Complex: Cardiovascular

Question 1

Cardio: Describe why lifting your arms is contraindicated in post-op patient’s who had a permanent pacemaker implanted

Answer 1

Patients who get a permanent pacemaker should be educated to not lift their arms for a period of time post operatively because the lead wires that rest on the heart have not had time to stabilize and could easily be displaced.

Question 2

Cardio: Explain why a patient with a pacemaker should report a new onset of fatigue and weakness

Answer 2

Pacemaker malfunction causes bradycardia and a drop in cardiac output. This can cause hypoxia, with classic manifestations of weakness, fatigue, and dizziness.

Question 3

Cardio: Explain why defibrillation takes priority over any other intervention when a patient is in ventricular fibrillation

Answer 3

The greatest risk to the client is death from a lack of cardiac output. Ventricular fibrillation is a lethal rhythm in which the ventricles are in a quivering pattern and there is no atrial activity. Defibrillation is essential to resolve ventricular fibrillation promptly and convert the rhythm to restore cardiac output. The nurse should follow defibrillation with cardiopulmonary resuscitation and repeated defibrillation, if necessary, to convert the ventricular fibrillation into a sustainable rhythm.

Question 4

Cardio: Describe the appearance of ventricular tachycardia

Answer 4

Rate: fast

Rhythm: Regular

P wave: no

QRS: wide and bizarre

T: no

Question 5

Cardio: Explain the difference between V. Tach with a pulse and pulseless V. Tach

Answer 5

V. Tach with a pulse is typically intermittent and the patient should be observed and treated for symptoms. Pulseless V. Tach is a shockable rhythm and defibrillation is the priority action

Question 6

Cardio: When interpreting an ECG strip for a patient with a pacemaker, describe what you should be able to see if the pacemaker is functioning properly

Answer 6

Atrial pacing will show pacer spikes before each P wave

Ventricular pacing will show pacer spikes before each QRS complex

Question 7

Cardio: Describe why pulmonary embolism is a high risk complication of atrial fibrillation

Answer 7

Altered atrial contractions can cause blood pooling and thrombus formation. The client is at risk for developing a pulmonary embolism or embolic stroke. The client should monitor and report immediately manifestations, such as shortness of breath, or neurological changes.

Question 8

Dosage: Run Heparin at 1,500u per hour

Heparin is delivered from pharmacy in 25,000u mixed in 500ml

How many ml/hr will you set the pump for?

Answer 8

30ml/hr

Question 9

Cardio: State the arrhythmias that are shockable and describe why defibrillation is the priority action

Answer 9

Ventricular Fibrillation and Pulseless Ventricular Tachycardia

Both of these are incompatible with life because there is virtually no cardiac output due to the left ventricle not squeezing efficiently.

Question 10

Cardio: Describe the characteristics of Atrial Fibrillation

Answer 10

In A. Fib, there are multiple foci of electrical stimulation in the atria which makes the isometric line of the ECG appear squiggly and without a visible P wave. The QRS complex is present because occasional beats are fully conducted.

Question 11

Cardio: Describe why Amiodarone is the treatment of choice for a patient who converts into ventricular tachycardia but has a pulse

Answer 11

Ventricular tachycardia with a pulse is not defibrillated nor is CPR started. Pacing is not indicated. The rhythm will be treated with antiarrhythmics

Question 12

Cardio: Describe vagal maneuvers and why you would use them

Answer 12

Vagal maneuvers refer to actions that stimulate the vagus nerve and causes the heart rate to slow down. Things like baring down and carotid stimulation are considered vagal maneuvers and are used for patients with stable supraventricular tachycardia (SVT)

Question 13

Describe the priority nursing action for a patient in asystole and why

Answer 13

A patient in asystole should be given high-quality CPR as a priority. Defribrillation is not indicated for asystole because there is no electrical activity.

Question 14

Describe what titration of a medication means

Answer 14

Titrating medications is the process of adjusting doses to maximize the benefit of medicaitons without adverse effects. Orders for titration are written to meet parameters of lab results and should be adjusted according to orders.

Question 15

State proper delivery of adenosine for tachycardic arrhythmias

Answer 15

Adenosine must be delivered in a controlled environment such as an ICU setting where advanced cardiac life support resources are readily available.

