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NCLEX > Cardiac Part 1 > Flashcards

Cardiac Part 1 Flashcards

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1
Q

What is the opposite of aldosterone?

When is is released?

A

ANP

When there is increased preload so it causes us to lose Na and water

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2
Q

CO = ___ x ____

A

CO = Stroke Volume x HR

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3
Q

Stroke volume

A

Amount of blood pumped out of the ventricles with each beat

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4
Q

What 3 things affect CO

A

HR and rhythm (arrhythmias)
Blood volume
Contractility (MI, meds, disease)

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5
Q

When to worry about arrhythmias? What 3?

What are we going to do if they occur?

A

When they affect CO
V fib, pulseless V tach, Systole

NEED TO ASSESS BEFORE CALLING THE PHYSICAIN!
H-T assessment to see if they affect CO (LOC, chest pain, SOB, crackles, cold/clammy, low UO, weak pulses)

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6
Q

What is the most common type of cardiac disease?

What does this include?

A

CAD

Chronic stable Angina & Acute Coronary Syndrome

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7
Q

What causes CHRONIC stable angina?

What is the pain due to?
What relieves it?

A

Decreased blood flow to the myocardium causing ISCHEMIA and temporary pain/pressure in the chest

Pain d/t low O2 usually due to exertion
Rest and SL NTG should relieve

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8
Q

Effects of NTG
How to take it?
How is it stored?
SE?

A

Venous and arterial VD
Decrease Preload & afterload
Dilation of coronary arteries
DECREASED BP - but should return

SL - may burn/fizz

Dark, glass bottle - don’t mix, keep it cool and dry

SE: Headache

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9
Q

How often should the patient renew NTG?

What about the spray?

A

3-5 months

2 years

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10
Q

What if the BP doesn’t come back up after NTG?

A

They are unstable!! Need medical attention

NEVER LEAVE AN UNSTABLE CLIENT! If BP changes, DON’T LEAVE! The BP could keep decreasing

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11
Q

3 drug types that prevent angina

A

BB, CCB, aspirin

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12
Q

Affects of BB on angina and the heart

SE

A

PREVENT angina
Decreased BP, HR, contractility,
Decrease CO
Decreased heart workload

Beta cells are receptor sites for the catecholamines that release epi and NE –> We block this

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13
Q

Examples of CCB

A

Nifedipine, Verapamil, amlodipine, diltiazem, nicardipine

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14
Q

CCB affect on angina and the heart

A 
PREVENT angina
Decreased BP
Arterial vasodilation
Dilate coronary arteries
Decreased afterload
Increase O2 to the heart
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15
Q

Generic name for Aspirin

A

Acetylsalicylate Acid

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16
Q

Client teaching for Chronic stable angina

Rest?
Diet/Eating?
Exercising?
Temperature changes?
NTG
Avoid what kind of exercising and why?
A

Rest frequently
Avoid overeating, lose weight
Avoid excess caffeine or drugs that increase HR
Wait 2 hours after eating to exercise
Dress warm in cold weather (Temp change can precipitate an attack)
Take NTG prophylactically - Need to sit down wile taking!
Smoking cessation
Reduce stress (relaxation)
Avoid isometric exercises (exercises that squeeze muscles - increases workload)

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17
Q

Chronic Stable Angina NCLEX RULE OF THUMB

A

DO EVERYTHING YOU CAN DO TO DECREASE THE WORKLOAD ON THE HEART

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18
Q

Surgical way to diagnose Chronic unstable angina

A

Cardiac Cath

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19
Q 
What to do before cardiac cath
Ask what?
Check what?
What may be given especially with kidney problems?
How will they feel?
A

Allergy to iodine or shellfish

Check kidney function because dye is nephrotoxic

acetylcysteine (Mucomyst) to protect the kidneys

Hot shot (dye may make them feel like they are peeing)

Palpitations are normal

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20
Q

Post-cardiac cath

Monitor what?
Watch for what?
Big thing to asses?
How should they lie?

A

Monitor VS
Watch for bleeding/hematoma at the puncture site
Assess extremity distal to site (5 Ps)
Bed rest, flat, leg straight for 4-6 hours

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21
Q

What are the 5 P’s?

A

Post cardiac cath distal extremity assessment

Pulselessness
Pallor
Pain
Paralysis
Paresthesia

CIRCULATION! Skin and cap refill are also important

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22
Q

What do we hold after the a cardiac cath? For how long? Why?

A

Metformin if they are on it
48 hours
It is nephrotoxic

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23
Q

What is the major complication post-cardiac cath?

A

Bleeding and pain - Report ASAP

24
Q

What 2 things does Acute coronary Syndrome include?

A

MI and unstable angina

25
Q

ACS/MI/Unstable Angina

What is happing with the blood flow?

A

There is decreased blood flow leading to ischemia AND necrosis

26
Q

S/S of an MI

A 
Pain - SOB, GI with women
Cold/clammy hands
Decreased cO
ECG changes
Vomiting
27
Q

Unstable Angina / MI

Can it occur at rest?
Where does the pain occur and what does it feel like?
What else may occur besides pain?

