Cardiology Flashcards
What symptoms may be present with a patient with mitral valve prolapse?
palpitations, dizziness, lightheadedness (sometimes chest pain that is unresponsive to nitrates)
What medications are often prescribed for MVP?
beta blockers
What client teaching is provided for MVP?
healthy eating, avoiding caffeine (Worsens Sx) [check for stimulants in ingredients list]
reduce stress
avoid alcohol
begin or maintain aerobic exercise program
Involves injection of iodine contrast using a catheter to examine for obstructed coronary arteries
Cardiac catheterization
What are different complications that can arise from cardiac catheterization?
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
Describe ways in which the complications of cardiac catheterization can be reduced.
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
a group of diseases in which the heart muscle has a reduced ability to pump blood effectively
Cardiomyopathy
Clients with cardiomyopathy are at a high risk for developing what?
Cardiogenic shock
Describe cardiogenic shock
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
What drug class is given for cardiogenic shock?
Inotropes
What meds are contraindicated in cardiogenic shock?
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
Why is bleeding at the puncture site of cardiac catheterization considered a medical emergency?
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.
Describe nursing considerations for clients having undergone cardiac catheterization
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
What nursing assessments and considerations are important following AAA repair?
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
• Vasospastic disorder resulting in episodic vascular response related to cold temperatures or emotional stress
Raynaud’s phenomenon
Raynaud’s phenomenon:
- Related to what two factors?
- Most common in this cohort
- Signs and symptoms?
- Tx
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
What is client teaching for Raynaud’s phenomenon?
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)
If conservative management of Raynaud’s is unsuccessful, what pharmacological treatment may be prescribed?
Calcium channel blockers
What is the general rule of thumb for sex after an MI?
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
PAD
- Etiology
- Clinical features
Common clinical patterns?
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
When should blood pressure readings <150/90 not be treated?
in patients >60
Describe mechanical and electrical capture for pacemakers.
Pacer spike prior to P or QRS complex - electrical capture
Pulse rate corresponds to electrical rate on monitor - mechanical capture
• Arteries are thickened and have lost their elasticity due to calcification of the artery walls, and are narrowed by atherosclerotic plaques
PAD
What is the most common symptom of PAD?
pain
- intermittent claudication
- pain alleviated by dependence
Where does ulcers and gangrene more often present in PAD?
at the most distal part of the body
Where are ulcers (stasis ulcers) most often found in patients with venous insufficiency?
medial side of the ankle
What colour can legs become after venous insufficiency?
Brown
• Non-atherosclerotic vasculitis involving the arteries and veins of the lower and upper extremities
Buerger’s disease (Thromboangiitis obliterans)
Buerger's disease - most common in this cohort - how does it present? - Tx? What is contraindicated?
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
The nurse should question the administration of what in clients with acute decompensated heart failure?
Beta blockers (although good in chronic heart failure)
What are the major side effects of ACEIs?
symptomatic hypotension, intractable cough, hyperkaemia, angioedema, temporary increase in serum creatinine
For clients unable to tolerate ACEIs, what is recommended?
ARBs
Where are pacer spikes seen for ventricular paced rhythms?
Why is the QRS complex widened?
What are ventricular pacemakers used for treatment of?
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
Where is the PMI?
Midclavicular line, 4th-5th ICS
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
aortic dissection
Aortic dissection can rapidly progress to what conditions?
life-threatening cardiac tamponade or aortic rupture
What is the characterizing symptoms of aortic dissection?
Acute onset of excruciating, sharp or “ripping” chest pain that radiates to the back
Describe treatment of an aortic dissection.
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
In the event of pacemaker failure to capture, what is the nurse’s initial priority?
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
Describe considerations/treatment for lymph node removal after mastectomy.
(positioning and exercises)
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
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?
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)
Describe the discharge teaching for a permanent pacemaker.
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
