Watch puncture site for bleeding
    3) Assess extremity distal to puncture site (5-Ps).
  3. ) Bed rest, flat, leg straight X 4-6 hours
  4. ) Report pain ASAP
  5. ) hold Glucophage (Metformin) _l
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30
Q

What is Major complication post cath cardiac Catheterization

A

Bleeding

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31
Q

What are the 5 P’s

A 
Pulselessness 
Pallor 
Pain 
Paresthesia (NUMBNESS & TINGLING)
 Paralysis
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32
Q

Unstable chronic angina=

A

Unstable chronic angina= Impending MI

33
Q

Acute Coronary Syndrome is also called

A

MI, Unstable Angina

34
Q

Acute Coronary Syndrome:

a. Pathophysiology:
1) Decreased blood flow to myocardium→ ischemia, necrosis or both? ___________

2) Does the client have to be doing anything to bring this pain on? ______________
3) Will rest or Nitroglycerin (Nitrostat®) relieve this pain?

A

Pathophysiology:

  1. Decreased blood flow to myocardium→ ischemia, necrosis or both? _
  2. Does the client have to be doing anything to bring this pain on? ______no
  3. Will rest or Nitroglycerin (Nitrostat®) relieve this pain? ______no
35
Q

12S/S of acute coronary syndrome

A

S/S:
1.)Crushing Pain , like an elephant sitting on their
chest,
2.)pressure radiating to the left arm and left jaw,
3.)N/V, or
4.)pain between their
shoulder blades.

women usually present with
5.) GI signs and symptoms, 
6.)epigastric
complaints or pain between the shoulders, 
7.)an aching jaw or a choking sensation.

What is the #1 sign of an MI in the elderly? _
8.)shortness of breathe

  1. ) Cold/clammy/BP drops
  2. )Cardiac output is going ___down_.
  3. )ECG changes
  4. )Vomiting
36
Q

c. Diagnostic Lab Work:
1. )What is CPK-MB?

When does CPK-MB elevate?When does it peak?

2.)what is Troponin?

When does it elevate? How long does it stay elevated ?

What is Myoglobin?
When does it elevate? When does it peak?_____ results are a good thing.
Which cardiac biomarker is the most sensitive indicator for an MI? _____________
Whichenzymesormakersaremosthelpfulwhentheclientdelaysseekingcare? ________________

A

CPK-MB:

  1. cardiac specific _____iso Enzyme_____
  2. i
    Increase if theres damage to cardiac cells
  3. E
    Elevates in 3-12 hours after the outset of symptoms and peaks in __24 hours

2.)Troponin: if troponin is elevate there is heart muscle damage

  1. C
    cardiac biomarker with ____high specificity to myocardial damage
  2. E
    elevates within ____3-4 hours after the onset of chest pain and remains ____elevated
    for up to 3 weeks
  3. i
    s the most sensitive and specific in detecting cardiac muscle damage
  4. T
    his is the one that means the cardiac muscle is damage

Myoglobin
1. I
increases within __1 hour and peaks in __12 hours after the onset of symptoms
2. H
It’s not very specfic diagnose acute coronary syndrome but if its negative_ results are
a good thing it can rule out a acute MI.
Which cardiac biomarker is the most sensitive indicator for an

37
Q

Complications of acute coronary syndrome
Major arrhythmias:
•
What untreated arrhythmias will put the client at risk for sudden death? ____________________
____________________ ____________________, plus we are going to add ____________________

A

Major arrhythmias:

• What untreated arrhythmias will put the client at risk for sudden death?
_____pulseless tachycardia
____________V fib
____________asystole, plus we are going to add bradycardia

38
Q

What is the Priority treatment for V-Fib: ?

What do do between the dfib until u get a affect heart beat?

If the first shock doesn’t work and client remains in V-Fib, what is the first vasopressor we give? _________________

What is Amiodarone (Cordarone®)?and when is it used ?

• What anti-arrhythmic drugs are commonly given to prevent a second episode of V-Fib? ________________ and ___________________.
• Lidocaine toxicity: any _________ changes
• Amiodarone (Cordarone®) is the first anti-arrhythmic of choice. Important side effect? ____________
This _______ can lead to _______?.

