Cardiology

Question 1

What symptoms may be present with a patient with mitral valve prolapse?

Answer 1

palpitations, dizziness, lightheadedness (sometimes chest pain that is unresponsive to nitrates)

Question 2

What medications are often prescribed for MVP?

Answer 2

beta blockers

Question 3

What client teaching is provided for MVP?

Answer 3

healthy eating, avoiding caffeine (Worsens Sx) [check for stimulants in ingredients list]
reduce stress
avoid alcohol
begin or maintain aerobic exercise program

Question 4

Involves injection of iodine contrast using a catheter to examine for obstructed coronary arteries

Answer 4

Cardiac catheterization

Question 5

What are different complications that can arise from cardiac catheterization?

Answer 5

Allergic reaction (to IV contrast)
Contrast nephropathy - iodine contrast can cause kidney injury - clients with Cr >115umol/L shold not receive IV contrast (unless absolutely necessary)
Lactic acidosis - associated with metformin use

Question 6

Describe ways in which the complications of cardiac catheterization can be reduced.

Answer 6

premedication with corticosteroids or antihistamines to reduce allergy

hydration to reduce odds of nephropathy

Discontinuing metformin for 24-48 hours prior to cardiac cath and restarted 48 hours later, when stable renal function is confirmed

Question 7

a group of diseases in which the heart muscle has a reduced ability to pump blood effectively

Answer 7

Cardiomyopathy

Question 8

Clients with cardiomyopathy are at a high risk for developing what?

Answer 8

Cardiogenic shock

Question 9

Describe cardiogenic shock

Answer 9

Manifested by reduced CO (hypotension, decreased pulse pressure), which can lead to pulmonary edema
Catecholamines are released to compensated and increase CO, but this fails leading to:
decreased perfusion and oxygenation of tissues, then death

Question 10

What drug class is given for cardiogenic shock?

Answer 10

Inotropes

Question 11

What meds are contraindicated in cardiogenic shock?

Answer 11

IVF - may lead to increased circulatory volume and cardiac workload, precipitating pulmonary edema
Nitro - may worsen hypotension –> morphine for chest pain can be given instead

Question 12

Why is bleeding at the puncture site of cardiac catheterization considered a medical emergency?

Answer 12

Bleeding at the puncture site indicates that a clot has not formed at the insertion site. This is an arterial bleed, which can lead to hypovolemic shock and death is not treated immediately.

Question 13

Describe nursing considerations for clients having undergone cardiac catheterization

Answer 13

Monitor for bleeds at insertion site - may progress to hypovolemia and death

Monitor neurovascular status, - cool extremities may indicate decreased perfusion leading to tissue necrosis

Client may lie flat for several hours and is encouraged to engage in quiet activities for 24 hour to prevent dislodging the clot at the insertion site

Clients are encouraged to drink fluids to flush out dyes

Question 14

What nursing assessments and considerations are important following AAA repair?

Answer 14

The nurse should monitor neurovascular status (esp of the lower extremities)

• pulses can be absent for 4-12 hours after surgery due to vasospasm
• • however, a pedal pulse decreased from baseline or an absent pulse with a painful, cool or mottled extremity can indicate the presence of arterial or graft occlusion

Question 15

• Vasospastic disorder resulting in episodic vascular response related to cold temperatures or emotional stress

Answer 15

Raynaud’s phenomenon

Question 16

Raynaud’s phenomenon:

• Related to what two factors?
• Most common in this cohort
• Signs and symptoms?
• Tx

Answer 16

cold temps, emotional stress
Women aged 15-40
Vasospasm induces a colour change in the fingers, ears and nose - appendage turns white, then bluish purple - coldness and numbness often reported
- after reperfusion - area becomes red, throbbing and aching with swelling and tingling

Acute vasospasms are treated by immersing the hands in warm water

Question 17

What is client teaching for Raynaud’s phenomenon?

Answer 17

o Wear gloves when handling cold objects
o Dress in warm layers, particularly in cold weather
o Avoid extremes and abrupt changes in temperature
o Avoid vasoconstricting drugs (caffeine, amphetamines, ergotamine, pseudoephedrine)
o Refrain from using tobacco
o Implement stress management strategies (e.g. yoga or tai-chi)

Question 18

If conservative management of Raynaud’s is unsuccessful, what pharmacological treatment may be prescribed?

Answer 18

Calcium channel blockers

Question 19

What is the general rule of thumb for sex after an MI?

Answer 19

if the client can climb 2 flights of stairs, or walk 1 block without symptoms, the client can resume sexual activity
often safe to resume sexual activity 7-10 days after an uncomplicated MI

Question 20

PAD
- Etiology
- Clinical features
Common clinical patterns?

Answer 20

Diabetes, hyperlipidemia, HTN, smoking, age >70

Asymptomatic in 50% of population
Physical exam:
- weak or absent peripheral pulses
- bruits on auscultation
- poor wound healing
- cool; pale skin and prolonged cap refill
- shiny, atrophied skin with missing hair
- broken nails

Common clinical patterns

• erectile dysfunction
• ischemic heart pain with activity that is alleviated with rest

Question 21

When should blood pressure readings <150/90 not be treated?

