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NCLEX > Cardiac > Flashcards

Cardiac Flashcards

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1
Q

What is released when the heart is stretched

A

BNP

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2
Q

What is sterlings law

A

CO = HR X SV

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3
Q

What drugs affect preload

A

diuretics and nitrates

vasodilate or diurese to reduce preload (amount of stretch)

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4
Q

what drugs affect afterload

A

ACE inhibitors, ARBS, Hydralazine, Nitrates (vasodilate to reduce afterload)

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5
Q

what drugs improve contractility

A

Inotropes

dopamine, dobutamine, milrinone

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6
Q

What drugs are used for rate control

A

beta blockers, calcium channel blockers, digoxin

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7
Q

what is used for rhythm control

A

antiarrhythmics

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8
Q

What 3 arrhytmias are always a big deal

A

pulseless V tach, Vfib, asystole

CPR NOW NO CO

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9
Q

What is chronic stable angina

A

when there is intermittent decreased blood flow to the heard causing ischemia.
usually on exertion

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10
Q

when does stable angina cause pain

A

on exertion due to low O2 to heart

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11
Q

what relieves pain in stable angina

A

rest or nitro SL

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12
Q

what are the actions of nitoglycerin

A

venous and arterial dilation decreasing preload and afterload
dilates coronary arteries –> increase blood flow

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13
Q

what is the timing of administering nitro

A

1 every 5 min x 3 doses

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14
Q

how often should nitro SL be renewed? spray?

A

SL: 6 months
spray: 2 years

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15
Q

common side effect of nitro

A

HA

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16
Q

for pts taking nitro when should an ambulance be called

A

if still pain after 1 spray

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17
Q

what should happen to BP after nitro

A

decrease

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18
Q

what do BP do

A

block beta cells –> receptor sites for epi and NE

decrease BP, P and contractility –> decreases workload of heart

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19
Q

what happens with CO when taking beta blockers

A

decreases

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20
Q

what drugs are given for stable angina

A

nitro
beta blockers
calcium channel blockers
ASA

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21
Q

give examples of calcium channel blockers

A

nifedipine
verapamil
amlodopine
diltiazem

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22
Q

how do calcium channel blockers work

A

vasodilation of arterial system

dilate cornary arteries

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23
Q

what are two benefits of caclcium channel blcokers

A

decrease afterload and increase oxygen to the herat muscle

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24
Q

How does Aspirin work

A

prevents platelets from sticking together –> keeps blood flow

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25
Q

What is an important question to ask pre procedure regarding cardiac catheterization

A

are they allergic to iodine or shellfish

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26
Q

what is important to check prior to cardiac catheterization

A

renal function since you excrete the dye through your kidneys

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27
Q

what might the patient experience during dye injection for cardiac catherterization

A

warm and flush

palpitations

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28
Q

post cardiac catherization what it is important to do as a nurse

A

assess puncture site for bleeding
assess extremeity distal to puncture site for 5ps
bed rest, flat, extremeity striaghht
ask pt. to report pain asap

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29
Q

what are the 5 ps you must assess post cardiac catheterization

A 
pulselessness
pallor
pain
paresthesia
paralysis
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30
Q

where do you assess the 5 ps and when

A

post cardiac catheterization and extreity distal to puncture site

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31
Q

what is the major complication we are worried about post cardiac catheterization

A

hemorrhage

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32
Q

what medication is held prior to cardiac catheterization and when is it given again. why?

A

metformin, 48 hours after; worried about kidneys

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33
Q

what is the number 1 sign of an MI in the elderly

A

SOB

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34
Q

what 3 components in lab work are we looking at regarding the heart

A

CPK-MB
Troponin
Mytoglobin

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35
Q

what is CPK-MB

A

cardiac specific
increased with damage to cardiac cells
elevates w/in 3-12 hours and eaks in 24 horus

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36
Q

What is troponin

A

cardiac biomarker with high specificity to myocardial damage

elevates within 3-4 hours and reminas elevated for up to 3 weeks

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37
Q

2 things about myoglobin

A

increases within 1 hour and peaks within 12 wnat a negative result

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38
Q

what cardiac biomarker is the most sensitive indicator for an MI

A

troponin

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39
Q

which enzymes or biomarkers are most helpful when the client delays seeking care?

A

troponin

40
Q

If shocking a client doesnt’ work and the client remains in V-fib what is the first vasopressor we give

A

epinephrine

41
Q

what common antiarrhythmic do we give for rapid heartrates and pulseless VT

A

amiodarone

42
Q

what anti-arrhythmic drugs are given to preven a second episode of V fib

A

amiodarone and lidocaine

43
Q

what sign is indicative of lidocaine toxicity

A

neuro changes

44
Q

what is an important side effect of amiodarone

A

hypotension

45
Q

what 4 things are given for P in emerg

A

oxygen
aspirin 160-325
nitro
morphine

46
Q

what position do we keep an MI patient in and why

A

head up - decreases workload on the heart and increases CO

47
Q

what is ideal door to drug time for thrombolytics

A

30 mins

48
Q

how soon after the onset of myocardial pain should these drugs be administerd?

