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NCLEX > Cardiac Part 2 > Flashcards

Cardiac Part 2 Flashcards

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1
Q

Leading cause of HF

A

HTN

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2
Q

Left HF S/S

A 
Lung problems
Blood tinged frothy sputum
S3
Restless
Orthopnea (SOB laying down)
Nocturnal SOB
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3
Q

2 common causes of RHF

A

PE - lung clot causes pooling of blood before it gets there, causing increased pressure and pulmonary HTN (RV has to push HARD to get blood to the lungs)

COPD - always have low O2 causing pulmonary HTN (hypoxia is #1 cause of pul HTN)

Pulmonary HTN b/c of increased workload on the R side of the heart

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4
Q

3 ways to diagnose HF

A
  1. BNP
  2. CXR
  3. Echo
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5
Q

What is BNP?
What do results mean?
What may alter this test?

A

B-Type Natriuretic Peptide

A substance that the ventricle tissue secretes when there is increased volume and pressure within the heart

Increased amounts are a sensitive indicator of HR and can be positive for HF when the CXR doesn’t show any problems

If a patient is taking nesiritide, turn it off 2 hours before drawing a BNP because this drug is man-made BNP and will give a false high

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6
Q

What will a HF CXR look like?

A

Enlarged heart

Pulmonary infiltrates / edema

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7
Q

What will an echo do?

A

Look at the pumping action of the heart muscle

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8
Q

What does a Swan Ganz cath do?

A

Cath floated to R side of heart and pulmonary artery to rapidly get hemodynamics, CO, and mixed venous blood sample

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9
Q

What is an easy access to get ABG samples?

A

Art line

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10
Q

NY heart association functional Classification of HF

A

Classes 1-4, 4 being the most

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11
Q

What are the 4 main drugs used in the management of HF?

A

ACE
ARB
Dioxin
Diuretics

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12
Q

Drug of choice for HF?

A

ACE Inhibitors

SE: hypotension, cough, hyperkalemia

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13
Q

How do ACE Inhibitors work?
How do ARBs work?

What do they both do?
So what do we watch for?

A

Suppress RAAS resulting in arterial dilation and increased stroke volume - prevent angio 1 to 2 conversion

Decrease arterial resistance and decreased BP - block angio 2 receptors

Block aldosterone, resulting in losing Na and water, and retaining K
Watch for S/S hyperkalemia

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14
Q

Standard core measure that a HF patient will be sent home with what? Why?

A

ACE Inhibitor and/or BB

They decrease the workload of the heart by preventing VC and promoting forward blood flow out of the heart

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15
Q

How does digoxin work?

Usually used for what?

A

Increased contractility and decreases HR to increase CO and kidney perfusion

A slow HR gives the ventricles more time to fill

Usually used with sinus rhythm or A fib in combo with HF

Often given with the 4 HF drugs

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16
Q

How is the dosing of Digoxin?

Normal level on the body?

A

Digitalizing dose - large 1st dose

Normal level: 0.5-2

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17
Q

What kind of blood transfusions do HF patients get?

A

NOT WHOLE BLOOD! If they need a specific component, they will receive that
Ex: Platelet transfusion, RBC transfusion

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18
Q

Early and Late signs of Dig toxicity

What should we monitor while they are on it?

What 2 things will especially put the patient at risk for toxicity?

NCLEX strategy here

A

Early: Anorexia, N/V
LateL Arrhythmias, Vision changes

Monitor Electrolytes

LOW potassium and dig

NCLEX: ANY E IMBALANCE CAN PROMOTE DIG TOXICITY

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19
Q

Signs that Dig is working?

What to check before we give it?

A

Increased CO

Apical pulse (5th IC space, left midclavicular line)

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20
Q

What do diuretics do?

When do we give them?

A

Decrease Preload

In the morning - pee a lot

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21
Q

How does a low sodium diet do for HF?
What should we watch for?
Examples of high sodium foods?

A

Decreases fluid retention and decreases preload

Na substitutes - contain excessive K

Canned/processed foods and OTC meds

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22
Q

How do pacemakers work in regards to HF?

A

Increase HR with SYMPTOMATIC bradycardia (HR

23
Q

Always worry if what happens with the pacemaker?

A

It drops below the set rate (minimal HR)

  • It’s okay for the rate to increase but NEVER decrease
24
Q

Fixed vs demand pacemaker

A

Fixed:Fire at a fixed rate constantly

Demand: Only kicks in if the patient needs it

25
Q

Post op pacemaker care

Most common complication?
What not to move
Why do we do assistive passive ROM?
How high can we raise the arm?

A

Monitor the incision
Electrode displacement (wires pulled out - wires need time to imbed into the heart muscle)
Immobilize arm - prevent displacement
Frozen shoulder
Not above shoulder height!! Unless wires might come out

26
Q

Failure to capture

What is happening?
What causes this?
What do we watch for?

A

Stimulus fired but heart doesn’t react

Not programmed right
Dislodged electrodes
Low battery

Watch for decreased CO or decreased HR

27
Q

Pacemaker edu

Need a ID bracelet/card?
What to avoid?
Will they set off alarms?

A

Check HR daily

YES
Avoid electromagnetic fields (use opposite cell ear, large motors)
Avoid MRI
Avoid contact sports

Will set off airport alarms

28
Q

What is an ICD?

