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NCLEX prep > Cardiac > Flashcards

Cardiac Flashcards

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1
Q

function of the SA node

A

pacemaker

60-100 beats/min

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2
Q

function of the AV node

A

receives impulses from SA node
if SA node fails, AV node starts
40-60 beats/min

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3
Q

function of purkinje fibers

A

acts as pacemaker when SA and AV nodes fail

20-40 beats/min

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4
Q

what happens when the coronary arteries are blocked?

A

increased risk of MI

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5
Q

heart sounds

A

1st (S1): heard at apex of heart

2nd (S2): heard at base of heart

3rd (S3): occurs with heart failure and regurg

4th (S4): atrial asystole, abnormal, causes cardiac hypertrophy disease or injury

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6
Q

sinus tach

A

> 100 beats/min

faster the heart rate the less cardiac output

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7
Q

sinus brady

A

<60 beats/min
treat if patient is symptomatic (decreased cardiac output)
low HR is normal for athletes

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8
Q

what does renin do?

A

vasoconstriction

increases BP

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9
Q

what does vasopressin (ADH) do to BP

A

ADH influences regulation of vascular volume.

when there is an increase blood volume less ADH will be released, increase urination, decreasing blood voulme and BP

when there is a decrease in blood volume more ADH will be released, which promotes blood volume to increase and increase BP

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10
Q

arteries

A

take oxygenated blood AWAY from heart

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11
Q

veins

A

transport deoxygenated blood to the heart

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12
Q

troponin

A

protein that increases with an MI
rises within 3 hours and last 7-10 days

normal level < 0.3

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13
Q

myoglobin

A

oxygen binding protein that rises within 2 hrs of cell death

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14
Q

RBC

A

4.2-6.1

decreases in rheumatic heart disease and infective endocarditis

increases in conditions where there is an inadequate tissue oxygenation

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15
Q

WBC

A

5-10

increases with infection and inflammation and after MI

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16
Q

H&H

A

hgb 12-18
hct 32-57

elevated hct: vascular volume depletion

decreased H&H: anemia

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17
Q

effects of potassium on the heart

A

hypokalemia: ventricular dysrythmias and increase risk of dig toxicity. flat and inversed T wave, U wave, and depression of ST
hyperkalemia: asystole and ventricular dysrhythmia. tall peaked T wave, wide QRS complex, prolonged PR intervals, flat P waves

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18
Q

effects of sodium on heart

A

decreases with diuretics

decreases with heart failure

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19
Q

effects of calcium on heart

A

hypocalcemia: ventricular dysrhythmias, prolonged ST and QT interval, and cardiac arrest
hypercalcemia: short ST segment and wide T wave, AV block, tachycardia or bradycardia, dig hypersensitivity and cardiac arrest

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20
Q

effect of phosphorus on heart

A

interpreted with calcium levels because kidney retain or excrete one or the other

when calcium is high phosphorus is low or vice versa

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21
Q

effects of mag on heart

A

low mag: vtach or vfib
tall T wave
depressed ST segment

high mag: muscle weakness hypotension and bradycardia.
long PR interval
wide QRS

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22
Q

BUN and heart

A

elevated BUN with heart failure and cardiogenic shock due to effects on renal circulation

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23
Q

BNP

A

anything >100 is heart failure

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24
Q

meanings of the ECG components

A

reflects electrical activity of cardiac cells and record electrical activity

P wave: atrial depolarization

PR interval: time it take impulse to get from atria to AV nose bundle of his to purkinje fibers (0.12-0.2 sec)

QRS complex: ventricular depolarization (0.04-0.1 sec)

ST segment: early ventricular repolarization

T wave: ventricular repolarization

U wave: follows T wave and indicates electrolyte issues

QT interval: total time required for ventricular depolarization and repolarization (0.32-0.4)