Answer 21

in patients >60

Question 22

Describe mechanical and electrical capture for pacemakers.

Answer 22

Pacer spike prior to P or QRS complex - electrical capture

Pulse rate corresponds to electrical rate on monitor - mechanical capture

Question 23

• Arteries are thickened and have lost their elasticity due to calcification of the artery walls, and are narrowed by atherosclerotic plaques

Answer 23

PAD

Question 24

What is the most common symptom of PAD?

Answer 24

pain

• intermittent claudication
• pain alleviated by dependence

Question 25

Where does ulcers and gangrene more often present in PAD?

Answer 25

at the most distal part of the body

Question 26

Where are ulcers (stasis ulcers) most often found in patients with venous insufficiency?

Answer 26

medial side of the ankle

Question 27

What colour can legs become after venous insufficiency?

Answer 27

Brown

Question 28

• Non-atherosclerotic vasculitis involving the arteries and veins of the lower and upper extremities

Answer 28

Buerger’s disease (Thromboangiitis obliterans)

Question 29

Buerger's disease
- most common in this cohort
- how does it present?
- Tx?
What is contraindicated?

Answer 29

young men (<45) with a long history of tobacco or marijuana use and chronic periodontal infection with NO OTHER CV risk factors

Clients experience thrombus formation, resulting in distal extremity ischemia and digit ulcers, or digit gangrene
- often have intermittent claudication of hands and feet

Tx is cessation of ALL tobacco and marijuana
- avoid cold exposure to limbs, walking proram, Abx for ulcers, analgeisa for pain and avoidance of trauma to digits

Nicotine replacement products are contraindicated

Question 30

The nurse should question the administration of what in clients with acute decompensated heart failure?

Answer 30

Beta blockers (although good in chronic heart failure)

Question 31

What are the major side effects of ACEIs?

Answer 31

symptomatic hypotension, intractable cough, hyperkaemia, angioedema, temporary increase in serum creatinine

Question 32

For clients unable to tolerate ACEIs, what is recommended?

Answer 32

ARBs

Question 33

Where are pacer spikes seen for ventricular paced rhythms?
Why is the QRS complex widened?
What are ventricular pacemakers used for treatment of?

Answer 33

pacer spike seen before QRS complex

depolarizes the RV first, and then the left ventricle causing a widened QRS complex

used in the treatment of sympatomatic bradycardia or heart block

Question 34

Where is the PMI?

Answer 34

Midclavicular line, 4th-5th ICS

Question 35

Tear in the inner lining of the aorta that allows blood to surge between the layers of the arterial wall, separating and weakening the aortic wall

Answer 35

aortic dissection

Question 36

Aortic dissection can rapidly progress to what conditions?

Answer 36

life-threatening cardiac tamponade or aortic rupture

Question 37

What is the characterizing symptoms of aortic dissection?

Answer 37

Acute onset of excruciating, sharp or “ripping” chest pain that radiates to the back

Question 38

Describe treatment of an aortic dissection.

Answer 38

Decrease the risk of aortic rupture by maintaining normal BP in the aorta
- administration of IV beta blockers to lower the heart rate and BP
Emergency surgical repair

Question 39

In the event of pacemaker failure to capture, what is the nurse’s initial priority?

Answer 39

Use transcutaneous pacing (to normalize the HR, stabilize BP and adequately perfuse organs)
- administer analgesia and/or sedation as prescribed as pacing is very uncomfortable

Question 40

Describe considerations/treatment for lymph node removal after mastectomy.
(positioning and exercises)

Answer 40

Elevate arm to heart level to reduce fluid retention and prevent lymphedema
hand and arm exercises are initiated gradually - starting with finger flexion and extension - return of full ROM expected in 4-6 weeks
keep client semi-fowler
pneumatic compression indicated if lymphedema occurs

Question 41

What is a major side effect of erythropoeitin?
What is a contraindication to the drug?
When is therapy initiated?
How is it administered?
What may be co-administered? Why?

Answer 41

HTN is a major adverse effect - uncontrolled HTN is thus a contraindication

Therapy is initiated with Hb less than 100g/L to alleviate anemia symptoms

EPO is administered SQ or IV, NOT IM

Iron (iron sucrose or ferric gluconate) may be co-administered to promote an adequate response to EPO (which needs adequate iron, B12 and folic acid stores to work)

Question 42

Describe the discharge teaching for a permanent pacemaker.

Answer 42

o Report fever or any signs of redness, swelling, or drainage at the incision site
o Carry a pacemaker identification card and wear a medical alert bracelet
o Take the pulse daily and report it to the HCP if below the predetermined rate
o Avoid MRI scans
o Avoid carrying a cell phone in a pocket directly over the pacemaker and, when talking on a cell phone, hold it to the ear on the opposite side of the pacemaker
o Notify airport security of a pacemaker – screening wand should not be held directly over the device
o Avoid standing near antitheft detects in store entry ways; walk through at a normal pace and do not linger near the device
o Client should wait to raise arm above shoulder on the side of the pacemaker until approved by the HCP as it may dislodge the wires