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NCLEX > Cardiac > Flashcards

Cardiac Flashcards

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1
Q

preload

A

amount of blood returning to the right side of the heart and the stretch in muscle the volume causes

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2
Q

_____ is released when we have this preload stretch

A

ANP -> diurese

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3
Q

increased preload =

A

increased workload

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4
Q

afterload

A

the pressure (resistance) in the aorta and the peripheral arteries that the LV has to pump against to get the blood out

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5
Q

diagnosis with increased afterload

A

HTN

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6
Q

HTN can lead to… (2), because why?

A
  1. HF|2. pulmonary edema||- high afterload decreases CO and forward flow -> wears your heart out
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7
Q

stroke volume

A

amount of blood pumped out of the ventricles w/ each beat

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8
Q

CO = ____ x ____

A

CO = HR x SV

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9
Q

____ is dependent on adequate CO

A

tissue perfusion

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10
Q

*4 factors that affect CO*

A
  1. HR|2. certain dysrhythmias|3. blood volume|4. decreased contractility
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11
Q

3 potential causes of decreased contractility

A
  • MI|- medications|- cardiac muscle disease
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12
Q

Medications: preload|- how do medications work to affect preload and increase CO?||- 2 examples

A
  • by vasodilating or diuresing to decrease preload||1. Diuretics (furosemide)|2. Nitrates (nitroglycerine)
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13
Q

Medications: afterload|- how do medications work to affect afterload and increase CO?||- 4 examples

A
  • by vasodilating to reduce afterload||1. ACE Inhibitors (captopril, enalapril, fosinopril)|2. ARBS (valsartan, losartan, irbesartan)|3. hydralazine|4. nitrates
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14
Q

Medications: contractility|- how do medications work to affect contractility and increase CO?||- 3 example

A
  • by providing an inotropic effect on the heart -> increases contractility ||1. inotropes (dopamine, dobutamine, milrinone)
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15
Q

Medications: rate control|- how do medications work to affect HR and increase CO?||- 3 examples

A
  • by slowing the rate down to a more controlled, effective pump||1. Digoxin|2. B-blockers (metoprolol, propanolol, atenolol, carvedilol)|3. Ca-Channel blockers (diltiazem, verapamil, amlodipine)
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16
Q

Medications: rhythm contol|- how do medications work to affect rhythm and increase CO?||- 1 example

A
  • by converting the heart back to a NSR, the heart pumps more effectively and CO increases||1. antiarrythmics (Amiodarone)
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17
Q

6 areas affected by decreased CO

A
  1. brain|2. heart|3. lungs|4. kidneys|5. skin|6. peripheral pulses
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18
Q

Decreased CO:|- brain|- heart|- lungs|- kidneys|- skin|- peripheral pulses

A
  1. brain: LOC decreases||2. heart: chest pain||3. lungs: wet sound/crackles, SOB||4. skin: cold, clammy||5. kidneys: UO decreases||6. peripheral pulses: weak/thready
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19
Q

dysrhythmias are no big deal until what?

A

they affect your CO

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20
Q

*3 arrythmias that are ALWAYS a big deal + ACTION*

A
  1. pulseless v-tach|2. v-fib|3. asystole||- CPR!!
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21
Q

most common CV disease

A

coronary artery disease

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22
Q

CAD includes… (2)

A
  • chronic stable angina||- acute coronary syndrome
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23
Q

Patho: chronic stable angina

A
  • intermittent decreased BF to myocardium leads to ischemia||- this ischemia can lead to temporary pain/pressure in chest
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24
Q

CSA:|- what brings on the chest pain?|- what relieves it?

A
  • low O2, usually d/t exertion||- rest and/or nitroglycerine sublingual
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25
Q

4 medications for CSA

A
  1. nitroglycerine sublingual|2. B-blockers|3. Ca-Channel blockers|4. Aspirin
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26
Q

Nitroglycerine:|- action|- route|- use

A
  • causes venous, arterial, and coronary artery vasodilation -> decreases preload and afterload; and increases blood flow to the myocardium||- sublingual||- used for angina
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27
Q

Nitroglycerine:|- how to take?|- swallow?|- burn/fizz?|- expected outcome?