A

w/in 6-8 hours

49
Q

what is the major complication associated with thrombolytics?

A

bleeding

50
Q

what are 4 medications that require bleeding precautions

A

anti coags
anti platelets
anti thrombotics
acetaminophen

51
Q

should you do ABGs on someone on bleeding precaution meds

A

hellz no; arteries bleed more

52
Q

what is PCI what are some examples

A

percutaneous coronary intervention

include all angioplasty and stents –> can be any artery including renal

53
Q

what is a major complicatoin of angioplasty

A

MI

54
Q

what happens if there is any problem with PCI

A

pt. goes straight to sx

55
Q

What is CABG? when is it used?

A

coronary artery bypass graft

used for multiple vessel disease or left main coronary artery

56
Q

what coronary artery if occluded resuts in immediate death

A

LCA or widowmaker

57
Q

what types of exercises should cardiac patients avoid?

A

isometric (weights)

58
Q

when can sex be resumed for cardiac patients

A

when they can walk around the block or up a flight of stairs w/o discomfort

59
Q

what is the safest time in the day for sex

A

morning time

60
Q

what is the best exercise for an MI patient

A

walking

61
Q

how is heart failure diagnosed

A

BNP (sensiive indicator; secreted b ventricle V and P is increased)
CXR (enlarged heart)
echo (look at pumping action and ejection fraction; also gives inromation on backflow and valve diseaes)

62
Q

What do ACE inhibitors do

A

suppress RAS
prevent conversion of angio I –> II
dilation and increased stroke volume

63
Q

what do ARBS do

A

block angiotension II receptors and cause a decrease in arterial resistance and BP

64
Q

What do ACE and ARBs block? what does this do?

A

block aldosterone –> lose water and sodium and retain potassium

65
Q

what needs to be monitored when taking digoxin

A

toxicity

66
Q

what does digoxin do

A

slows HR and increases strength of contractions, thus improving CO and kidney perfusion

67
Q

what is normal digoxin level

A

0.5-2

68
Q

what are the early signs and symptoms of digoxin toxicty

A

anorexia

N/V

69
Q

what are the late signs and symptoms of digoxin toxicitiy

A

arrhytmias and vision changes

70
Q

where is the apical HR found

A

5yh intercostal space mid clavicular

71
Q

what electrolyte imbalance are we worried about with digoxin? why

A

hypokalemia + digoxin = toxicity

ANY ELECTROLYTE IMBALANCE CAN CAUSE DIG TOXICITY

72
Q

what do diuretics do

A

decrease preload

73
Q

why should salt substitutes not be used in cardiac patients

A

contain excessive potassium

74
Q

what amount of weight gain needs to be reported

A

1-2 kg

75
Q

what should you think with fluid retention problems

A

HEART PROBLEMS

76
Q

when are pacemakers used

A

with symptomatic bradycardia

77
Q

what are the 3 types of pacemakers

A

temporary (invasive or non-invasive)

permanent

78
Q

whats the difference between demand and permanent pacemakers

A

fixed - constant rate

demand - kicks in when HR goes below set rate

79
Q

what is the most ommno complication post-op

A

electrode displacement

80
Q

what exercises should be done with permanent pacemaker clients? WHy?

A

assisted passive range of motion exercises –> prevent frozen shoulder

81
Q

why do you want to prevent pacemaker clients from raising their arms

A

could cause wires to fall out

82
Q

what is it called if no contraction will follow the stimulus

A

loss of capture

83
Q

wht is it called if the pacemaker fires at inappropriate times

A

failure to sense

84
Q

what can cause loss of capture, failure to sense or other malfunctions

A

not programmed properly
electrodes dislodge
battery may be depleted

85
Q

what client teaching needs to be done regarding pacemakers

A

check pulse daily
ID card and bracelet
avoid electromagnetic fileds (use cellphone on other side)
AVoid MRIS

86
Q

who is at risk for pulmonary edema

A

reeiving IV fluids really fast
the very young and very old
any person who has a histroy of heart or kidney disease

87
Q

when does pulmonary edema ussually occr

A

at night –> increased venous return lying down

88
Q

what cough is associated with pulmonary edema

A

pink frothy sputum

89
Q

how is pulmonary edema treated

A 
oxygen
furosemide (push slow to prevent hypotension and ototoxicity)
nitroglycerin
morphine --> vasodilation
nesiritide --> vasodilation
sit upwright
90
Q

what drug infusion needs to be turned off 2 hours prio to drawing a BNP lvl

A

nesiritide

91
Q

what is cardiac tamponade

A

blood, fluid or exudate leaks into the pericardial sac resluting in compression of the heart

92
Q

what are the two hallmark signs of tamponade

A 
increaseing CVP (heart is being squeezed)
decreasing BP
93
Q

what should you think with narrowed pulse pressure

A

cardiac tamponade

94
Q

what should you think with widened pulse pressure

A

increased ICP

95
Q

what is the pulse pressure

A

difference between systolic and the diastolic

96
Q

we ______ veins and we ______arteries

A

elevate veins

dangle arteries

NCLEX (10 decks)

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