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25
Q

ECG

A

noninvasive diagnostic test that records electrical activity of the heart

used to detect cardiac issues, location and extent of MI and cardiac hypertrophy

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26
Q

ECG interventions

A 
lie still 
breathe normally 
no talking 
electrical shocks will NOT occur
document any heart meds the patient is taking
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27
Q

holter monitoring

A

noninvasive
patient wear monitor that continously records ECG
identifies dysrhythmias
evaluates effectiveness of antidysrhytmic meds or pacemaker

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28
Q

holter monitor care

A

resume normal daily activities
maintain diary of activities and s/s that develops
avoid tub baths or showers

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29
Q

echocardiography

A

noninvasive ultrasound that evaluates structural and functional changes in the heart

used to detect vale issues, congenital heart defects, wall motion, ejection fraction and cardiac function

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30
Q

echocardiography care

A

lie still
breathe normally
no talking

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31
Q

stress test

A

noninvasive test that studies the heart during activity
detects and evaluates coronary artery disease

treadmill test is most common

if patient can NOT tolerate exercise; IV dipyridamole or dobutamine is give to dilate coronary arteries and simulate effect of exercise: patient is NPO 3-6 hrs before test

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32
Q

before the stress test

A

informed consent (if using IV option)
adequate rest the night before
light meal 1-2 hrs before
no smoking, ETOH, caffeine
check with MD about which meds to hold
(usually calcium channel blockers and beta blockers are held the day of the test)
wear loose comfy clothes and supportive shoes
report to MD any chest pain, dizziness, SOA

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33
Q

after stress test

A

no hot bath or shower for at least 1-2 hrs after

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34
Q

before an MRI

A

check to see if patient has a pacemaker or other implanted devices that would be contraindicated
remove all metallic objects
may have claustrophobia due to tight space

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35
Q

cardiac cath

A

invasive test involving insertion of catheter into heart

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36
Q

before cardiac cath

A

informed consent
assess for allergies to seafood iodine or dye (may be given antihistamines and steroids to prevent reaction)
NO solid food 6-8 hrs before and NO fluids 4 hrs before to prevent aspiration and vomiting
ht and wt to determine amount of dye needed
baseline VS
check pulses
inform about local anesthetic
may feel fluttery feeling as catheter passes through heart
flushed and warm feeling when dye injected
desire to cough and palpitations caused by irritated heart
shave and clean site with antiseptic solution

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37
Q

metformin and dye

A

withhold metformin for 24 hrs before procedures with dye because it can lead to lactic acidosis

not to be given again until after procedure when MD says it is ok or when renal function is evaluated (usually 48 hrs)

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38
Q

after cardiac cath

A 
check VS and heart rhythm at least q 30 mins for 2 hrs
check for chest pain 
report chest pain and dysrhythmias
check pulses and color of extremities 
report numbness and tingling
report cool pale or cyanotic extremity 
report loss of pulses 
sandbag or compression device 
check for bleeding 
if bleeding: apply manual pressure  ASAP and report 
check for hematoma and report ASAP
keep extremity extended for 4-6 hours (leg needs to stay straight)
bed rest for 6-12 hrs
HOB NO HIGHER THAN 15 DEGREES
increase fluids
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39
Q

percutaneous transluminal coronary angioplasty

PTCA

A

invasive nonsurgical
arteries are opened up with balloon catheter to improve blood flow

patient needs to completely stop smoking, change diet, lose weight, LIFESTYLE CHANGES

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40
Q

before the percutaneous transluminal coronary angioplasty (PTCA)

A

SAME AS CARDIAC CATH
report chest pain during balloon inflation
may be given aspirin before

informed consent
assess for allergies to seafood iodine or dye (may be given antihistamines and steroids to prevent reaction)
NO solid food 6-8 hrs before and NO fluids 4 hrs before to prevent aspiration and vomiting
ht and wt to determine amount of dye needed
baseline VS
check pulses
inform about local anesthetic
may feel fluttery feeling as catheter passes through heart
flushed and warm feeling when dye injected
desire to cough and palpitations caused by irritated heart
shave and clean site with antiseptic solution with antiseptic solution

