Class 1 nursing management and interventions in CV

Question 1

HTN management

Answer 1

-DASH diet
-Low sodium diet 1200-1500 mg with max of 2000 mg per day
-Healthy body weight and moderate exercise activity
-Limit alcohol consumption and tobacco use
-Stress management

Question 2

HTN drug management

Answer 2

-Multiple drugs often used, especially with Type 2 diabetes
-Replace multiple antihypertensive agents with single pill combination therapy
-Single pill combinations or monotherapy should be considered for initial antihypertensive therapy.
-Low doses of multiple drugs may be more effective and better tolerated than higher doses of fewer drugs
-Don’t mix ACE&ARBs
-In combination therapy, an ACE inhibitor plus a long-acting dihydropyridine CCB is preferred

Question 3

Hypertensive crisis

Answer 3

-Severe and abrupt
-Treatment goals is to decrease MAP to 10-20% in first 1 to 2 hours, with gradual reduction in the next 24 hours

Question 4

Hypertensive emergency IV medications

Answer 4

-Vasodilators (sodium nitroprusside*, nitroglycerin, hydralazine)
-Adrenergic inhibitors (phentolamine, labetalol, esmolol)
-Ace Inhibitors (Enalapril)

Question 5

Nursing considerations in hypertensive emergency

Answer 5

-Monitor BP with an art line
-Continuous ECG monitoring to observe for dysrhythmias
-Hourly urine output
-Bed rest to avoid cerebral ischemia and fainting

Question 6

Hypertensive emergency therapy goals

Answer 6

-Minimize end-organ damage (cardiac, renal, respiratory, and retinal damage), maintain adequate perfusion with special assessment of neuro, cardiac, and renal monitoring

Question 7

Hypertensive urgency

Answer 7

-Can be managed with PO medications (captopril and clonidine)

Question 8

Acute hypertension

Answer 8

-Evidenced by hypoperfusion to the brain, heart & kidneys

Question 9

Acute hypotension caused by blood or fluid loss tx

Answer 9

-IV fluids, blood, or blood products

Question 10

Acute hypotension caused by primary CV dysfunction tx

Answer 10

-AMI, cardiac tamponade & pulmonary embolism will result in a fall in CO and may need drug intervention

Question 11

Acute hypotension caused by secondary CV dysfunction tx

Answer 11

-Result of negative chronotropic & inotropic effects caused by beta blockers, digoxin, or opioids and may need to administer vasoconstrictive agents

Question 12

Non-cardiac factors causing decreased O2 supply

Answer 12

-Anemia
-Low blood volume
-Hypoxemia
-Pneumonia
-Asthma
-COPD

Question 13

Non-cardiac factors that increase myocardial O2 demand

Answer 13

-Anxiety
-Cocaine
-Physical exertion
-HTN, hyperthermia, hyperthyroidism

Question 14

Cardiac factors that decrease O2 supply

Answer 14

-Coronary artery spasm & thrombis
-Dysrhythmias
-HF
-Valve disorders

Question 15

Cardiac factors that increase O2 demand

Answer 15

-Aortic stenosis
-Cardiomyopathy
-Dysrhythmias
-Tachycardia

Question 16

Angina goal of treatment

Answer 16

-Improve perfusion, and reduce pain through vasodilation
-Also with use of antiplatelet and cholesterol lowering drug therapy

Question 17

Pneumonic for treatment of stable angina

Answer 17

-A; Antiplatelet agent, antianginal, ACE I
-B; Beta-adrenergic blockers, BP
-C; Cigarette smoking, cholesterol
-D; Diet, diabetes
-E; Education, exercise
-F; Flu vaccination

Question 18

Coronary artery disease management: Diagnostic testing

Answer 18

-Stress test: Outpatient procedure, non-urgent
-Echocardiogram

Question 19

Acute coronary syndrome: Serum cardiac markers after AMI

Answer 19

-Full Electrolyte Panel with focus on: Sodium, potassium, magnesium
-Lipid Panel: Total Cholesterol, triglycerides, HDL, LDL
-Creatinine, BUN
-Blood Glucose
-B-Type (Brain-type) Natriuretic Peptide

