Cardiac Emergencies

Question 1

The electrical stimulus for the healthy heart to beat originated where? In which part of the heart is this electrical stimulus located?

Answer 1

Sinoatrial node (SA Node)

Right atrium

Question 2

List two ways cardiac output can be increased.

Answer 2

Increasing heart rate

Increasing stroke volume

HR x SV = Cardiac Output

Question 3

A thrombus in a coronary artery can lead to what complication?

Answer 3

AMI
(Acute Myocardial Infarction)

Question 4

A 56-year-old patient is complaining of chest pain. Your working diagnosis is angina and you are using OPQRST to assess the patient’s chief complaint. List an answer would you expect to hear from asking the “Q” question?

Answer 4

Heavy pressure on chest

Question 5

Briefly explain the three differences between an AMI and angina pectoris.

Answer 5

Duration: Angina pain typically is short lived while AMI pain is long term

Provocation/palliation: Angina pain typically is brought on by stress and stops shortly after stress ceases; AMI is sudden and needs treatment to relieve pain

Severity: Angina usually doesn’t lead to long term damages and AMI causes permanent damage.

Question 5

What is the function of the right atrium?

Answer 5

Receiving deoxygenated blood from systemic circulation, via the Superior Vena Cava

Question 6

What is preload?

Answer 6

The amount of blood that fills the heart before the contraction

Question 7

What is the function of the coronary arteries?

Answer 7

Provide myocardial tissue with O2 rich blood

Question 8

An AMI is more likely to occur in which part of the heart? Explain why.

Answer 8

Left ventricle.

It’s the part of the heart that works the hardest.

Question 9

Not all patients experiencing an AMI will complain of chest pain. Which types of patients would fall under this category?

Answer 9

Women, geriatrics, diabetics

Question 10

Answer the following for aspirin: What is the indication, the recommended dose and the action?

Answer 10

Chest pain (cardiac related)

162–324 mg

Decreases clotting

Question 10

The text lists 5 common cardiac arrhythmias. List the arrhythmias that do not generate a pulse.

Answer 10

Tachycardia

Bradycardia

Ventricular fibrillation (pulseless) (VF)

Ventricular tachycardia (VT)

Asystole

Question 11

During your assessment of a 65-year-old female patient ℅ general fatigue, you notice JVD and pedal edema. The patient denies any chest pain but states that she does take “Heart pills” . Explain what may be causing these S/S.

Answer 11

Right-side heart failure

JVD - increased pressure in the jugular veins causing them to protrude

Pedal edema - heart cannot maintain adequate circulation, blood and fluids build up in lower extremities

Question 12

A 53-year-old patient who is complaining of chest pain and difficulty breathing. Vitals signs are RR 20, HR 94, BP 98/78 and an Sp02 of 93%. During the secondary assessment you find that the patient has a heavy pressure type of chest pain. Outline your treatment for this patient?

Answer 12

Provide O2 therapy to maintain 94% SPO2 levels, using NRM. Have patient sitting in Fowlers position to ease breathing. Administer 325mg Aspirin. (not NTG: systolic BP needs to increase to above 100 before giving Nitrogylcerin) Promptly transport patient to cardiac center.

Question 13

You are treating a 62-year-old patient is ℅ difficulty breathing. Your assessment reveals an irregular HR of 108, BP of 188/114, a RR of 26, with wheezing and crackles. You are unable to obtain a pulse oximeter reading. During the history taking part of your assessment you find that the patient has a heart condition and hypertension. What is the treatment for this patient?

Answer 13

Administer high flow O2 using a NRM while patient is sitting in a Fowlers position or position of comfort. Consider inhaler or nebulizer for bronchodilation and give 0.4mg Nitroglycerin as sublingual treatment if no other contraindications are present. Continue to monitor vitals and promptly transport patient to a hospital with a respiratory center.

Question 14

You are treating a 74-year-old female patient who is complaining of general weakness. Your assessment reveals pale, cool skin, a RR of 18, HR of 90 that is weak and thready, BP of 94/62 and an SP02 of 95%. During the history taking part of your assessment, you find that the patient takes Glucophage, nitroglycerin, aspirin and Lipitor. What is the treatment for this patient?

Answer 14

Lay patient in a supine position to improve venous return. Continuously monitor vital signs and for change in patients mental status. Ask the patient when last medications were taken, provide Glucophage, Nitrogylcerin, aspirin if no contraindications are present. Immediately transport patient to cardiac center at hospital while monitoring patients vitals every 5 minutes.

Question 15

You are treating an altered 88-year-old patient who is complaining of nausea. Your assessment reveals a RR of 26, HR od 102 that is weak and thready, BP of 86/62 and bilateral crackles noted with an SP02 of 92%. These S/S are MOST likely caused by what condition? What is your treatment for this patient?

Answer 15

CHF or pulmonary edema. Immediately provide high flow O2 usinG NRM. Position patient in Fowlers position to maximize air flow. Monitor patients vital signs every 5 minutes as well as mental status. Immediately transport to cardiac facility.