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41
Q

after the percutaneous transluminal coronary angioplasty (PTCA)

A 
SAME AS CARDIAC CATH 
give anticoags and antiplatelets 
IV nitro
increase fluids
daily aspirin
lifestyle changes 
check VS and heart rhythm at least q 30 mins for 2 hrs
check for chest pain 
report chest pain and dysrhythmias
check pulses and color of extremities 
report numbness and tingling
report cool pale or cyanotic extremity 
report loss of pulses 
sandbag or compression device 
check for bleeding 
if bleeding: apply manual pressure  ASAP and report 
check for hematoma and report ASAP
keep extremity extended for 4-6 hours (leg needs to stay straight)
bed rest for 6-12 hrs
HOB NO HIGHER THAN 15 DEGREES
increase fluids
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42
Q

coronary artery stents

A

used in conjunction with PTCA to eliminate risk of vessel closure and improve vessel long term
reopening of blocked vessels

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43
Q

care for coronary artery stents

A

major concern is thrombosis (clot formation)
antiplatelets (clopidogrel or aspirin) months before
check for complications: stent migration or occlusion, coronary artery dissection, bleeding from anticoags

similar to PTCA
check VS and heart rhythm at least q 30 mins for 2 hrs
check for chest pain 
report chest pain and dysrhythmias
check pulses and color of extremities 
report numbness and tingling
report cool pale or cyanotic extremity 
report loss of pulses 
sandbag or compression device 
check for bleeding 
if bleeding: apply manual pressure  ASAP and report 
check for hematoma and report ASAP
keep extremity extended for 4-6 hours (leg needs to stay straight)
bed rest for 6-12 hrs
HOB NO HIGHER THAN 15 DEGREES
increase fluids
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44
Q

atherectomy

A

removes plaque from artery

improves blood flow to limbs in patients with PAD

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45
Q

atherectomy care

A

cheek for complications of perforation, embolus, or re-occlusion

similar to PTCA
check VS and heart rhythm at least q 30 mins for 2 hrs
check for chest pain 
report chest pain and dysrhythmias
check pulses and color of extremities 
report numbness and tingling
report cool pale or cyanotic extremity 
report loss of pulses 
sandbag or compression device 
check for bleeding 
if bleeding: apply manual pressure  ASAP and report 
check for hematoma and report ASAP
keep extremity extended for 4-6 hours (leg needs to stay straight)
bed rest for 6-12 hrs
HOB NO HIGHER THAN 15 DEGREES
increase fluids
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46
Q

transmyocardial revascularization

A

for patients with widespread atherosclerosis in vessels that are too small

uses high power laser that creates 20-24 channels that provide region of heart with oxygenated blood

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47
Q

peripheral arterial revascularization

A

increases arterial blood flow to limbs

bypassing occlusions

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48
Q

before the peripheral arterial revascularization

A

check baseline VS and pulses
insert IV and foley
maintain central line or art line

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49
Q

after the peripheral arterial revascularization

A

check VS and report changes
check for hypotension: hypovolemia
check for hypertension: stress on graft and causes clot
bed rest for 24 hrs
keep affected extremity stright
limit movement
no bending at knee or hip
check for warm, red, edema: EXPECTED OUTCOMES that means there is an increased blood flow to area
check for graft occlusion
check pulses , changes in color and temp
check incision for drainage, warmth or swelling
small amount of bleeding is EXPECTED
too much bleeding is bad
check graft for infection: hardness, tender, warm and report to MD
foot care and ulcer prevention
modify lifestyle

MONITOR FOR SHARP INCREASE IN PAIN BECAUSE THIS IS THE FIRST INDICATOR OF POSTOP GRAFT OCCLUSION: NEEDS TO BE REPORTED TO MD

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50
Q

coronary artery bypass grafting (CABG)