A

Priority treatment for V-Fib: ______Dfib do cpr between the dfib until u get a affect
heart beat

• If the first shock doesn’t work and client remains in V-Fib, what is the first
vasopressor we give? _____epi

Amiodarone (Cordarone®) is an anti-arrhythmic and is used when V-Fib and
pulseless VT are resistant to treatment, and also for fast arrhythmias.

• What anti-arrhythmic drugs are commonly given to prevent a second episode of
V-Fib? _______________ Amiodarone_ and _______________lidocaine____.
• Lidocaine toxicity: any ___neuro changes

• Amiodarone (Cordarone®) is the first anti-arrhythmic of choice.

Important side effect? __hyopotension

This hypotension can lead to further arrhythmias

39
Q

What is the Treatment:
• What drugs are used for chest pain when they get to the ED?

What’s the Head up position. Why?

A

Treatment:
• What drugs are used for chest pain when they get to the ED?
MONA

Morphine
Oxygen
Nitroglycerin
Aspirin- (chewable or tablet?) to Prevent platelet aggravated

Head up position. Why? Sitting up right !!!!! To Decreases work on the heart and increases CO.

DO NOT LAY FLAT because it put stress on the heart

40
Q

Treatment for acute coronary syndrome

A

1.)Fibrinolytics

41
Q

Fibrinolytics
• what is the Goal of fibrinolyics?and this Does what?

What do Fibrinolytics end in?

• How soon after the onset of myocardial pain should these drugs be administered? Within _____________ hours
• Brain attack? __________ IS BRAIN.
• Major complication: _________________
Obtain a _______________ history.

What are some Absolute contraindications ?

• During and after administration we take ___________________ precautions.
Obtain a _______________ history.

What are some Absolute contraindications?

• During and after administration we take ___________________ precautions.

Why do draw Draw blood when starting IVs?
• Do we do ABGs? ______________
• What is the Follow-Up Therapy?

A

Goal: Dissolve the clot that is blocking blood flow to the heart muscle→
decreases the size of the infarction.
If u have to have infraction u want a Teeny tiny one! We’re trying to hurry up and restore
bloodflow!!

Fibrinolytics meds end in ASE

• Medications: Streptokinase (Streptase®)-This is the one people have trouble with that have
allergies they still give it they just treat the allergies, Alteplase (t-PA®), Tenecteplase
(TNKase®) (one time push), Reteplase (Retavase®)
• How soon after the onset of myocardial pain should these drugs be
administered? Within _____6-8hours

  • Brain attack? ___time IS BRAIN. Time lost is brain lost = stroke
  • Major complication: _____bleeding
Obtain a  \_\_\_\_\_\_\_bleeding history.
• Absolute contraindications:
1.)Intracranial neoplasm, 
2.)intracranial bleed, 
3.)internal bleeding 
4.)suspected aortic dissection,

• During and after administration we take ____________bleeding precautions.
Bleeding Precautions:

Draw blood when starting IVs, decrease the number of __puncture sites.

• What about ABGs? _no

• Follow-Up Therapy: Antiplatelets are another important component of
fibrinolytic therapy.

● Acetylsalicylic Acid (Aspirin®),
● Clopidogrel (Plavix®), Clo-Pin-Do-Grill
● Abciximab (ReoPro IV®) (continuous infusion to inhibit platelet aggregation) Ab-6-i-Mab

42
Q

Bleeding Precautions:

What 3 things do we watch out for ?

Use a ____???

We avoid anyone who ?

A
  1. )bleeding gums
  2. )black stools.
  3. ) hematuria

Use an electric razor, a soft toothbrush, and No IMs.

Anyone with liver disease like
alcoholic or anyone to overdose on aspirin cause aspirin kills your liver

43
Q

Medical Interventions:
a) what does PCI (Percutaneous Coronary Intervention) include ?

What do stents or balloons do?

• What is Major complication of the angioplasty ?

Don’t forget client may what???
• If any problems occur→ go to ___________________.
What does Chest pain after procedure mean?

