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AHI > CARDIOVASCULAR CASE STUDIES > Flashcards

CARDIOVASCULAR CASE STUDIES Flashcards

1
Q

Acute episodes lands them in hospital for HF exacerbation
Manage outpatient and edu how manage outpat
Pump failure-chronic inability of heart to work effectively as a pump
Heart not able to maintain adequate cardiac output to meet the metabolic needs of the body
Types
Most heart failure begins with failure of the left ventricle and progresses to failure of both ventricles

A

HF

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2
Q

Left-sided heart failure
Right-sided heart failure
High-output failure

A

Types - HF

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3
Q

Decreased tissue perfusion from poor cardiac output and pulmonary congestion
Backs up into lungs: s/s of pulm congestion
Often happens first
Systolic heart failure (2/3 of cases)
Diastolic heart failure

A

Left-sided heart failure

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4
Q

Heart doesn’t pump adequately; reduced EF: <40% diagnostic HF

A

Systolic heart failure (2/3 of cases) - Left-sided heart failure

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5
Q

Heart doesn’t fill adequately

A

Diastolic heart failure - Left-sided heart failure

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6
Q

Right ventricle can not empty
Backs up into body: s/s of systemic congestion
Happens if have chronic obstructive disease

A

Right-sided heart failure

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7
Q

Cardiac output remains normal but there are increased metabolic needs or hyperkinetic conditions
Normal EF (prob not with pump) - issue is with increase in metabolic needs

A

High-output failure

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8
Q

Bert is concerned and he is not sure what caused this problem? What prior medical history puts Bert at risk for heart failure(Select all that apply)?
1. Hypertension
2. Hypothyroidism
3. GERD
4. Aortic valve stenosis

A

Answer: 1, 4
Why? (Think about plumbing)
What are some other causes of HF?
Smoking (risk factor/contribute), Age, overweight, CAD, following a MI - area heart muscle damaged end up with HF

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9
Q

Left ventricular failure - backs up into right side after so long of back up
Right ventricular MI (myocardial infarction)
Pulmonary hypertension
Chronic lung disease

A

Causes of right sided heart failure:

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10
Q

Hypertension
Coronary artery disease
Valvular disease
Ventricular remodeling after MI - ventricles remodel and reshape after MI around area that have infarct

A

Causes of left sided heart failure:

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11
Q

Which question will provide the nurse the best data about any additional risk factors for heart failure? (Select all that apply)
1. “Do you have any chronic lung disorders?”
2. “Have you ever had a heart attack?”
3. “Do you have varicose veins?”
4. “Have you ever had low blood pressure?”

A

Answer: 1, 2
Chronic goes along with right-sided
Varicose veins - tells having other issues in extremities; HTN is more a risk factor than low BP

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12
Q

When planning care for Bert the nurse anticipates what diagnostic procedure?
1. Cardiac catheterization
2. Echocardiogram
3. Angiography
4. Exercise electrocardiograpy

A

Answer: 2
Standard tool for diagnosing HF
ECG - looking at heart rhythm; electrocardiogram

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13
Q

Imaging:
Lab

A

Diagnostic assessment - HF

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14
Q

CXR
Echocardiogram

A

Imaging:

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15
Q

Cardiomegaly (enlarged heart) may be present

A

CXR

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16
Q

US of the heart
Best tool in diagnosing HF
Looks at structure of the heart
Measures chamber size, ejection fraction and flow
If EF (ejection fraction) <40% then diagnostic of HF
Can look at valves
Can increase EF back up with back meds and lifestyle modifications; can also get lower if not take care of self
Do when have acute exacerbations

A

Echocardiogram

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17
Q

BNP (B-type natiuretic peptide)
Electrolytes
BUN and creatinine
H&H
Urinalysis
ABG

A

Lab

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18
Q

Will be elevated and used for diagnosing HF
BNP is produced and released by the ventricles when the patient has fluid overload
Natriuretic peptides promote vasodilation and diuresis through sodium loss in the renal tubules

A

BNP (B-type natiuretic peptide)