A

bypassing of an occluded artery

used when patient does NOT respond to medical management of coronary artery disease

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51
Q

before the coronary artery bypass grafting (CABG)

A

expect sternal incision, chest tubes, foley, and multiple IV sites
ET tube placed for a short time and pt will not be able to speak
will be mechanical vented
patient needs to breathe with vent and not fight it
discontinue certain meds: diuretics 2-3 days before, dig 12 hrs before, aspirin and anticoags 1 week before
give potassium, antihypertensives, antidysrhythmics, and antibiotics

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52
Q

after the coronary artery bypass grafting (CABG)

A

mechanical vent
monitor HR, rhythm, urine output, and neuro status
report chest tube drainage greater than 75 ml/ht
monitor fluid and electrolytes
fluid restriction d/t edema
hypotension collapses graft
hypertension promotes leakage causing bleeding
check temp
rewarm patient using warm thermal blankets if temp less than 96.8
rewarm no faster than 1.8 degrees/hr to prevent shivers
discontinue rewarming when temp gets to 98.6
IV potassium to maintain potassium between 4-5
check s/s cardiac tamponade: sudden cessation of heavy mediastinal drainage, JVD with clear lung sounds, equalization of right atrial pressure and pulmonary wedge pressure, and pulsus paradoxus

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53
Q

pulsus paradoxus

A

abnormally large decrease in stroke volume and bp during inspiration

54
Q

transfer patient from the CICU

A 
check VS
check LOC
check perfusion
check for dysrhythmias
listen to lungs 
assess respiratory 
spline incision 
cough deep breathe and IS to prevent atelectasis
check temp
check WBC
give fluids  to liquefy secretions
assess suture line and chest tube insertion for infection
assess sternal suture for infection
gradually resume activity
assess for tachycardia, ortho hypotension and fatigue
discontinue activities if BP drops more than 10-20 mm Hg or if pulse increase more than 10 beats/min
55
Q

heart transplant

A

donor heart must have comparable body weight and ABO compatibility
transplanted within less than 6 hrs
will have 2 unrelated P waves on ECG because part of atria is left in from old heart
new heart is denerved and does NOT respond to vagal stimulation (will not have angina d/t denerving of heart)
endomyocardial biopsies performed regularly and when rejection expected
required lifetime immunosuppressives
strict aseptic technique and hand washing

56
Q

s/s heart rejection

A 
hypotension
dysrhythmias
weakness
fatigue
dizziness
57
Q

home care for patients with cardiac surgery

A 
slowly return to activities
limit pushing or pulling activities for 6 wks
monitor incision for infection 
sternal incision should heal 6-8 wks 
no crossing legs
no panty hose till edema is gone
no elevating surgical limb when sitting 
no saturated fats 
no cholesterol
no salt 
can resume sex if patient can walk 2 block or climb 2 flights of stairs without s/s
58
Q

normal sinus rhythm

A

SA nose

60-100 beats/min

59
Q

sinus brady interventions

A 
determine cause of brady
if med is causing brady: withhold med and notify MD
give O2
give atropine to increase HR 
transcutaneous pacemaker if atropine does NOT work 
NO extra atropine: causes tachycardia 
check for hypotension and give fluids 
may need permanent pacemaker
60
Q

sinus tach interventions

A

find the cause

decrease HR to normal by treating cause

61
Q

a fib

A

multiple rapid impulses from multiple atrial depolarizations

atria quivers leading to thrombi

no P wave; just wiggly lines before the QRS

62
Q

a fib interventions

A

give O2
give anticoags
give cardiac meds to control ventricular rhythm and assist in maintenance of cardiac output
cardioversion

63
Q

PVC premature ventricular contractions

A

early ventricular contractions resulting from increase irritability of ventricles

unifocal or multifocal QRS

upside down QRS

64
Q

PVC premature ventricular contractions interventions

A

ID cause and treat
check O2 sat for hypoxia: can cause PVC
check electrolytes (potassium): can cause PVC
O2 and meds in cause of acute MI