A
  • sublingual: take 1 every 5 minutes x 3 doses for acute angina -> no help, call 911||- DON’T SWALLOW||- may or may not burn/fizz||- patient WILL get a headache -> but also their BP will decrease
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28
Q

Storing Nitroglycerine:|- store it how?|- renew SL tablets how often?|- spray how often?

A
  • store in a dark, glass bottle in a dry and cool place||- q3-6months||- q2yr
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29
Q

After giving nitro, can you leave the pt?

A

NO: never leave an unstable pt!

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30
Q

nitro: home teaching (2)

A
  • take one NTG SL -> after 5 minutes if chest pain/discomfort is unrelieved or worse, call 911||- take @ home -> have a BP monitor to check your BP
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31
Q

B-blockers:|- use|- action (3)

A
  • prevention of angina||- decrease:|1. BP|2. HR|3. contractility||…therefore, decreasing the workload of the heart
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32
Q

What happens to CO when you give B-blockers?

A
  • decreases -> decreases workload of heart
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33
Q

considerations for b-blockers

A
  • good to a certain point to decrease the work/CO on the heart||- but we could potentially decrease CO too much
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34
Q

Ca-channel blockers:|- 4 examples|- use|- action

A
  1. nifedipine|2. verapamil|3. amlodipine|4. diltiazem||- prevention of angina||- dilation of the arterial system (coronary arteries) -> decreasing BP
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35
Q

2 benefits of Ca-channel blockers

A
  1. decrease afterload|2. decrease heart’s oxygen demand
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36
Q

Acetylsalicylic acid (aspirin): use

A

to keep blood flowing freely

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37
Q

general strategy for pt teaching for CSA

A

do whatever you can to decrease the workload on the heart

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38
Q

*pt teaching: CSA (8)*

A
  1. rest frequently|2. avoid overeating|3. avoid excess caffeine/drugs that increase HR|4. dress warmly in cold weather|5. take NTG prophylactically|6. quit smoking|7. lose weight|8. reduce stress
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39
Q

diet for CSA

A
  • low fat, high fiber
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40
Q

CSA: exercise teaching (2)

A
  • wait 2 hr after eating to exercise||- avoid isometric exercise (squeeze/release muscles)
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41
Q

Why do CSA pt’s need to dress appropriately for the weather?

A

any temperature extreme can precipitate an attack

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42
Q

procedure that may need to be performed in a CSA pt

A

cardiac catheterization

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43
Q

Considerations: pre-cardiac cath (4)

A
  1. assess if allergic to iodine or shellfish (an iodine-based dye is used)||2. assess kidney function: dye is excreted thru kidneys||3. inform pt that the shot will feel hot and that palpitations are normal||4. hold metformin
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44
Q

What is often ordered before a cardiac cath if a pt has kidney problems?

A
  • acetylcystine (Mucomyst): helps to protect kidneys
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45
Q

considerations: post-cath (4)

A
  1. monitor VS|2. watch puncture site|3. assess extremity distal to puncture site|4. proper positioning
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46
Q

watch puncture site for what? (2)

A
  1. bleeding: major complication post-cath||2. hematoma formation: bleeding behind them
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47
Q

assess extremity distal to puncture site how often? for what? (5 P’s)

A
  • q15m for 1 hr||Pulselessness|Pallor|Pain|Paresthesias|Paralysis
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48
Q

*Positioning post-cath* (3)

A
  • bedrest||- lie flat||- keep extremity straight for 4-6 hr
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49
Q

after cath, report ______ ASAP

A

PAIN

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50
Q

withhold which med after cath? for how long? why?

A
  • metformin||- 48 hr||- worried about kidneys
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51
Q

Unstable chronic angina = ….

A

impending MI

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52
Q

Acute Coronary Syndrome (ACS) is another name for..

A
  • MI||- unstable angina
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53
Q

ACS:|- patho

A
  • decreased BF to myocardium -> ischemia and necrosis
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54
Q

difference b/n ACS and CSA

A

ACS:|- pt does not have to be doing anything to bring this pain on||- NTG will not relieve the pain

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55
Q

6 general s/s of ACS

A
  1. pain|2. cold/clammy|3. hypoTN|4. decreased CO|5. ECG changes|6. vomiting
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56
Q

how might the pain from ACS be described?