Post op care?

A

Implantable Cardioverter Defibrillator / Cardiac device

Be be used to pace the heart or defibrillate the patient in V Fib

Same pot op care as pacemaker

29
Q

Risks for getting pulmonary edema?

A

IVF really fast
Young and old
Hx of heart or kidney disease

30
Q

What is happening in pulmonary edema?

When does it usually occur?

A

Fluid in the lungs, heart can’t more the volume forward

Night time- promotes pooling

31
Q

S/S Pulmonary edema

A 
Sudden onset
Breathless
Restless/anxiety
SEVERE HYPOXIA
Productive cough and pink frothy sputum
32
Q

How to treat pulmonary edema

A 
High flow oxygen - keep above 90%
Furosemide
Bumetanide
NTG
Morphine
Nesiritide
33
Q

How do we give Furosemide?

A

40 mg IVP slowly over 1-2 min to prevent ototoxicity and hypotension

34
Q

How do we give Bumetanide?

A

IVP or continuous infusion

1-2 mg IVP over 1-2 min

35
Q

Why do we give NTG for pulmonary edema?

A

Decreases preload and after load to increase CO and promote forward blood flow

36
Q

Why do we give morphine?

A

Causes vasodilation to decrease preload and after load

Decrease agitation

37
Q

Why do we give Nesiritide?
Precaution?

What to remember about this drug?

A

For short term therapy
Don’t give for more than 48 hours!

Vasodilator veins and arteries and had diuretic effect

DC 2 hours before BNP draw

38
Q

How to position pulmonary edema patient

A

Upright with legs dependent (down)

This improves CO and promotes pooling in LE

39
Q

What happens in cardiac tamponade?

What can cause this?

A

Blood, fluid, or exudate have leaked into the pericardial sac resulting in compression of the heart and improper filling capabilities

MVA, RV biopsy, MI, pericarditis, hemorrhage after CABG

40
Q

Hallmark signs of cardiac tamponade?

Other S/S?

A

Increased CVP and Decreased BP

Muffled/distant heart sounds
Distended neck veins with clear lungs
Same pressure in all chambers (fluid all around the heart)
SHOCK d/t decreased CO
Narrowed pulse pressure
41
Q

Narrow Pulse pressure think:

Widened pulse pressure think:

A

Narrow: Cardiac tamponade
Widened: Increased ICP

** Need to know the baseline!!!

42
Q

How to treat cardiac tamponade?

A

Pericardiocentesis to remove the fluid around the heart

Surgery

43
Q

If you have atherosclerosis in 1 place, you have it ______

A

everywhere

44
Q

What does it mean if you have an arterial occlusion? (numb, pain, cold, pulseless)

A

MEDICAL EMERGENCY

45
Q

Hallmark sign of intermittent claudication

A

PAIN

46
Q

What does pain at rest mean?

A

A severe obstruction

47
Q

When arterial/oxygenated blood can’t get to the tissues, what would we see?

A 
Cold, numb
DECREASED PERIPHERAL P
Atrophy (decreased muscle tone d/t lack of O2)
Bruit (turbulent blood flow)
Skin/nail changes
Ulcerations
48
Q

If arterial/oxygenated blood is having trouble getting to the tissue, what’s going to happen if you elevate the extremity?

A

Increased PAIN!!!! You are making it even hard for the blood to get there!

49
Q

How are arterial disorders usually treated?

A

Angioplasty (balloon & stent)
Endarterectomy (remove inner artery lining)
Both increase perfusion

50
Q

Rule of thumb for extremity placement for arterial / venous insufficiencies

A

ELEVATE veins

DANGLE arteries

51
Q

If you don’t know the artery in the question, try to think of where the artery feeds

A

Ex: Radial feeds hand, carotid feeds head, femoral feeds leg

Ex: Carotid endarterectomy
Think- Replenishing blood flow to the head so think ^LOC

Ex: AAA patient post op has a leg cramp – BAD! perfusion disrupted - DVT - Never delay treatment!! Get a wheelchair and then call MD!

Don’t just assume an answer that has increased perfusion anywhere or that flow will come booming in

52
Q

Chronic ARTERIAL Insufficiency

Pain:
Pulses: 
Color: 
Temp:
Edema: 
Skin changes: 
Ulceration: 
Gangrene: 
Compression:
A

ARTERIAL Insufficiency

Pain: Intermittent claudication
Pulses: Decreased or absent
Color: Pallor w/ elevation, red with lowering
Temp: Cold, numb
Edema: Absent or mild
Skin changes: Thin, shiny, loss of hair over feet/toes, nail thickening
Ulceration: If present, will involve toes
Gangrene: May develop
Compression: Not used

53
Q

Chronic VENOUS Insufficiency

Pain: 
Pulses: 
Color:
Temp:
Edema: 
Skin changes: 
Ulceration: 
Gangrene: 
Compression:
A

VENOUS Insufficiency

Pain: None to aching
Pulses: Normal (may be hard to palpate d/t edema)
Color: Normal or petechiae or brown
Temp: Normal
Edema: Present 
Skin changes: Brown, leathery, scarring
Ulceration: If present, will be on sides of ankles
Gangrene: None
Compression: Used

NCLEX (23 decks)

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