NOTIFY MD IF PATIENT COMPLAINS OF CHEST PAIN OR IF PVCS INCREASE IN NUMBER ARE MULTIFOCAL OCCURE ON T WAVE OR OCCUR IN RUNS OF VTACH

65
Q

v tach

A

repetitive firing of irritable ventricles

leads to cardiac arrest

66
Q

stable patients with sustained vtach

A

with pulse and no s/s of decreased cardiac output

give O2
give antidysrhythmics

67
Q

unstable patient with vtach

A

with pulse and s/s of decreased cardiac output

give O2
give antidysrhythmics
cardioversion if patient is unstable
cough CPR: coughing hard every 1-3 secs

68
Q

pulseless patient with vtach

A

defib and CPR

69
Q

vfib

A

chaotic rapid rhythm where ventricles quiver and there is NO cardiac output

fatal if not stopped within 3-5 mins

lack pulse, BP, respirations, heart sounds, and is unconscious

70
Q

vfib interventions

A 
CPR until defibrillator gets there 
check entire length of patient 3 times to make sure no one is touching the patient or the bed 
when clear: defib 
CPR another 2 mins 
reassess cardiac rhythm
give O2
give antidysrhythmic
71
Q

vagal maneuvers

A

induce vagal stimulation to terminate SVTs

72
Q

carotid sinusmassage

A

instruct patient to turn head away from side that is being massaged
massage 1 carotid for a few seconds to determine change in rhythm
patient must be on cardiac monitor
check ECG strips before during and after
document
have defibrillator and CPR equipment at bedside
check VS, cardiac rhythm, and LOC after

73
Q

valsalva maneuver

A

instruct patient to bear down or induces gag reflex to stimulate vagal response
check HR, rhythm, BP
record ECG before during and after
provide emesis basin if gag reflex is stimulated
aspiration precautions
have defib and CPR equipment in room

74
Q

cardioversion

A

synchronized countershock to convery undesirable rhythm to stable

75
Q

pre-cardioversion

A

if elective, ensure informed consent is obtained
if elective hold dig for 48 hrs before
if elective for afib or aflutter: patient should get anticoags for 4-6 weeks before
give sedative

76
Q

during cardioversion

A

ensure skin is clean and dry in area where electrode pads will be placed
stop O2 to avoid fire hazard
make sure no one is touching the bed or patient when giving the shock (check 3 times before shocking)

77
Q

post-cardioversion

A 
priority: maintain airway and breathing 
resume O2
check VS
check LOC
check cardiac rhythm
check for indications of successful response: conversion to sinus rhythm, strong pulses, adequate BP and urine output 
check skin on chest for burns from pads
78
Q

defib

A

countershock for pulseless vtach and vfib

1 defib then 5 cycles (2mins) of CPR
reassess after 2 mins
shock again

BEFORE SHOCKING MAKE SURE O2 IS TURNED OF TO AVOID FIRE HAZARD AND BE SURE THAT NO ONE IS TOUCHING THE BED OR THE PATIENT

79
Q

pad electrodes

A

1 pad on 3rd intercostal space to right of sternum
1 pad on 5th intercostal space on left of midaxillary line
apply firm pressure to each pad (25lbs)
make sure no one is touching bed or patient for shock

80
Q

AED

A

place patient on firm dry surface
stop CPR
make sure no one is touching patient or bed
place electrode patches in correct spots
press analyzer button
shock for pulseless vtach or vfib ONLY (up to 3 shocks)
if unsuccessful, CPR is continued for 1 min and the another 3 shocks are given

