Cardiovascular Problems Flashcards
Client had artery stenting through right femoral artery and is taking metoprolol, clopidogrel, aspirin. Which info is most important to tell HCP?
- Black stools
- BP 104/52
- Bruising in right groin
- Radial pulse 55b- 60 bpm
Black stools
Combination if aspirin & clopidogrel can cause GI bleeds.
PPI or Histamine ² blockers can decrease the risk
Client with elevat3d cholesterol level is taking atorvastatin. Which is the most significant
- K 3.4
- BUN 9
- AST 30u/L
- LDL 170
What serious side effect may statins produce?
- LDL 170
Statins can produce Rhabdomyolsis
( breakdown of muscle tissue that releases a damaging protein into the blood) - dark reddish decreased amount of urine.
Rhabdomyolsis can increase BUN & K
Also, monitor level values with Statins
Aortic stenosis. Which is most important to tell HCP
- Temp 102
- Loud systolic murmur over sternum
- BP 110/88
- Weak radial and pedal pulse
Why this answer?
- Temp 102
Endocarditis is a concern with Valvular disease. ECG W/ blood cultures will be needed to diagnose Endocarditis
Systolic murmur, decreased pulse pressure, and weak pulses are to be expected with Aortic Stenosis
Reports substernal and left arm discomfort for past 3 hrs. Which test is most useful in determining whether the nurse should anticipate implementing acute coronary syndrome standard protocol
- Creatine kinase MB level
- Troponin I level
- Myoglobin level
- C-reactive protein
Troponin I level
Tropin levels are elevated 3 hrs after onset of MI & are specific to Cardiac muscle injury
Creatine kinase MB (6 hrs) & myoglobin levels also increase (Unspecified time)
Elevated C-reactive protein is a risk factor for coronary artery disease not useful in detection of MI
Initial treatment for all ACS includes…
aspirin (300 mg)
heparin bolus and intravenous (IV) heparin infusion if there are no contraindications to the same.
Antiplatelet therapy with ticagrelor or clopidogrel is also recommended.
53 client taking treadmill stress test which findings causes immediate action
- BP 158/88
- HR 134
- Ox Sat 91%
- Chest pain 3 / 10
Chest pain 3 / 10
This signifies an mypcardial ischemia and means Stop the test
Moderate rising of VS is normal woth exercise
Acute substernal pain. Which are appropriate for LPN
- Attachment of cardiac leads
- Heparin 5000 u IV push
- Morphine Sulfate 4 mg IV
- Obtain 12 lead ECT
- Ask about medical history
- Chew and swallow aspirin 162mg
- Attachment of cardiac leads
- Obtain 12 lead ECT
- Chew and swallow aspirin 162mg
Although LPN can administer High-alert meds (Heparin & Morphine) this client is unstable and RN is better choice.
Asking medical history is RN scope of practice
Best choice to assign an RN float who came from a med-surg unit
- Discharge needs teaching about coronary artery stenting before going home.
- IV furosemide for acute left ventricular failure
- Transfer from radiology dept after coronary angioplasty
- Client admitted with unstable angina with orders for heparin & aspirin
- IV furosemide for acute left ventricular failure
When matching assignments for Float try to match where the Float came from and eliminate Acute problems.
Acute MI. Which is most important to discuss with HCP considering using fibrinolytic therapy & tissue plasminogen activator (alteplase).
- Treated with alteplase 8 months ago
- Takes Famotidine for GERD
- ST-elevation on ECG
- Reports having chest pain for 12 hrs
12 hr chest pain indicates irreversible myocardial necrosis.
Fibrinolytic (Alteplase) drugs are not recommended for chest pain past 12 hrs.
Alteplase
Class
Uses
SE and Serious SE
Contradictions
Class: Alteplase
Tissue plasminogen activators (tPAs). Thrombolytic agent.
Uses: Alteplase:
Acute ischemic stroke,
Acute myocardial infarction (heart attack)
Pulmonary embolism.
It works by dissolving blood clots (thrombi).
Side Effects (SE)
Bleeding (injection sites)
Serious side effects may include
Hemorrhage
Internal bleeding,
Contradictions
Recent major surgery or trauma, Stroke within the past 3 months (Unless ischemic stroke),
Uncontrolled hypertension,
Structural cerebral vascular lesion (e.g., Aneurysm).
New script for sacubitril-valsartan.
Which is most important to discuss with HCP
- OX Sat 92%
- Lisinopril 10mg
- BP 150/90
- K 3.3
- Lisinopril 10mg
Angiotensin receptor blocker - neprilysin blockers increase Angioedema risk in ACE inhibitors (Lisinopril)
Also increases risk of Hyperkalemia & hypotension
Sacubitril-valsartan
Class
Use
SE & serious SE
Contradictions
Sacubitril-Valsartan Combination medication. It consists of Sacubitril, which is a neprilysin inhibitor, and Valsartan, which is an angiotensin II receptor blocker (ARB).
Uses: Heart failure with reduced ejection fraction (HFrEF). It helps to improve symptoms and reduce the risk of hospitalization for heart failure.