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19
Q

Abnormalities from complications of HF or side effects of drug therapy
Diuretics given for HF; loop: excreting electrolytes and K low - aggressive K protocol

A

Electrolytes

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20
Q

Inadequate perfusion of kidneys can result in impairment and elevated levels
Can get kidney disease when not perfusing as well
Diuretics can affect kidneys: want get fluid off - creatinine can get too high and not want damage kidneys

A

BUN and creatinine

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21
Q

Could be low secondary to hemodilution

A

H&H

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22
Q

Possible proteinuria and high specific gravity
Microalbuminuria - early indicator of decreased compliance of the heart and occurs before the BNP rises

A

Urinalysis

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23
Q

Decrease in gas exchange secondary to fluid filled alveoli
May also have obstructive pulm disease

A

ABG

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24
Q

Which assessment finding would indicate to the nurse that Bert is experiencing right-sided heart failure?
1.Dyspnea
2.Tachycardia
3.Edema
4.Fatigue

A

Answer: 3
Systemic effect with right-sided HF

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25
Q

Does Bert have right or left sided heart failure symptoms?
Physical assessment findings:
Irregular HR 138; BP of 140/86
Lungs with fine crackles in the bases bilaterally
Dyspnea
Positive jugular vein distention (JVD)
Bilateral 1+ pitting edema of his ankles

A

Both - often see both in pats

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26
Q

Systemic Congestion
Jugular (neck vein) distention
Enlarged liver and spleen
Anorexia and nausea
Dependent edema (legs and sacrum)
Distended abdomen
Swollen hands and fingers
Polyuria at night
Weight gain - need weigh every day
Increased blood pressure (from excess volume)
Decreased blood pressure (from failure)

A

Symptoms of right sided heart failure

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27
Q

Pulmonary congestion
Decreased cardiac output

A

Symptoms of left sided HF

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28
Q

Hacking cough, worse at night
Dyspnea - not lay flat because fluid builds up
Crackles/wheezes in lungs
Pink, frothy sputum - lot congestion
Tachypnea
S3/S4 gallop

A

Pulmonary congestion

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29
Q

Fatigue and weakness
Oliguria during day/Nocturia at night
Angina - chest pain
Confusion and restlessness - hypoxia sign
Dizziness
Pallor and cool extremities - not good perfusion
Weak peripheral pulses
Tachycardia - increase CO

A

Decreased cardiac output

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30
Q

reduce the resistance to left ventricular ejection (afterload) and improve cardiac output
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-receptor blockers (ARBs)

A

Arterial vasodilators

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31
Q

Enalapril (Vasotec)
Fisinopril (Monopril)
-pril
ACE inhibitors are the first-line drug of choice
Monitor for:

A

Angiotensin-converting enzyme (ACE) inhibitors

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32
Q

May cause dry cough; monitor

A

ACE inhibitors are the first-line drug of choice

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33
Q

Orthostatic hypotension - safety big concern; be with them when getting up and up slowly
Acute confusion
Angioedema
Poor peripheral perfusion
Reduced urine output in patients with low systolic BP
Potassium and creatinine levels
Start slowly - lower dose and work up because not want BP too low

A

Monitor for: - ACE; ARBs

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34
Q

Valsartan (Diovan)
Irbesartan (Avapro)
Losartan (Cozaar)
-sartan

A

Angiotensin-receptor blockers (ARBs)

35
Q

Reduce preload by decreasing volume and pressure in the left ventricle
Up in weight and take extra dose
First-line drug of choice in older adults with HF and fluid overload
Enhance renal excretion of sodium and water
Can be PO, IV push, IV drip
Ex.
Monitor for:

A

Diuretics

36
Q

Loop - Furosemide (Lasix) - excrete K
Loop - Torsemide (Demadex) - excrete K
Loop - Bumetanide (Bumex) - excrete K
Thiazide – Hydrochlorothiazide (HCTZ); Metolazone (Zaroxolyn) - K held onto
Potassium-sparing – Spironolactone (Aldactone) - K held onto