81
Q

automated implanted cardioverter-defibrillator

A

monitors cardiac rhythm and detects and terminated episodes of vtach and vfib

used in patients with episodes of spontaneous sustained vtach or vfib

planted in left pectoral

82
Q

automated implanted cardioverter-defibrillator education

A

wear loose fitting clothes
avoid contact sports to prevent trauma
report fever redness welling or drainage from site
report fainting nausea weakness blackouts and rapid pulse rates
during shock discharge, patient may feel faint or short of breath
instruct patient to sit or lie down if they feel a shock and report
maintain log of date time and activity before the shock, s/s before shock, and postshock sensations
encourage family to learn CPR
avoid electromagnetic fields (airport security)
move away from magnetic fields if beeping tones are heard and report

83
Q

pacemakers

A

device that provide electrical stimulation and maintains the HR when patient’s heart can no longer be the pacemaker

84
Q

temporary pacemaker: noninvasive transcutaneous pacing

A

used as temporary emergency measure in patients with profound bradycardia or asystole

electrode pads placed on check and back and connected to external generator

wash skin with soap and water before applying electrodes

no need to shave hair or apply alcohol

posterior electrode goes between the spine and left scapula behind the heart: avoid placing on bone

place anterior electrode between V2 and V5 positions over the heart: do not place over female breast tissue, place under breast

do not take pulse or BP on left side
set pacing rate

85
Q

temporary pacemaker: invasive transcutaneous pacing

A

pacing lead wire placed through antecuital, femoral, jugular, subclavian vein into right atrium or right ventricle

check insertion site
restrict patient movement to prevent displacement

86
Q

reducing risk of microshock

A

use only inspected and approved equipment
insulate exposed portion of wires to plastic or rubber (rubber gloves)
ground all electrical equipment using 3 pronged plug
wear gloves when handling wires
keep dressings dry

VS ARE MONITORED AND CARDIAC MONITORING IS DONE CONTINUOUSLY FOR CLIENT WITH PACEMAKER

87
Q

permanent pacemakers

A

surgical implantations in subcutaneous pocket below clavicle
limit arm movement postop to prevent wire dislodgement
powered by lithium battery with average life span of 10 years

88
Q

pacemaker education

A

teach about programmed rate
teach s/s of battery failure and when to report to MD
report fever, redness, swelling, or drainage
report dizziness, weakness, fatigue, swelling of ankles or legs, chest pain, or SOA
teach how to take pulse
take pulse daily and keep diary
wear loose fitting clothes over site
no contact sports
inform all HCP that pacemaker is inserted
inform airport security about pacemaker because it will set off the alarms
most electrical appliances can be used without interference
do not operate electrical appliances directly over pacemaker
avoid transmitter towers and anti-theft devices in stores
move 5-10 feet away and check pulse if unusual feelings occur near electrical devices
important to follow up with MD
use cellphones on opposite side of the pacemaker

89
Q

coronary artery disease

A

narrowing or obstruction of arteries d/t atherosclerosis

causes decreased perfusion and inadequate O2 supply

leads to HTN, angina, dysrhythmias, MI, heart failure, death

90
Q

coronary artery disease s/s

A 
chest pain
palpitations
dyspnea
syncope
cough or hemoptysis
excessive fatigue

can lead to ischemia of the heart

91
Q

coronary artery disease diagnostic tests

A

ECG
cardiac cath
blood lipid levels

92
Q

coronary artery disease care

A 
find risk factors that can be modified 
set goals to promote lifestyle changes 
low calorie low sodium low cholesterol low fat diet 
increase fiber 
dietary changes are for life 
increase exercise
stop smoking 
reduce stress
93
Q

coronary artery disease meds

A

nitrates
calcium channel blockers
cholesterol lowering meds
beta blockers

94
Q

angina

A

chest pain from heart ischemia from lack of blood and O2 to heart

95
Q

goal of angina treatment

A

provide relief from acute attack, correct imbalance between heart O2 supply and demand, and prevent progression of disease and further attacks to reduce risk of MI