What do we give Anti-platelet medications: (hint)family matters tv show

A

PCI (Percutaneous Coronary Intervention):

• Includes all interventions such as PTCA (angioplasty) and stents ! Stents or balloons open
up The coronary artery to try to restore blood flow To the heart muscle

• Major complication of the angioplasty is a ________MI
Don’t forget client may bleed from heart cath site, or they could
reocclude

• If any problems occur→ go to ___________surgery.

Chest pain after procedure: call the physician at once→ re-occluding

Anti-platelet medications: CARL AND AND EDDIE
• Clopidogrel (Plavix®)
• ASPIRIN
• Abciximab (ReoPro IV®)
• Eptifibatide (Integrilin IV Ep-Tie-Fib-Tide

44
Q

What is Given to high risk clients who have been stented to keep artery open those waiting to go to cath lab

A

Abciximab (ReoPro IV®)

• Eptifibatide (Integrilin IV®)

45
Q

Medical Interventions for acute coronary syndrome

A
  1. ) PCI

2. ) Coronary Artery Bypass Graft (CABG)

46
Q

Coronary Artery Bypass Graft (CABG)

• what type of procedure is it ?

What is it used for ?

• The Left main coronary artery supplies what?

Left main coronary artery occlusion = __??

A

Can be scheduled or emergency procedure
• Used with multiple vessel disease or left main artery occlusion.
• The LEFT main coronary artery supplies the entire left
ventricle.
• Left main coronary artery occlusion, Think:SUDDEN DEATH
or
Widow Maker.

47
Q

Cardiac Rehabilitation 10teaching for Mi?

A

1 Smoking cessation
2 Stepped-care plan (increase activity gradually)
3 Diet changes- LOW fat, _LOWsalt, LOW cholesterol
4 No isometric exercises-__INCREASE workload of heart ,they make your muscle squeeze or tense up
5 No Valsalva -is bad in heart people the Vegas nerve is hyperexcitable• it is ready to be stimulated so don’t touch it especially in heart people because is going to bottom out their heart rate and throw them into asystole;
6 no straining no suppository; they need to be on Docusate (Colace®)
7 When can sex be resumed? When they can walking around the block or up a flight of stairs with no Discomfort•
8 What is the safest time of day for sex? Morning time when the client is well rested. alot of time occur when yiur coming out of rem sleep about 4, 5, 6 am in the morning
9.Best exercise for MI client? WAlking

  1. Teach 4 S/S of heart failure:
  2. Weight gain
  3. Ankle edema
  4. Shortness of breathe
  5. Confusion
48
Q

HF is a complication that can result from 5 problems such as

A
  1. )Acute MI
  2. )Hypertension
  3. )valvular heart disease,
  4. )endocarditis
  5. )cardiomyopathy
49
Q

Describe left side Heart failure

A

Left Side Failure: the blood is not moving forward into the aorta and out to the
body…IF it does not move forward, then it will go backwards into the lungs

50
Q

What are the syndrome of left sided heart failure

A
  1. Dyspnea
  2. Nocturnal dyspnea
  3. Orthopnea
  4. Cough
  5. Pulmonary congestion
  6. Blood tinged frothy sputum
  7. .Tachycardia
  8. Restlessness
  9. S-3
51
Q

Describe right sided heart failure

A

the blood is not moving forward
into the lungs…IF it does
not move forwards then it goes backwards into the venous
system.

52
Q

S/S of right sided heart failure

A
  1. Distended neck veins
  2. Edema
  3. Enlarged organs
  4. Weight gain
  5. Ascites
53
Q

What is Systolic heart failure

A

heart can’t contract and eject.

54
Q

What is Diastolic heart failure?

A

ventricles can’t relax and fill

55
Q

Dx for heart failure

Name the 4 dx for heart failure ?

Describe a Echocardiogram?

Describe a Swan-Ganz (Pulmonary Artery) catheter ?what information does it provide ? And it also access to __?

A
  1. ) BNP: B-type natriuretic peptide:
  2. )chest X-ray
  3. ) Echocardiogram-is a test that uses high frequency sound waves (ultrasound) to make pictures of your heart.
  4. ) The Swan-Ganz (Pulmonary Artery) catheter -is a balloon flotation catheter that can be floated into the right side of the heart and pulmonary artery.