A

Ex. - Diuretics

37
Q

Dehydration - fluid comes off too fast; may need give back some fluid
potassium levels (potassium wasting for potassium sparing)
If creatinine level is greater than 1.8 mg/dL, notify health care provider before administering supplemental potassium - look what going on with kidneys; not typ give diuretics

A

Monitor for:- Diuretics

38
Q

Reduce preload by decreasing volume and pressure in the left ventricle
For HF patients that have persistent dyspnea
May be administered IV, orally, topically (paste)
Headache is common but the patient will develop a tolerance to this effect
Must monitor BP - drops quickly

A

Venous vasodilators (nitrates)

39
Q

Reduces venous return
Given in acute heart failure to reduce anxiety
Decreases preload and afterload
Slows respirations and reduces the pain associated with an acute myocardial infarction (MI)

A

Morphine sulfate

40
Q

Blocks the sympathetic stimulation, increases contractility and decreases demand of heart; decreases BP
Monitor for:
Not used in patients with acute HF - go home on it; daily/q12hr
Ex.

A

Beta-adrenergic blockers

41
Q

BP and HR
Slow position changes
Start slowly and don’t stop abruptly

A

Monitor for: - Beta-adrenergic blockers

42
Q

Carvedilol (Coreg)
Metoprolol succinate (Toprol XL)
Bisoprolol (Zebeta)
-lol

A

Ex. - Beta-adrenergic blockers

43
Q

Interferes with calcium ions causing vasodilation to lower blood pressure
Monitor for:
Verapamil (Calan)
Amlodipine (Norvasc)
Diff endings

A

Calcium channel blockers:

44
Q

BP and HR
Slow position changes

A

Monitor for: - Calcium channel blockers:

45
Q

Provides symptomatic benefits for patients in chronic HF
Inconsistent absorption in GI tract so monitor for toxicity
Monitor for:

A

Digoxin (Lanoxin)

46
Q

Reduce HR; Increase contractility; slows conduction through AV node; increases filling of the ventricles

A

Provides symptomatic benefits for patients in chronic HF- Digoxin (Lanoxin)

47
Q

HR (apical HR check prior to every administration)
Digoxin toxicity (anorexia, fatigue, blurred vision, changes in mental status, dysrhythmias) - erratically absorbed
Drug levels - not too much of it/too low

A

Monitor for:- Digoxin (Lanoxin)

48
Q

Prior to administration what assessment finding would prevent the nurse from administering lanoxin?
1. BP 99/68
2. Apical pulse 48
3. Respiratory rate 28
4. SpO2 89%

A

Answer: 2
Count for full min then decide if admin apical pulse
Apical pulse most accurate noninvasive way of looking at cardiac health
Want greater than 60

49
Q

Which assessment is most important for the nurse to perform prior to the administration of captopril(Capoten)?
1.Apical pulse
2.Blood pressure
3.Respiratory rate
4.Intake and output

A

Answer: 2
BP med; BP prior to med then reassess BP med; low BP will feel it; too low BP may experience syncope

50
Q

Which complaint by Bert would be of highest concern after adminstration of captopril?
1.Diarrhea
2.Itching in throat
3.Constant dry cough
4.Dizziness when standing

A

Answer: 2
Dizziness is safety concern but highest concern is itching - AE of drug induced angioedema: swelling of airway; itching in throat highest concern

51
Q

When planning care for Bert what should be the priority nursing diagnosis?
1.Fluid volume deficit
2.Ineffective airway clearance
3.Altered nutrition, greater than needs
4.Impaired gas exchange

A

Answer: 4
Issues with breathing and HF, fluid in lungs (impaired gas exchange), not having airway issues; fluid volume overload

52
Q

Which intervention should be implemented based on the diagnosis of activity intolerance?
1.Provide 3 large meals daily
2.Provide all activities of daily living (ADLs) for the patient
3.Encourage frequent rest periods
4.Encourage regular aerobic exercise

A

Answer: 3
Might need take it slow and work back up; encourage get up to prevent comps; cardiac rehab more appropriate