96
Q

stable angina

A

occurs with activities that involves exertion or emotional stress

relieved with rest or nitro

stable pattern

97
Q

unstable angina

A

unpredictable degree of exertion or emotion

increases in occurrence duration and severity

NOT RELIEVED WITH NITRO

98
Q

variant angina

A

from coronary artery spasm

occurs at rest

associated with ST segment elevation on ECG

99
Q

intractable angina

A

chronic incapacitating angina that does NOT respond to treatment

100
Q

preinfarction angina

A

acute coronary insufficiency

last longer than 15 mins

s/s of worsening cardiac ischemia

chest pain that occurs days to week before MI

101
Q

angina s/s

A

substernal crushing squeezing pain
pain may radiate to shoulders, arms, jaw, neck, back
pain usually lasts less than 5 mins but can last up to 15-20 mins
pain relieve by nitro and rest

dyspnea
pallor
sweating 
palpitations
tachycardia
dizzy 
syncope
hypertension
digestive issues
102
Q

angina diagnostic

A 
ECG
stress test 
cardiac enzyme
troponin
cardiac cath
103
Q

angina care

A 
give nitro
cardiac monitoring 
give O2
bed rest
semi fowlers 
stay with patient 
obtain 12-lead ECG
get IV access
104
Q

acute angina episode

A 
stop activity 
rest 
nitro
call 911 if nitro does not relieve pain 
aspirin
105
Q

MI

A

ischemia that leads to necrosis

infarction occurs over several hours

106
Q

MI diagnostics

A

troponin level rise w/in 3 hrs and remains elevated for 7-10 days
CK level
WBC count
ECG

107
Q

MI s/s

A

women experience atypical s/s: SOA and fatigue
crushing substernal pain that radiate to jaw back and left arm
pain without cause (early in the AM)
pain unrelieved by rest or nitro
only relieved by opioids
pain lasts 30 mins or longer

n/v
sweating
dyspnea
dysrhythmias
fear 
anxiety
pallor 
cyanosis
cool extremities
108
Q

MI care

A

PAIN RELIEF INCREASES O2 SUPPLY TO HEART; GIVE MORPHINE AS PRIORITY IN MANAGING PAIN TO PATIENT WITH MI

MONA: morphine, O2, nitro, aspirin
check RR, HR
check for crackles or wheezes or edema
bed rest
semi fowlers
stay with patient
get IV access
obtain 12-lead ECG
check for tachycardia or PVCs because they occur hours after MI: give antidysrhythmics
give anti thrombolytic and check for bleeding
check pulses and skin temp because poor cardiac output (cool sweaty skin and decreased pulses)
check BP
give beta blockers to slow HR and increase myocardial contraction

109
Q

acute MI episode

A

bed rest
stand to void or use bedside commode
ROM exercises to prevent thrombus formation
maintain muscle strength
progress to dangle legs at side of bed or out of bed to chair for 30 mins 3 times/day
progress to ambulation in patients room and to bathroom and then hallway 3 times/day
check for complications
give ACE, ARBs, calcium channel blockers, aspirin, clopidogrel, lipid lowering meds

110
Q

heart failure

A

impaired pumping ability that leads to inability of heart to maintain adequate cardiac output

decreased tissue perfusion

111
Q

right sided heart failure

A 
edema
JVD
abdominal distention
hepatomegaly
splenomegaly 
anorexia 
nausea
weight gain
nocturnal diuresis 
swelling of fingers and hands
increased BP from increased fluid volume
decreased BP from pump failure
112
Q

left sided heart failure

A 
pulmonary congestion 
dyspnea
tachypnea
tachycardia
crackles 
nasal flaring 
use of accessory muscles 
wheezing
blood frothy sputum
dry hacking cough
nocturnal dyspnea 
cold clammy skin 
cyanosis 
increased BP from increased fluid volume
decreased BP from pump failure
113
Q

pulmonary edema priority nursing actions

A 
high fowlers 
legs in dependent position 
high flow O2
assess lung sounds
get IV access
give diuretic (furosemide) and morphine 
insert foley
prepare for intubation and vent 
document

can give dig and bronchodilators

114
Q

after acute episode with heart failure

A 
dig
diuretics
ace inhibitor 
beta block
vasodilator
no OTC
no large amounts of caffeine (coffee, tea, cocoa, chocolate, carbonated drinks)
eat K+ rich foods 
fluid restriction 
suck on hard candy to reduce thirst 
rest periods 
avoid isometric activities 
daily weights 
report signs of fluid retention (edema or weight gain)
115
Q

cardiogenic shock

A

failure of heart to pump

goal of treatment is to maintain tissue oxygenation and perfusion and improve pumping of heart