A
  • pressure|- elephant sitting on my chest|- pressure radiating to left arm/jaw|- N/V|- pain between shoulder blades
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57
Q

3 patients we are most concerned about when considering MI + why?

A
  1. women|2. elderly |3. diabetics||- these patients don’t have typical s/s of ACS
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58
Q

Women usually present w/…..during an MI (5)

A
  1. GI s/s|2. epigastric complaints|3. pain between shoulder blades|4. aching jaw|5. choking sensation
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59
Q

*classic triad a woman will present w/ when having an MI*

A
  1. abd fullness|2. chronic fatigue|3. SOB
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60
Q

Why are we worried about the elderly?

A

they might have less or no pain

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61
Q

2 most common s/s of ACS in elderly

A
  1. SOB = most common||2. change in behavior
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62
Q

why are we worried about diabetics?

A

can’t feel pain properly (neuropathy)

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63
Q

Which patient is more severe: STEMI or NSTEMI?|- *action?*

A

STEMI: this indicates that the pt is having a heart attack||- need to get them to the cath lab for PCI in less than 90 minutes

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64
Q

3 labs used to diagnoses MI

A
  1. CPK-MB|2. Troponin|3. Myoglobin
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65
Q

which lab value is most sensitive and most specific for diagnosing MI?

A
  • troponin
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66
Q

CPK-MB:|- increases with..|- elevates how fast?|- peaks when?

A
  • damage to cardiac cells||- within 3-6 hr||- 12-24 hr
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67
Q

Troponin: normal levels|- T|- I

A
  • T: < 0.10||- I: < 0.03
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68
Q

Troponin:|- elevates how fast?|- remains elevated how long?

A
  • within 3-4 hr||- up to 3 weeks
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69
Q

Why is troponin the best indicator of an MI?

A
  • it is the most sensitive biomarker to myocardial damage||- it remains elevated for a long time, good for the pt who delayed seeking care
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70
Q

why is myoglobin not reliable for diagnosing MI?

A

it is not cardiac specific

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71
Q

One benefit of myoglobin levels

A

it will elevate first: within 1 hr

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72
Q

potential complication of an ACS

A

major arrythmias

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73
Q

*3 untreated arrythmias that will put the pt at risk for sudden death*

A
  1. pulseless v-tach|2. v-fib|3. asystole
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74
Q

*priority tx for v-fib*

A

DEFIBRILATE!: de-fib the v-fib||- also CPR!

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75
Q

*the first shock doesn’t work and the pt remains in v-fib. what are the next 2 actions to take?*

A
  • epinephrine -> then amiodarone
76
Q

Amiodarone:|- uses (3)

A

when:|1. v-fib and|2. pulseless v-tach|…are resistant to tx||3. fast dysrhythmias

77
Q

2 anti-arrythmics commonly given to prevent a 2nd episode of v-fib

A
  1. amiodarone|2. lidocaine
78
Q

1 antiarrythmic of choice + major S/E

A
  • amiodarone||- hypoTN -> can lead to further dysrhythmias
79
Q

s/s of lidocaine toxicity

A

any neuro changes

80
Q

*order of medications given to pt w/ chest pain when they arrive at the ED*

A
  1. Oxygen: keep O2 sat > 90%|2. Aspirin: chewable|3. Nitroglycerine|4. Morphine||*OANM*
81
Q

what position should you place pt c/o of chest pain in?

A

head up: decreases workload and increases CO

82
Q

what other kind of medication will the pt c/o chest pain be given?