It provides information to rapidly determine 1.)hemodynamic pressures

  1. ) cardiac output and
  2. )Access to mixed venous blood sampling.
56
Q

Arterial lines can be places in what ?

What is the most common Site ?

What 2 things does Arterial lines provide?

A

Arterial lines can be places in multiple arteries,

most common site is the radial artery.

•It provides
1.)continuous intra-arterial blood pressure monitoring

2.) repeated ABG samples to be collected without injury to the client.

57
Q

6 Treatment for HF?

A

Standard medication therapy for HF is

  1. ) Elevate HOB
  2. ) Report signs and symptoms of recurring failure
  3. ) ACE Inhibitors, and ARBS.
  4. )digoxin
  5. ) Diuretics
  6. ) Low Na Diet:
  7. ) Weigh daily and report a gain of __?
58
Q

) Digitalis (Lanoxin®) Actions:
• is digoxin Used less today? Why?

When is it used?

What are drugs is often given in combination with ?

How does it work

• Contraction? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
• Heart rate? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Why How happen to the Harare rate ?
• Cardiac output will go \_\_\_\_\_\_\_\_\_\_\_.
• Kidney perfusion \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
A 
Digitalis (Lanoxin®) 
Actions: 
• Used less today, because of the risk of drug toxicity, especially
in the 
elderly.

• Used with

  1. )sinus rhythm
  2. )atrial fibrillation
  3. ) accompanying chronic HF

• Often given in combination with an 1.)ACE Inhibitor,

  1. )ARB,
  2. )Beta Blocker
  3. )diuretic
It makes CONTRACTIONS last  Longer 
And it slows down the THE HEART RATE
       When the heart rate is slowed this gives the ventricles more
time to fill 
       with blood. 
• Cardiac output will go up
• Kidney perfusion up.
59
Q

Nursing Considerations:
• Would diuresis be a good thing or bad thing for this client? _________

  • Why do we Digitalizing dose-loading dose?
  • How do you know the Digoxin is working?
A

Nursing considerations:
• Would diuresis be a good thing or bad thing for this client? A
good thing ! We Always want to Diurese heart failure clients because
they can’t handle the fluid.

• Digitalizing dose-loading dose
because were trying to build up a therapeutic blood level
• How do you know the Digoxin is working? Because the
cardiac output
goes up

60
Q

What are normal digoxin level

A

Normal Dig level=

0.5to 2ng/ml-anything over to your toxic

61
Q

S/S of toxicity:
Early: ____, ____, and _____
Late: ______ and _____\

A

S/S of toxicity:
Early: Anorexia, nausea, and vomiting
Late: Arrhythmias and _vision changes

62
Q

Before administering digoxin do what? ________________________
• Monitor electrolytes
All electrolytes levels must remain normal, but what electrolyte is the one that causes the most trouble?

A

Check the APICAL PULSE at the fifth intercostal space at the midclavicular line!!! This pulse can move

potassium

63
Q

Pacemaker:
• What is “natural” pacemaker of your heart Called?

What does it do ?_

What is depolarization?

What is Repolarization?

If your heart rate drops to 60 or below, cardiac output can _____________and ____ wont

• If he client has symptomatic bradycardia then why is a pacemaker used ?

Describe the different types of pacemakers.

Describe the 2 types of temporary pacemaker’s?

Name the 2 types of permanent pacemakers ?

Most permanent pacemakers are?

What do you worry abt ?

When does a demand pacemaker work ?

When does a Fixed pacemakers work ?

It’s okay for the rate to increase but never what?

A

• Your “natural” pacemaker is the SA node or sinus node.

It sends out impulses that make the heart contract
So it depolarize the heart

• Repolarization (ventricles are resting and are filling up with blood

• If your heart rate drops to 60 or below, cardiac output can
__ decrease then your vital organs wont perfuse well__.
• Pacemakers are used to increase the heart rate with symptomatic bradycardia.

1) Pacemakers may be temporary (invasive or non-invasive) or
permanent.

2 types of permanent pacemakers

 1. ) Demand 
  2. ) Fixed

Most permanent pacemakers are demand, but you can also see fixed pacemakers.