116
Q

cardiogenic shock s/s

A 
hypotension
decreased urine output 
cold clammy skin 
poor pulses 
tachycardia
tachypnea
pulomonary congestion
restless
chest discomfort
117
Q

cardiogenic shock care

A 
give O2
give morphine IV 
intubation and mechanical vent
give diuretics and nitrates
give vasopressors and inotropes
check ABGs 
check urinary output
118
Q

central venous pressure

A

pressure within SVC

pressure in which blood is returned to SVC

119
Q

measure CVP

A

transducer needs to be at level of right atrium
position supine with HOB at 45 degrees
no coughing or straining
to maintain patency: continuous small amount of fluid delivered under pressure

120
Q

mean arterial pressure (MAP)

A

60-70

121
Q

pericarditis

A

inflammation of pericardium

pericardial sac becomes inflamed

122
Q

pericarditis s/s

A

anterior chest pain that radiates to left side of neck, shoulder, or back
pain made worse by breathing, coughing, swallowing
pain worse in supine position and relieved by leaning forward
pericardial friction rub
fever
chills
fatigue
elevatedWBC
ECG changes (ST elevation, afib)

123
Q

pericarditis care

A

high fowlers or upright and leaning forward
give O2
give pain meds (NSAIDs or steroids)
listen for pericardial friction rub
check blood cultures to find cause
give antibiotics for bacterial infection
give diuretics and dig
check for cardiac tamponade and report to MD

124
Q

myocarditis

A

inflammation of myocardium d/t pericarditis, systemic infection, or allergies

125
Q

myocarditis s/s

A 
fever 
dyspnea
tachycardia
chest pain 
pericardial friction rub 
gallop rhythm
murmur that sounds like fluid passing an obstruction
pulsus alternans 
s/s heart failure
126
Q

myocarditis care

A 
sit up and lean forward
give O2
pain meds, aspirin, NSAIDS
dig 
antidysrhythmics
antibiotics 
check for complications: thrombus, heart failure, cardiomyopathy
127
Q

endocarditis

A

inflammation of inner lining of the heart and valves

IV drug abusers (need a replacement valve)

128
Q

endocarditis s/s

A 
fever
anorexia
weight loss
fatigue
cardiac murmurs
heart failure
vegetation fragments 
petechiae 
splinter hemorrhages on nail beds
oslers nodes (red tender lesions on pad of fingers, hands, toes)
janeway lesions (nontender hemorrhagic lesions)
splenomegaly
clubbing of fingers
129
Q

endocarditis care

A

schedule rest
antiemolism stockings
check for s/s heart failure
check for splenic emboli (sudden abdominal pain radiating to left shoulder and presence of rebound abdominal tenderness)
check for renal emboli (flank pain radiating to groin, hematuria, and pyuria)
check for confusion, aphasia, or dysphasia
check for pulmonary emboli
check blood cultures
give antibiotics

130
Q

endocarditis education

A

aspetic technique during setup and administration of IV antibiotics
IV antibiotics are scheduled
check IV site for s/s infection
report s/s infection
record daily temp for up to 6 weeks
report temp
oral hygiene twice a day with soft tooth brush
rinse well with water after brushing
avoid oral irrigation devices and flossing
cleanse skin lacerations and apply antibbiotic ointment
inform all HCPs about condition and get prophylactic antibiotics before respiratory and dental procedures

NCLEX prep (12 decks)

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