CARDIOVASCULAR/NCLEX LIPPINCOTT

Question 1

Position after cardiac catherization? (3)

Answer 1

• supine
• 4 hrs
• affected leg straight

Question 2

Pulmonary capillary wedge pressure is an indirect measure of?

Answer 2

left ventricle end-diastolic pressure, an indication of ventricular contractility

Question 3

When would cappillary wedge pressure not be accurate regarding pressure in left ventricle?

Answer 3

is pt has COPD or Pulmonary HTN

Question 4

Massage legs to prevent thrombus?

A thrombus is a solid mass of platelets and/or fibrin (and other components of blood) that forms locally in a vessel. Throm_bi f_orm when the clotting mechanism is activated. This is supposed to happen when you are injured. However, it can also occur at the site of an ulcerated atherosclerotic plaque or wherever the endothelial cells lining the inner surface of an artery have been damaged.

Answer 4

NO

Question 5

Embolus

Answer 5

An embolus is most often a piece of a thrombus that has broken free and is carried toward the brain by the bloodstream. The term thromboembolus is used a lot because it turns out that most emboli arise from thrombi. However, bits of plaque, fat, air bubbles, and other material also qualify as emboli. Presumably an embolus floats along with the flowing blood until it encounters a narrowing in an artery through which it cannot pass. When the embolus gets stuck, it blocks the artery. This reduces blood flow to downstream tissues and causes them to become ischemic.

Question 6

Three important sources of emboli to the brain

Answer 6

Three important sources of emboli to the brain

• Thrombus that initially formed within the diseased heart
For example, the irregular, ineffective contractions of the heart muscle seen in atrial fibrillation lead to blood pooling in the left atrium and increased thrombus formation. Bits of these thrombi enter the systemic circulation as emboli that can travel to any organ, including the brain.
• Thrombus that forms on a heart valve
This occurs more frequently in the left heart, because the mitral and aortic valves are slammed shut by higher pressures. When the endothelium that usually covers a valve is damaged, it exposes the underlying tissue which is highly thrombogenic. A thrombus on a heart valve is sometimes called a vegetation. This is because it often looks like a branching bush that is attached to the valve by its main stem.
• Thrombus associated with atherosclerotic plaque formed in extra- or intracranial parts of a carotid or vertebral artery
A bit of the thrombus breaks off and is carried more distally in the same vessel by the flowing blood (this is sometimes called artery-to-artery embolism).

Question 7

Is oxygen flammable or combustionable?

Answer 7

Combustion

Question 8

MI/ECG

Answer 8

elevated ST segment

Question 9

Flattened or depressed T wave

Answer 9

indicates hypokalemia

Question 10

When do Q waves become distorted?

Answer 10

with conduction or rhythm problems but they do not disappear unless there is cardiac stand still

Question 11

P Wave

Answer 11

repolarization of atria

Question 12

T Wave

Answer 12

repolarization of ventricles

Question 13

PR Interval ?

Answer 13

Tme taken to spread through atria

Question 14

SA Node is located? fx?

Answer 14

“Right atrium” Pacemaker

Question 15

AV Node, location

Answer 15

“bottom of right atrium” junction box to electrical impulse to ventricles

Question 16

Thallium scan

Answer 16

used to assess myocardium

Question 17

What would hypovolemia affect pulse pressure?

Answer 17

decrease pulse pressure which is systolic pressure minus diastyolic pressure

Question 18

Will nitroglycerin relieve PAIN during MI?

Answer 18

NO Morphine

Question 19

MI Intervention

Answer 19

Pre-hospital

Call ambulance
Aspirin 300mg orally – unless an obvious contraindication
Pain relief, e.g. 5-10mg morphine + metoclopramide (anti-emetic)10mg IV - avoid IM injections as there is a risk of bleeding - and you just gave loads of aspirin!
Sublingual GTN (unless hypotensive)

You can give up to 3 sprays of GTN – but don’t give any if the HR <50, or the systolic BP <90.

Hospital

Attach ECG – make a recording – it is also reasonably likely that this will have been done in the ambulance. You have to differentiate raised ST segment Mi from non-raised ST segment MI.
Assess oxygen saturation - if sats are above 94% you do not need to give oxygen (in practice, people are often given oxygen regardless but this is not best practice)
If sats are below 94% then give high-flow oxygen via a non-rebreather mask (i.e. with an inflated bag on)
In patients with known COPD, aim for sats between 88-92% - give oxygen via a 24% or 28% Venturi mask (colour coded) and get an ABG.

Get IV access – take bloods for

• See more at: http://almostadoctor.co.uk/content/systems/-cardiovascular-system/myocardial-infarction-and-acute-coronary-syndromes-acs#sthash.xURPIECB.dpuf

Question 20

Normal Blood Pressure

Answer 20

A normal blood pressure for a healthy adult ranges from 90 to 120 mm Hg systolic and from 60 to 80 mm Hg diastolic. Under normal circumstances, blood volume remains constant at 5,000 mL. Changes in this volume can affect blood pressure, as can age, ethnicity, gender, position changes, exercise, weight, anxiety, medications, time of day, and smoking.

Question 21

Korotoff sounds

Answer 21

To measure blood pressure, listen for the five Korotkoff sounds. As you deflate the blood-pressure cuff, you’ll hear a clear, rhythmic tapping sound that coincides with the patient’s systolic blood pressure. The second sound is a whooshing sound, the third is a knocking sound, and the fourth is a softer blowing sound that fades. For most adult patients, you’ll document the fifth sound, which is actually the disappearance of sound, as the diastolic blood pressure. However, with some patients, there is no distinct fifth sound. You’ll hear sounds all the way to 0 mm Hg. For these patients, you’ll record the fourth Korotkoff sound as the diastolic blood pressure.

Question 22

Cor pulmonale

cause

Answer 22

Cor pulmonale is a condition that causes the right side of the heart to fail. Long-term high blood pressure in the arteries of the lung and right ventricle of the heart can lead to cor pulmonale.

Question 23

Pulmonary Hypertension

Answer 23

High blood pressure in the arteries of the lungs is called pulmonary hypertension. It is the most common cause of cor pulmonale.

In people who have pulmonary hypertension, changes in the small blood vessels inside the lungs can lead to increased blood pressure in the right side of the heart. This makes it harder for the heart to pump blood to the lungs. If this high pressure continues, it puts a strain on the right side of the heart. That strain can cause cor pulmonale.

Chronic lung conditions that cause low blood oxygen levels in the blood over a long time can also lead to cor pulmonale.

Question 24

Classic Signs of MI (3)

Answer 24

1. Chest pain feels like pressure or weight on the chest
2. Nauseated
3. very weak

Initiate a rapid response

Question 25

MI and Morphine…what does morphine do?

Nitroglycerine relives angina pain not MI pain

Answer 25

decreases systemic vascular resistance which decreases left ventricle afterload followed by decrease in myocardial oxygen use

PREVENTS CARDIOGENIC SHOCK!

Question 26

What kind of med is Lidocaine?

Answer 26

antidysrhythmic

CAN BE ADMINISTERED TO PREVENT FIBRILLATION OF THE HEART

Question 27

PT WITH MI always try to pick intervention that (2)

Answer 27

uses least amount of oxygen and energy

Question 28

Pt with MI how to determine effectiveness of ventricular contraction?

Answer 28

Urine output