  • Always worry if the heart rate drops below the set rate.
  • A demand pacemaker kicks in only when the client needs it to.
  • Fixed rate pacemakers fire at a _fix rate constantly.
  • It’s okay for the rate to increase but never ____ decrease.
64
Q

Post-Procedure Care (for permanent pacemakers):
• • • • •
1.)What do we monitor?
2.)What do we do to the arm ?
3.)Why do you Assisted Passive Range of Motion?
4.)And you prevent the client from what ?
5.)what is Most common complication post-op?

A

Post-Procedure Care (for permanent pacemakers):

  1. )Monitor the incision.
  2. ) Immobilize arm
  3. ) Assisted Passive Range of Motion to prevent frozen _shoulder
  4. ) Keep the client from raising their arm higher than shoulder
    height. Because the wires could come out

5.)Most common complication post-op? Electrode _ displacement
(in other words the wires are pulled out)
•.
•
•

65
Q

4 S/S of Malfunction:

Describe loss of capture?

A

S/S of Malfunction:

  1. ) Lost of capture
  2. ) Programmed incorrectly
  3. )Depleted batteries
  4. ) Electro displacement

Lost of capture= no contraction will follow the stimulus.

Watch for: Any sign of decreased CO or decreased _rate

66
Q

6 Client Education/Teaching:

•

A
  1. )Check pulse daily.
  2. ) ID card or bracelet
  3. ) Avoid electromagnetic fields (cell phones, large motors).
  4. )Avoid MRIs.
  5. ) Avoid contact sports.
  6. )notify security at the airport
67
Q

Pacemakers

Why do we check the pulse ?

Cells phones should be use on what side ?

Why do we avoid MRI?

Why do you notify airport security?

A 
. 
1.)To make sure pacemaker is working  
2.)(cell phones--should be used on
the opposite ear, large motors). 
3.)Avoid MRIs. 
Because he's a big magnet and can turn the pacemaker off or
change the settings
4.)Are they going to set off alarms at airport? Yes, they need to go
to a special little door and pat now_
68
Q

) ICD – Implantable Cardiac Device
May be used to do what 2 things ??
so basically it does what ?

2.)Post-op care for an ICD is the same as ____?

A

2) ICD – Implantable Cardiac Device
ICD- May also see referred to as
Implantable Cardioverter Defibrillator

May be used to

  1. )pace the heart or
  2. ) Defibrillate people in V-FIB. So it basically speed up or slow down the heart rate

Post-op care for an ICD is the same as for a pacemaker

69
Q

Pulmonary Edema:

1. What 3 type of people are at risk?

A

Who is at risk?
1).Any person receiving IV fluids real fast,
2.)any person who has a history of __heart_ or ________kidney
disease
3.)the very young and the very old,

70
Q

Pathophysiology of pulmonary edema

What’s the problem?

And why is this happening?

When does Pulmonary edema usually occur? And why ?

A

Pathophysiology:
• THE PROBLEM is Fluid is backing up into the lung

THIS HAPPEN because The heart is unable to
move the volume forward

Pulmonary edema usually occurs at _night, when the client
goes to
___bed _. At day fluid pools in the lower extremity when you
lay down you increased venous return therefore more preload
and client can’t handle that extra volume

71
Q

5 S/s of Pulmonary edema

A

S/S:

  1. Sudden onset
  2. Severe Hypoxia
  3. . Breathless
  4. Productive cough (pink frothy sputum)
  5. ) Restless/anxious
72
Q

Tx for Pulmonary edema

Mnemonic: Domn

A
  1. ) Diuretics
  2. )Oxygen
  3. )Morphine
  4. )Nitroglycerin/Nesiritide (Natrecor®) Nest-Sir-A-Tide
73
Q

Tx for pulmonary edema

What is the priority nursing action?
You Monitor oxygen sat and titrate to keep above ________%.

b. Medications:
1) Diuretics
• why is Furosemide (Lasix®) used? Which causes what ?

How much do you give ? And for how long to prevent what ?

  • Bumetanide (Bumex®)
  • Can be given in what 2 ways? And for what reason ?

How much do you give ?and for how long ?

Why do we give Nitroglycerin IV (Nitro-Bid IV®)?
What does Decreased afterload = ?