A

Yes

Crushing pain / pressure radiating to left arm and jaw, may be between shoulder blades
N/V - vomiting stimulates vagus nerve and causes decreased CO

28
Q

Signs of an MI in women

A 
GI symptoms
Epigastric complaints
Pain between shoulders
Aching jaw
Choking sensation
29
Q

What is the #1 sign of an MI in the elderly?

A

SOB - they may not feel pain

Could have behavioral changes

30
Q

General NCLEX rule of thumb concerning a patient with a STEMI

A

They are having an MI!

Goal it to get them to the cath lab for a PCI in less than 90 minutes

31
Q

What is CKMB

When does it elevate and peak?

A

Cardiac specific isoenzyme that increases with damage to cardiac cells

Elevates in 3-12 hours
Peaks in 24 hours

32
Q

What is troponin?

When does it elevate and peak?

A

Cardiac biomarker with HIGH specificity to myocardial damage

Elevates in 3-4 hours
Remains elevated for up to 3 weeks

33
Q

What is myoglobin?

When does it elevate and peak?

A

Protein in heart and skeletal muscle that increased with muscular damages

Elevates in 1 hour and peaks in 12

We want this to be negative

34
Q

What tis the most sensitive indicator of an MI?

A

Troponin, especially if the patient is delayed in getting treatment because it stays elevated for 3 weeks

35
Q

What addition arrhythmia can lead to sudden death?

A

Bradycardia

36
Q

Priority treatment for V Fib

What if this doesn’t work?
What is that doesn’t work?

A

Defibrillation with CPR between shocks

Epi or vasopressor
Amiodarone

37
Q

What do we give when V fib and pulseless V tach are resistant to treatment?

What is it’s important SE?

A

Amiodarone

Decreased BP that can lead to further arrhythmias

38
Q

What will we give to prevent a second episode of V fib?

A

Amiodarone and Lidocaine

39
Q

Sign of lidocaine toxicity

A

Neuro changes

40
Q

What drugs are given for chest pain in the ED

How do we position them?

A

O2
Aspirin chewable is faster - prevent platelets
NTG
Morphine if NTG doesn’t work (Know this order of MONA)

HOB elevated to decrease the workload on the heart and increase CO

41
Q

How do fibrinolytic work?

How soon after the MI should they be given?

A

They dissolve the clot that is blocking flow to the heart muscle, thus decreasing the size of the infarction

Give within 6-8 hours - MUCH SOONER if they have a stroke

42
Q

4 examples of fibrinolytic

Which one is prone for allergies?

A

Streptokinase *** allergy - have to treat allergy but still give it
Alteplase
Tecnecplase
Reteplase

43
Q

Major complication of fibrinolytic

What do we need?
Precautions?
Can we do an ABG?

A

Hemorrhage

Need to have a peripheral line
Need bleeding history

Bleeding precautions - less picture sites (draw blood from lines)
NO ABG!!!!!!!!!!

44
Q

What are major contraindications to fibrinolytic?

A

Intracranial neoplasm, brain bleed, suspected aortic dissection, internal bleeding, liver disease or NSID OD

45
Q

Example of platelets
Are these a part of fibrinolytic therapy?
How are they given?

A

Acetylsalicylic acid
Clopidogrel
Abciximab
Eptifibatide

These are given continuously

46
Q

What is the best way to give tPA?

A

We want a peripheral line (vs a central line) because if it starts to bleed, we are able to apply pressure to it

47
Q

How does a PCI (Percutaneous Coronary Intervention) work?

A

Interventions opens a coronary artery up to restore blood flow

48
Q

What is the major complication of an angioplasty?

A

MI

49
Q

What does CP after surgery indicate? What do we do?

A

Reocclusion!! Surgery is need if any problems occur

50
Q

What kind of anti-platelets are given after a PCI to a patient who is at high risk and have a stent or are awaiting cath lab?

A

Clopidogrel, Abciximab, Epitifibatide
These will keep the artery open if they have a stent and keep the clot from getting bigger if they are waiting for cath lab

51
Q

What is CABG and when is it used?

A

Another name for heart surgery (ED or scheduled)

Used with multiple vessel disease or left main coronary artery occlusion

52
Q

What does the left main coronary artery supply?

A

The entire left ventricle!! If there is an occlusion we are going to think SUDDEN DEATH!!!! Or widow maker..

53
Q

Cardiac Rehab

Smoking?
What kind of plan?
Diet?
What to avoid?

A

Stop smoking
Stepped care plan - Increase activity gradually

Low fat, low salt, low cholesterol - fried foods once a month, shop the parameter of the grocery store

Avoid isometric exercises
Avoid straining, suppositories - give them Docusate!
Avoid valsalva

54
Q

Cardiac Rehab

When can sex be resumed?
When is the safest time for sex?
Best kind of exercise?

A

Resume sex when the patient can walk up stairs / around the block without discomfort

In the morning - well rested

Walking

55
Q

Cardiac Rehab

What to teach the patients about heart failure?

A

Symptoms

Weight gain
Ankle edema
SOB
Confusion

NCLEX (23 decks)

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