A

thrombolytics

83
Q

thrombolytics:|- goal|- 4 examples

A
  • dissolve the clot that is blocking BF to the heart muscle -> decrease size of infarction||1. alteplase|2. tenecteplase|3. reteplase|4. streptokinase
84
Q

*how soon after onset of myocardial pain should thrombolytics be administered?*

A

within 6-8 hrs

85
Q

Stroke: ________ is BRAIN

A

TIME

86
Q

major complication of thrombolytic therapy

A

bleeding

87
Q

*4 absolute contraindications for thrombolytic treatment*

A
  1. intracranial neoplasm|2. intracranial bleed|3. suspected aortic dissection|4. internal bleeding
88
Q

antidote for dabigatran

A

iadrucizumab

89
Q

3 classes of drugs requiring bleeding precautions

A
  1. thrombolytics|2. antithrombotics|3. acetominophen
90
Q

3 other examples of thrombolytics

A
  1. heparin|2. warfarin|3. enoxaparin sodium
91
Q

*bleeding precautions (8)*

A

watch for:|1. bleeding gums|2. hematuria|3. black stools||use:|4. electric razor|5. soft toothbrush|6. stool softeners|7. lubricant for sex||no:|8. IM injections

92
Q

How to draw blood on a pt on bleeding precautions

A
  • draw blood when starting IVs -> decrease number of puncture sites
93
Q

any ABGs if a pt is on bleeding precautions?

A

NO

94
Q

_____ are another important follow-up component of thrombolytic therapy

A

antiplatelets: aspirin, clopidogrel, etc

95
Q

Which type of IV is preferred if you need a TPA for an MI?|- CVL or PIV?

A

PIV: because if you put in a central line there is an extreme risk for bleeding out

96
Q

2 medical interventions for MI

A
  1. percutaneous coronary intervention (PCI)||2. coronary artery bypass graft (CABG)
97
Q

use of PCI

A

to open up occluded artery to restore BF

98
Q

PCI includes… (2)

A
  • PTCA (angioplasty)||- stents
99
Q

major complication of PCI

A

MI (also bleeding from heart cath site, or reocclusion)

100
Q

if any problems occur after PCI, do what?

A

go to surgery

101
Q

*pt teaching: post-PCI*

A

report any pain! -> Call HCP STAT, they are reoccluding

102
Q

CABG:|- use (2)

A

(scheduled or emergent)||- multiple vessel disease||- left main artery occlusion

103
Q

why is the left main coronary artery so important?

A
  • supplies the LV -> ||- if occluded, think sudden death! (or “widow maker”)
104
Q

*Post-MI: pt teaching -> NO…(4)*

A

NO:|- smoking|- isometric exercises|- valsalva/straining|- suppository meds

105
Q

Give ____ to prevent straining post-MI

A

docusate

106
Q

Post-MI: exercise teaching (3)

A
  • stepped-care plan (increase activity gradually)|- no isometric exercises|- best exercise: walking
107
Q

Post-MI: diet (4)

A
  1. low fat|2. low salt|3. low cholesterol|4. high fiber
108
Q

Post-MI: sex teaching (2)

A
  • can resume sex when they can walk up a flight of stairs or around the block w/ no discomfort (1 wk-10 days)||- safest time to have sex: morning, when they are well rested
109
Q

teach Post-MI pt s/s of HF (4)

A
  1. increased wt|2. ankle edema|3. SOB|4. confusion
110
Q

5 main causes of HF

A
  1. untreated HTN: #1 causes|2. cardiomyopathy|3. endocarditis|4. MI|5. valvular heart disease
111
Q

S/S of LHF (9)

A
  1. pulmonary congestion|2. pink, frothy sputum|3. dyspnea|4. cough|5. restlessness|6. tachycardia|7. S-3 sound|8. orthopnea|9. nocturnal dyspnea
112
Q

S/S of RHF (5)

A
  1. distended neck veins|2. edema|3. enlarged organs|4. wt gain|5. ascites
113
Q

how can COPD/pulmonary embolus lead to cor pulmonale?

A
  • hypoxia -> pulmonary HTN -> increased workload -> RHF -> cor pulmonale
114
Q

what is cor pulmonale?

A

RHF caused by LHF/primary disorder in respiratory system

115
Q

Systolic vs Diastolic HF

A
  • systolic: heart can’t contract and eject||- diastolic: heart can’t relax and fill
116
Q

4 common ways to diagnose HF

A
  1. B-type natriuretic peptide (BNP)|2. CXR|3. Echocardiogram|4. NY Heart Association Functional Classification
117
Q

NY Functional classification: which is the worst?