3) Morphine (Morphine Sulfate®)

Why do we give this ?

How much do you give ? To cause?

Morphine can also help to __?
4) Nesiritide (Natrecor®)
• This a ??; ; not to be given more than what ?
• Vasodilates veins and arteries and has a ?

A

Oxygen
• The priority nursing action is to administer high flow
oxygen. Monitor
oxygen sat and titrate to keep above 90%.
b. Medications:
1) Diuretics
• Furosemide (Lasix®)
• Causes diuresis and vasodilation which traps more blood
out in the
arms and legs and reduces preload and _afterload
• 40 mg IV push slowly over 1-2 minutes to prevent
hypotension and ototoxicity
• Bumetanide (Bumex®)
• Can be given IV push or as continuous IV to provide
rapid fluid
removal
• 1-2 mg IV push given over 1-2 minutes

Nitroglycerin IV (Nitro-Bid IV®)
• Vasodilation: decrease afterload
• Decreased afterload = increased CO because the heart is
pumping against
less pressure and more blood can be moved ____foward.

3) Morphine (Morphine Sulfate®)
causes vasodilation which would trap blood in the extremities
• 2 mg IV push for vasodilation to decrease preload and
afterload
. Morphine also help decrease agitation
4) Nesiritide (Natrecor®)
• IV infusion; short term therapy; not to be given more than 48
hours

Vasodilates veins and arteries and has a diuretic effect

74
Q

Positioning: for pulmonary Edema

What is the positioning For pulmonary edema

Why is this position use?

A

up right position, legs down
Improves ____CO
BY SITTING THE CLIENT UP GRAVITY MAKES IT
EASIER FOR THE HEART TO PUMP FLUID AWAY FROM
THE LUNGS
KEEPING THE LEGS DOWN Promotes POOLING of blood in
lower extremities

75
Q

Pulmonay edema Prevention:
• Prevention when possible:
Check ________________________, and Avoid fluid volume __________________.

A

Prevention:
• Prevention when possible:
Check __________LUNG SOUNDS , and
Avoid fluid volume _____EXCESS

76
Q

4 Signs of acute arterial

occlusion

A
  1. )Numb
  2. )Pain,
  3. )Cold,
  4. )No pulse palpable
77
Q

Pathophysiology of atherosclerosis
• •
• • • • • •
•
If you have atherosclerosis in one place you have _______?
It is a medical emergency if you have an acute arterial _______________ (numb, pain, cold, no pulse).

Client will c/o 1.)____ and ______

  1. )The extremity will be ______
  2. )No _____ _______
  3. )More symptomatic in _______________extremities-

what is a hallmark sign ?
Arterial blood isn’t getting to the ______________________→coldness, numbness, decreased peripheral pulses, atrophy, bruit, skin/nail changes, and ulcerations.
Pain at rest means _________________ obstruction.

A

Pathophysiology:
• If you have atherosclerosis in one place you have it
everywhere.
• It is a medical emergency if you have an acute arterial __
occlusion
(numb, pain, cold, no pulse palpable).
• Client will c/o numbness and pain
• The extremity will be cold
• No palpable pulse
• More symptomatic in _______________lower_ extremities
• Intermittent claudication( pain)- hallmark __________sign_.
• Arterial blood isn’t getting to the
____________tissue__→coldness,
numbness, *decreased peripheral pulses(priority nursing
assessment) atrophy, bruit, skin/nail changes( thick & brittle),
and
ulcerations.
• Pain at rest means severe obstruction.

78
Q

Tx:
• Since arterial blood is having problems getting to the tissue, if you elevated the extremity would the pain increase or decrease? _____________________
• Arterial disorders of the lower extremities are usually treated with either ______ or ________.

What is the purpose of both procedures?

A

Tx:
• Since arterial blood is having problems getting to the tissue, if
you elevated
the extremity would the pain increase or decrease?
_________increase! So you want to dangle The affected Limb
to increased perfusion to it
• Arterial disorders of the lower extremities are usually treated
with either
angioplasty (the ballon with a stent) or endarterectomy. The
purpose of both procedures is to enhance perfusion.

Hurst Review (14 decks)

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