53
Q

Oxygen
Monitor respirations and lung sounds - need baseline assessment early so if have issues later can know if new
If dyspnea present, high-Fowler’s position
Reposition, cough and deep breathe every 2 hours
Drug Therapy
Nutrition therapy
Fluid restriction
Weigh daily
Monitor and record intake and output - strict; measuring how doing; base meds
Provide periods of uninterrupted rest - cluster care and try not wake up when asleep
Assess the patient’s response to increased activity - PT/OT

A

Nursing interventions - HF

54
Q

Keep oxygen saturations 90% or greater - Depends on pat and orders; typ order to be on O2

A

Oxygen

55
Q

Maximize chest expansion and improve oxygenation
Noninvasive

A

If dyspnea present, high-Fowler’s position

56
Q

Improve oxygenation and prevent atelectasis
Provide frequent rest periods when working

A

Reposition, cough and deep breathe every 2 hours

57
Q

To improve stroke volume
Big intervention for HF pats
Will reduce afterload, reduce preload, and improve cardiac muscle contractility

A

Drug Therapy

58
Q

Goal to reduce sodium and water retention
Reduce sodium intake: 2 gram/day - teach other ways to avoid salt; BIG

A

Nutrition therapy

59
Q

Range from 2 Liters to 3 Liters per day; measuring intake

A

Fluid restriction

60
Q

Most reliable indicator of fluid gain or loss; rapid weight gain concerning
1 kg of weight gain or loss equals 1 liter of retained or lost fluid

A

Weigh daily

61
Q

The nurse enters Bert’s room and finds him lying in bed in a supine position. His respiratory rate is 32 per minute and he states that his back hurts. Which action should the nurse implement first?
1.Notify the respiratory therapist
2.Assist Bert to turn on his side
3.Elevate the head of Bert’s bed
4.Offer Bert a back massage

A

Answer: 3
Needs help with breathing; less invasive and see supine and struggling and elevate HOB to see if helps him

62
Q

The nurse assesses that Bert is becoming increasingly confused and restless, and that he has developed a frothy, productive cough. His vital signs are temperature 98, P 148, R 36, BP 110/64. Which intervention should the nurse implement first?
1.Obtain an oxygen saturation level via pulse oximeter
2.Call the lab to obtain a stat serum potassium level
3.Collect a sputum specimen for culture and sensitivity
4.Initiate suctioning to remove lung secretions

A

Answer: 1
Increasingly confused and restless - hypoxia
Frothy, productive cough - increased fluid in lungs
Want assess further and see O2 sat - determines treatment

63
Q

Left ventricle fails to eject sufficient blood and pressure increases in the lungs
With pats with left sided HF; want avoid developing
The increased pressure causes fluid to leak across the pulmonary capillaries and into the lung airways and tissues
Pink frothy sputum classic pulm edema
Confused and restless because low O2 sat

A

Pulmonary Edema

64
Q

Bert’s condition worsens and he is transferred to ICU. What are the priorities of care at this time (Select all that apply)
1. Rapid acting diuretics
2. Nitroglycerin
3. Aggressive pulmonary therapy
4. Aggressive IVF replacement
5. Beta blockers

A

Answer: 1, 2, 3
Not give PO diuretics - IV push and/or drip
Not just low O2 therapy on them
IVF - IV fluid; want fluid off of them
Beta blockers: something to manage HF but not for acute exacerbation

65
Q

Monitor VS
If not hypotensive, put in high Fowler’s position
High flow oxygen therapy
Aggressive pulmonary therapy - may need this
Nitroglycerin (NTG)
Administer rapid-acting diuretics
IV Morphine Sulfate

A

Pulm edema interventions

66
Q

Maintain oxygen saturation above 90%

A

High flow oxygen therapy

67
Q

CPAP, BiPAP, or intubation and mechanical ventilation
Depends on how pat presenting: get fluid off, how quickly, how breathing, conscious

A

Aggressive pulmonary therapy - may need this

68
Q

if systolic BP is greater than 100; too low not give vasodilator

A

Nitroglycerin (NTG)

69
Q

IV Furosemide (Lasix) or Bumetanide (Bumex)