Side Effects (SE) and Serious Side Effects: Common side effects of Sacubitril-Valsartan
Low blood pressure (hypotension), high blood potassium levels (hyperkalemia),
kidney impairment.
Serious side effects may include angioedema (severe swelling), especially in patients with a history of angioedema related to previous ACE inhibitor or ARB use.
Contraindications: Sacubitril-Valsartan
History of angioedema related to previous ACE inhibitor or ARB use, as well as in patients who are pregnant (due to potential harm to the fetus). It should also not be co-administered with ACE inhibitors or within 36 hours of switching from or to an ACE inhibitor therapy, due to the risk of angioedema.
Systolic 140 client says “My BP is always lower than that when I take it at home” What action should the nurse take
- Instruct client on effects of untreated high BP
- Educate on lifestyle choices to reduced BP
- Ask to record BP at home 2x daily for a week and bring results in.
- Provide handout with types of Antihypertensive meds
- Ask to record BP at home 2x daily for a week and bring results in.
AHA recommends home BP monitoring Provides more accurate results than periodic monitoring
Client with stable angina take ranolazine 500mg twice daily. Finding most important to discuss with HCP.
- HR 52
- taking carvedilol for angina
- Chronic Constipation
- BP 106/56
Chronic Constipation
Common SE of ranolazine (Antianginal)
Ranolazine
Ranolazine
Class antianginals
Use: Treatment angina (chest pain) in patients that CCB & Beta Blockers didn’t work
SE:
Constipation,
N/V,
Prolonged QT interval
Recharge between beats is longer than normal.
Leads to irregular heart rhythm called Torsades de Pointes: Syncope / cardiac arrest
Liver enzyme abnormalities
Contradictions:
QT prolongation,
liver cirrhosis,
severe renal impairment (creatinine clearance less than 30 mL/min) Use potent CYP3A inhibitors (such as ketoconazole, clarithromycin) or inducers (such as rifampin)
After coronary arteriography which is biggest concern
- BP 154/78
- Pedal Pulse +1
- Left grion 3 cm bruise
- Apical pulse 122 and regular
- Apical pulse 122 and regular
After coronary arteriography major concern is hemorrhage.
Increased HR is 1st sign of Hemorrhage
Immediate intervention
- HF w/ Afib HR 88 at rest
- Newly implanted demand ventricular pacemaker, occasion periods of sinus rhythm rate 90 / 100
- Had acute MI sinus rhythm 76 and frequent premature ventricular contraction
- Recently started taking atenolol 1st degree heart block rate 58
- Had acute MI sinus rhythm 76 and frequent premature ventricular contraction
Premature ventricular contraction in the setting of acute myocardial injury / infarction can lead to V Tach or V Fib
First response for V fib
D fib
If D fib doesnt convert to perfusioning rhythm
CPR
Two weeks ago client started carvedilol 12.5mg orally. Most concerning finding
- Reports fatigue & activity intolerance
- 0.5 Kg weight gain over a week
- Sinus Bradycardia 48 bpm
- Traces of edema both ankles
- Sinus Bradycardia 48 bpm
When beta-blocker therapy is started on HF patients the symptoms may become worse for a few weeks.
Fatigue, weight gain, edema are normal
However 48 bpm means dose may need adjustment
Endocarditis & vegetation on mitral valve suddenly reports severe left foot pain . No Pulse is palpable and it’s cold and pale. Which action should the nurse take next
- Lower foot below heart level
- Admin 4 L oxygen
- Notify HCP
- Reassure client embolism is common in Endocarditis
- Notify HCP
Acute arterial occlusion has occurred due to Endocarditis.
Treatment Balloon angioplasty or surgery
Change posistion will not return blood flow to foot
Immediate post-op for repair of abdominal aortic aneurysm. Which findings is most concerning
- Arterial line shows BP 190/112
- Cardiac monitor shows frequent premature Arterial contractions
- Unresponsive to verbal stimulus
- Urine output 40 mL amber urine
1.Arterial line shows BP 190/112
This high BP may cause the graft suture to rupture & hemorrhage.
When deciding which assessment are Most Important think about which ones can lead to poor client outcome and which data are normal for the situation
Patient with DVT. Which med requires 2 RNs to verify
- Famotidine 20 mg IV
- Furosemide 40 mg IV
- Digoxin 0.25 mg PO
- Warfarin 2.5 mg PO
Warfarin 2.5 mg PO
High alert med requires 2 RN
Which lab result is most important for possible heart failure
- Serum Potassium
- B-type natriuretic peptid
- BUN
- Hematocrit
- B-type natriuretic peptid
Levels increase in clients with poor left ventricular function and symptomatic HF.
Losartan (Cozaar)
Valsartan (Diovan)
Irbesartan (Avapro)
Candesartan (Atacand)
Olmesartan (Benicar)
Telmisartan (Micardis)
Eprosartan (Teveten)
Class of med
Use
SE & Serious side effects
Contradictions
Class of med Angiotensin Receptor Blockers II
Use Treats HTN, Heart Failure, Diabetic Neuropathy
SE & Serious side effects
Hypotension
Hyperkalemia
Kidney failure
Angioedema (Increases w/ ACE inhibitors use)
Contradictions
Pregant- harms fetus
ACE Inhibitor use