Question 20

Acute coronary syndrome and unstable angina

Answer 20

-Unstable lesion that may be partially blocking coronary artery (unstable angina (UA) or NSTEMI) or totally blocking coronary artery (STEMI)
-Chest pain that is new in onset, occurs at rest, or has a worsening pattern is unstable angina

Question 21

Unstable angina treatment

Answer 21

-Anticoagulant therapy (IV or SC Heparin)
-Antiplatelet therapy (ASA)
-Antihypertensive to manage myocardial demand (Beta blockers, Ace Inhibitors, Statin)

Question 22

Pain management in acute coronary syndrome and unstable angina

Answer 22

-Rapid acting SL nitro spray for chest pain, if that does not work then IV nitro
-Must be in a critical care area to be monitored for continuous ECG and BP; morphine and supplemental oxygen if needed

Question 23

Acute coronary syndrome diagnostic tests

Answer 23

-Angiogram
-Angioplasty

Question 24

Post angiogram/angioplasty management

Answer 24

-Fibrinolytic therapy
-Coronary revascularization: Angiogram, balloon angioplasty, Percutaneous Coronary Insertion (PCI), stents, patient must be immobile prior to procedure, mark pulses with a marker

Question 25

Fibrinolytic therapy indications

Answer 25

-Tx of ST elevations, stroke, DVT or PE

Question 26

Fibrinolytic therapy contraindications

Answer 26

-Aortic dissection
-Internal bleeding
-Intracranial tumor
-Pericarditis

Question 27

Fibrinolytic therapy procedure purpose

Answer 27

-Dissolves blood clots

Question 28

Angiogram/angioplasty post procedural care

Answer 28

-May be on class IIb/IIIa Inhibitors; reperfusion dysrhythmias
-ASA, Beta, “Pril”, Statin and Plavix if PCI
-Fluids as patient may be bleeding or hypotensive
-Palpate pulses distal to insertion site
-Auscultate insertion site for a bruit
-Ambulation

Question 29

Post procedure care following a CABG

Answer 29

-Pulmonary artery catheter for measuring CO, other hemodynamic parameters
-Art line for continuous BP monitoring
-Chest tube for drainage
-Continuous ECG monitoring to detect dysrhythmias (esp. atrial dysrhythmias)
-Endotracheal tube/mechanical ventilation: extubate within 12 hours
-Epicardial pacing wires for emergency pacing of the heart
-Monitor urine output
-NG tube for gastric decompression

Question 30

Post procedure care following CABG

Answer 30

-Monitor for bleeding, fluid, electrolyte imbalances, hypothermia (blood is cooled in bypass machine), & issues with the bypass machine
-Replacing electrolytes PRN
-Restoring temperature (e.g., warming blankets)
-Monitoring rhythm, BP, and CO
-Assist with ambulation

Question 31

Management of dysrhythmias

Answer 31

-Transcutaneous pacemaker
-Permanenet pacemaker

Question 32

Management of sinus tachycardia

Answer 32

-B-adrenergic blockers to reduce HR and myocardial oxygen consumption
-Antipyretics to treat fever
-Analgesics to treat pain

Question 33

Management of common dysrhythmias + TEE

Answer 33

-Patients may need a transesophageal echocardiogram (TEE) prior to cardio version

Question 34

Pulseless electrical activity 6 H’s & 6T’s

Answer 34

-Hyperkalemia, hydrogen ion excess, hypovolemia, hypoxia, hypothermia, hypoglycemia
-Tampanode, tension pneumothorax, thrombis (PE), thrombus (MI), toxins, trauma

Question 35

Implantable cardioverter-defibrillator (ICD)

Answer 35

-Appropriate for patients who:
-Have survived SCD
-Have spontaneous sustained VT
-Have syncope with inducible ventricular tachycardia/fibrillation during EPS
-Are at high risk for future life-threatening dysrhythmias
-Consists of a lead system placed via subclavian vein to the endocardium

Question 36

Implantable cardioverter-defibrillator (ICD) nursing considerations and pt teaching

Answer 36

-Fear of body image change & recurrent dysrhythmias
-Expectation of pain with ICD discharge
-Anxiety about going home
-Participation in an ICD support group should be encouraged.