A
  • scale of 1-4, 4 being the worst
118
Q

sensitive laboratory indicator of HF

A

BNP

119
Q

BNP:|- when is it secreted?|- considerations when preparing to draw

A
  • secreted by ventricular tissues when ventricular volumes and pressures in the heart are increased||- discontinue nesiritide 2 hr before drawing BNP
120
Q

a CXR will show (2) in HF

A
  • enlarged ventricles||- pulmonary infiltrates
121
Q

echocardiograms can give you information on.. (2)

A
  1. pumping action/ejection fraction|2. backflow -> valve disease
122
Q

2 standard medications used for HF

A
  1. ACE inhibitors||2. ARBs
123
Q

drug of choice for HF

A

ACE inhibitors

124
Q

ACE inhibitor:|- action|- result in (2)

A
  • prevent conversion of angiotensin I to angiotensin II||1. arterial dilation|2. increased stroke volume
125
Q

ARBs:|- action|- result in (2)

A
  • block angiotensin II receptors||1. decreased arterial resistance|2. decreased BP
126
Q

ACE inhibitors and ARBs both block ________ => result (3)

A
  • aldosterone: ||1. lose Na|2. lose H2O|3. retain K+ ->
127
Q

watch for ______ w/ ACE inhibitors/ARBs

A

hyperkalemia

128
Q

it is a core practice that a pt w/ HF will be sent home on…what (2)?||Why?

A
  1. ACE inhbitor||and||2. B-blocker||- these drugs decrease workload by preventing vasoconstriction (decreasing afterload). This will increase CO and keep blood moving forward.
129
Q

2 other drugs for HF

A
  1. digoxin|2. diuretics
130
Q

Digoxin:|- use|- results (4)

A
  • used when pt is in sinus rhythm or a-fib and has HF||1. increased contractility|2. decreased HR|3. increased CO|4. increased kidney perfusion
131
Q

Important to assess for _____ w/ digoxin

A

toxicity (especially in elderly pt)

132
Q

normal digoxin levels

A

0.5 - 2.0

133
Q

we always want to ____ HF pts

A

diurese

134
Q

s/s of digoxin toxicity (4)

A
  • anorexia|- N/V|- arrythmias|- vision changes: yellow halos
135
Q

before giving digoxin, do what?

A

assess apical pulse for a full minute. Hold dose if it is <60

136
Q

where would you check for apical pulse?

A

5th ICS, MCL

137
Q

most important electrolyte to monitor if a pt is on digoxin

A

K+

138
Q

_______ + digoxin = toxicity

A

hypokalemia

139
Q

T/F: any electrolyte can promote digoxin toxicity

A

TRUE

140
Q

diuretics:|- action|- consideration

A
  • decrease preload||- always give in the morning
141
Q

5 other interventions for HF pt

A
  1. low Na diet|2. bed positioning|3. daily wt|4. report s/s of recurring failure|5. pacemaker
142
Q

low Na diet helps decrease ___

A

preload

143
Q

salt substitutes can contain excessive ____

A

K+

144
Q

position in bed for HF pt

A

HOB elevated

145
Q

report a wt gain of….

A

2-3 lb

146
Q

fluid retention, think ____ first

A

heart problems

147
Q

natural pacemaker

A

SA node

148
Q

Pacemaker:|- indication

A

symptomatic bradycardia

149
Q

What do pacemakers do?

A

depolarize the heart muscle -> contraction will occur

150
Q

repolarization

A
  • Re = rest: ventricles rest and fill up w/ blood
151
Q

pt w/ pacemaker: always worry if…

A

HR drops below the set rate

152
Q

post-permanent pacemaker care (4)

A
  1. monitor incision|2. immobilize arm -> put things close to them|3. assisted passive ROM to prevent frozen shoulder|4. keep pt from raising arm higher than shoulder
153
Q

loss of capture

A

no contraction follows stimulus -> decreased CO

154
Q

failure to sense

A

pacemaker fires at innappropriate times

155
Q

2 s/s of pacemaker malfunction

A
  • any sign of decreased CO||- bradycardia
156
Q

Pacemaker: pt teaching (6)

A
  1. check pulse daily|2. ID card/bracelet|3. avoid electromagnetic fields (cell phones, large motors)|4. avoid MRIs|5. will set off alarm at airport|6. avoid contact sports
157
Q

R/F for pulmonary edema (5)

A
  1. receiving IV fluids very fast|2. very young|3. very old|4. heart dz|5. renal dz
158
Q

when does pulmonary edema usually occur?