A

Administer rapid-acting diuretics

70
Q

Reduces venous return (preload)
Decreases anxiety - very anxious and confused because hypoxic
Reduces work of breathing

A

IV Morphine Sulfate

71
Q

Bert is now recovered and on a medical surgical unit preparing for discharge. What statement by Bert indicates to the nurse that further teaching is required?
1.“I must weigh myself once a month and watch for fluid retention”
2.“If my heart feels like it is racing I should call the doctor”
3.“I’ll need to consider my activities for the day and rest as needed”
4.“I’ll need periods of rest and should avoid activity after a meal”

A

Answer: 1
Weigh daily
Racing - increased HR, abnorm heart rhythm

72
Q

Diet
Activity schedule - active and periods rest
Drug therapy - why need cont keep taking meds
Discharge instructions - need appt before leave hospital because need good follow up so not end up back in hospital
Resources and equipment needs - O2; social work; medication regimen: know what take and how take it
VERY IMPORTANT TO DECREASE READMISSIONS - follow-up often; still happens but need be educated

A

Patient teaching for HF

73
Q

Sodium restriction and fluid restriction - watch Na; teach ways that do not involve salt

A

Diet

74
Q

Rapid weight gain (3 lbs in a week or 1-2 lb overnight)
Decrease in exercise tolerance lasting 2 to 3 days
Cold like symptoms (cough) lasting more than 3-5 days
Excessive awakening at night to urinate
Development of dyspnea or angina at rest or worsening angina
Increased swelling in the feet, ankles, or hands

A

Notify any of the following symptoms to health care provider - Discharge instructions - need appt before leave hospital because need good follow up so not end up back in hospital

75
Q

Six months later Bert is back on your unit recovering from an AVR (aortic valve replacement) with an artificial valve. What should be including in his discharge teaching (Select all that apply)?
1. Avoid crowds and sick people
2. Use electric razors for shaving
3. Pre-medicate with antibiotics prior to invasive procedures
4. Avoid heavy lifting for 3-6 months

A

Answer: 2, 3, 4
Put on blood thinners: INR: 2-3
Not want develop endocarditis
Depends on how go in for surgery - may do cardiac cath (have qualify) - bigger surgery

76
Q

Diagnostic testing:
Management depends on which valve is affected and the degree of valve impairment

A

Vavular heart disease

77
Q

Echocardiogram – procedure of choice; Echo - look at valves and see what going on with them
Transesophageal echocardiogram (TEE)
Chest x-ray
ECG

A

Diagnostic testing:

78
Q

Nonsurgical management: Medications
Surgical management: May need Replacement or repair
Patients with defective or repaired valves are at risk for infective endocarditis, so they do require prophylactic antibiotic therapy before any invasive procedures

A

Management depends on which valve is affected and the degree of valve impairment

79
Q

Infection of the endocardium
High mortality rate
Early detection is essential to protect pats
Causes:
Possible ports of entry
Key features:
Diagnostic assessment:
Interventions:

A

Infective endocarditis

80
Q

IV drugs use
Valve replacements
Systemic infection
Structural cardiac defects

A

Causes: - Infective endocarditis

81
Q

Oral cavity (if dental procedures have been performed)
Skin rashes, lesions, abscesses
Infections
Surgery or invasive procedures, including IV line placement
Imp for aseptic technique as a result

A

Possible ports of entry - Infective endocarditis

82
Q

Fever associated with chills, night sweats, malaise, fatigue
Anorexia and weight loss
Cardiac murmur
Petechiae (pinpoint red spots)
Splinter hemorrhages (black lines or small red streaks on the nail bed)

A

Key features: - Infective endocarditis

83
Q

positive blood cultures - couple days to grow out
TEE

A

Diagnostic assessment: - Infective endocarditis

84
Q

IV antibiotics for 4-6 weeks - drug choice depends on choice of blood cultures; start on broad then to narrow
Rest
Surgical management if antibiotic therapy is ineffective - replace/repair injured/affected valve - drainage if interventions not work;

A

Interventions: - Infective endocarditis

AHI (77 decks)

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