Question 16

Describe the rationale for using IV amiodarone

Answer 16

Amiodarone is used as an antiarrhythmic for maintenance of normal rhythms

Question 17

Cardiac: Describe the mechanism of action for Adenosine and what it is used for.

Answer 17

Adenosine slows the conduction through the AV and SA nodes, thereby disrupting erratic cardiac electrical activity. It is used in the treatment of SVT that is unresponsive to other methods of conversion. Adenosine must administered with consent from the patient, a physician at the bedside, and defibrillation pads in place.

Question 18

Cardiac: Describe the mechanism of action for Atropine and what is is used for

Answer 18

Atropine increases the sympathetic nervous system drive and depresses the parasympathetic drive thereby increasing the heart rate. Atropine can be used to treat symptomatic bradicardia.

Question 19

Cardiac: Describe the relationship between electrolytes and the appearance of ECG rhythms

Answer 19

Potassium- helps maintain normal muscle function. Too high = peaked/tented T waves; Too low = flattened/depressed T wave
Calcium- Impacts contractility and excitability. Too high = short ST segment & QT interval, ventricular arrhythmias; Too low: Prolonged ST & QT, V.Tach

Question 20

Cardiac: Explain nursing interventions involved in post-cath care

Answer 20

Patients who have recently had a femoral approach for a heart cath should remain in a supine position with legs extended for at least the first 3 hours, then HOB 30 degrees for the remaining time (up to 6 hrs). Direct pressure should be held to the site for at least the first 30 minutes. Nurses should assess the site for bleeding and apply direct pressure for additional bleeding. Pulses distal to the insertion site should be checked along with circulation assessment.

Question 21

Cardiac: Indicate the common signs and symptoms of a STEMI

Answer 21

Chest pain with or without radiation to the arm, dyspnea, nausea, diaphoresis, ST segment elevation, elevated troponin, change in vital signs

Question 22

Cardiac: Describe the interventions used for Supraventricular Tachycardia

Answer 22

Least invasive intervention is the use of vasovagal maneuvers. For persistent SVT, it is appropriate to use adenosine

Question 23

Cardio: What specific assessment must be done before administering Digoxin and why?

Answer 23

Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering. The nurse should hold the medication and notify the provider if the client’s heart rate is below 60/min or if a change in heart rhythm is detected.

Question 24

Cardio: Describe the use of dopamine for left ventricular failure

Answer 24

Dopamine is a pressor. When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure. It helps to increase cardiac output and urine output.

Question 25

Cardio: Describe the characteristics of endocarditis

Answer 25

Endocarditis is an infection on the inner layer of the heart. Often it will manifest as vegetation on the valves. It can be caused bacteria, virus, or fungus. People experience fever, chills, weakness, fatigue, malaise, and anorexia.

Question 26

Cardio: Describe the relationship between pericarditis, cardiac tamponade, and pericardiocentesis

Answer 26

Pericarditis is inflammation of the pericardium, the sack around the heart. When pressure is so great against the heart, cardiac tamponade occurs and must be treated. A pericardiocentesis will relieve the pressure and eliminate the tamponade

Question 27

Cardiac: Describe the primary causes of decreased cardiac output

Answer 27

Anything that disrupts normal circulating volume causing hypovolemia; and conditions that compromise cardiac muscle function or electrical function.

Question 28

Cardio: Describe the characteristics of endocarditis

Answer 28

Endocarditis is an infection on the inner layer of the heart. Often it will manifest as vegetation on the valves. It can be caused bacteria, virus, or fungus. People experience fever, chills, weakness, fatigue, malaise, and anorexia.

Question 29

Cardiac: Describe Mean Arterial Pressure and how to calculate it

Answer 29

MAP is the average arterial pressure during one cardiac cycle and is an indicator of tissue perfusion. Normal MAP is 70-100 and is calculated by taking SBP (+) 2 (DBP) divided by 3.

Question 30

Discuss the relationship between cardiac arrhythmias and tissue perfusion

Answer 30

Cardiac arrhythmias can impact cardiac output due to the fast or slow rate or the disrupted electrical conduction

Question 31

Cardiac: Describe pericarditis with clinical manifestations and complications

Answer 31

Clinical manifestations of pericarditis may include sharp pain in the chest, anxiety, dyspnea, a friction rub, and fever. Complications that should be reported immediately may be cardiac tamponade, low blood pressure, muffled heart sounds.