A

at night, when pt goes to bed

159
Q

S/S of pulmonary edema (5)

A
  • pink, frothy sputum|- sudden onset|- breathless|- restless/anxious|- severe hypoxia
160
Q

*priority nursing action for pulmonary edema*

A
  • administer high-flow oxygen: titrate to keep O2 sats > 90%
161
Q

4 medications for pulmonary edema

A
  1. diuretics|2. nitroglycerine|3. morphine|4. nesiritide
162
Q

Diuretics:|- use|- results (2)|- how to give?|- prevent (2)

A
  • reduce preload||1. diuresis|2. vasodilation||- IVP slowly over 1-2 minutes to prevent hypoTN and ototoxicity
163
Q

which diuretic can be given as a continuous IV infusion?

A

bumetanide

164
Q

result of NTG

A

decreased afterload

165
Q

results of morpine (2)

A
  • decreased afterload and preload
166
Q

Nesiritide:|- actions (2)|- considerations (2)

A
  1. vasodilates veins/arteries|2. diuretic effect||1. turn off 2 hr before drawing BNP|2. only used for short-term therapy: never longer than 48 hr
167
Q

pulmonary edema: positioning + why? (2)

A
  • upright position, legs down||1. improves CO|2. promotes pooling of blood in legs
168
Q

cardiac tamponade: patho

A
  • blood, fluid, or exudate has leaked into the pericardial sac resulting in compression of the heart||- often seen in MVA, MI, pericarditis, hemorrhage post-CABG
169
Q

2 hallmark signs of cardiac tamponade

A
  1. increased CVP|2. decreased BP
170
Q

other s/s of tamponade (5)

A
  1. narrowed pulse pressure|2. muffled/distant heart sounds|3. distended neck veins|4. pressures in all 4 chambers the same|5. shock
171
Q

tamponade tx

A

pericardiocentesis

172
Q

T/F: atherosclerosis is often limited to one certain spot

A

false: if you have it in one place, you have it everywhere

173
Q

hallmark sign of arterial disorder

A

intermittent claudication: |- only seen w/ arterial problems|- pain relieved w/ rest

174
Q

7 s/s of arterial disorder

A
  • coldness|- numbness|- decreased peripheral pulses|- atrophy|- bruit|- skin/nail changes|- ulcerations
175
Q

Pain at rest means…

A

severe arterial occlusion: medical emergency

176
Q

leg positioning:|- arterial disorder|- venous disorder

A
  • A: dangle arteries (A points down)||- V: elevate veins (V points up)
177
Q

2 common treatments for aterial disorders

A
  • angioplasty||- endarterectomy
178
Q

how to assess if an angioplasty/endarterectomy was successful?

A
  • look for positive changes in the area that the artery is feeding blood to (brain, abd, leg)
179
Q

Arterial vs. Venous: pain

A
  • A: intermittent claudication (progressing to pain at rest)||- V: none-to-aching pain; depends on dependency of area
180
Q

Arterial vs. Venous: pulses

A
  • A: decreased, may be absent||- V: normal (may be difficult to palpate d/t edema)
181
Q

Arterial vs. Venous: color

A
  • A: pale when elevated, red when lowered||- V: normal (may see petechiae/brown pigment)
182
Q

Arterial vs. Venous: temperature

A
  • A: cool||- V: normal
183
Q

Arterial vs. Venous: edema

A
  • A: absent or mild||- V: present
184
Q

Arterial vs. Venous: skin changes

A
  • A: thin, shiny, loss of hair over foot/toes, nail thickens||- V: brown pigment around ankles, thickening/scarring of skin
185
Q

Arterial vs. Venous: ulceration

A
  • A: will involve toes or areas of trauma on feet (painful)||- V: will be on sides of ankles
186
Q

Arterial vs. Venous: gangrene

A
  • A: may develop||- V: does not develop
187
Q

Arterial vs. Venous: compression

A
  • A: not used||- V: used

NCLEX (4 decks)

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