CVPV Flashcards
What is the amount of blood pumped in one minute called?
cardiac output
Lower cardiac output means
poor perfusion
Hypertension is the cause of
every other heart problem
1/8 death in the world
3rd leading cause of death
Hypertension BP is usually
140/90 or higher
What is the most common primary diagnosis in the US?
Hypertension
What is the most common modifiable risk factor for CV disease?
Hypertension
As hypertension gets higher, the cardiovascular disease
it gets worse
Hypertension Crisis
180/120
- a lot of concern (stroke, perfusion)
Why is there more and accelerating hypertension in the US?
obesity (poor diet and exercise) - sitting
Causes of hypertension
- increase in cardiac output (too much fluid)
increase heart rate and stroke volume - increase peripheral resistance (hypothermia/stress)
increase viscosity, vasoconstriction
Vasoconstriction
decrease in vessel diameter (shrink)
Vasodilation
increase in vessel diameter (expand)
Primary hypertension
not caused by identifiable disease/cause
- overactive sympathetic nervous system (RAAS, too much sodium)
Secondary hypertension
caused by another disease, stress
- renal vascular disease
- valve disorders
- sleep apnea
- pregnancy
- thyroid disorders
- drugs (oral contraceptives, antihistamines, corticosteroids)
If a patient has secondary hypertension, how should it be treated?
treat the cause
Secondary hypertension can be caused by what types of drugs?
oral contraceptives
antihistamines
corticosteroids
What does continued HTN do to the blood vessels?
Hypertrophy (enlarge)
Hyperplasia (replicate)
inflammatory
due to stress and stretching of vessels causes damage
macrophages will come to help but only narrow the vessels
Hypertrophy
enlargement of cells
Hyperplasia
replicate
What 2 things happen to the cells during the inflammatory response?
Hypertrophy
Hyperplasia
Risk factors Hypertension and cardiovascular disease
family hx
cig smoking
obesity
- high sodium, low potassium, calcium, and magnesium
heavy alcohol consumption
African American and age
diabetes
Men are at a higher risk factor of hypertension in what age range?
Women?
early to middle adulthood
over 50
What is considered the “silent killer”?
hypertension
- early stage no s/s other than gradually increasing B/P
- only noticed in crisis
S/S of hypertension
asymptomatic
HA
blurry vision
chest pain
dizzy
epistaxis
flushed face
Epistaxis
nose bleeds
Complicated Hypertension
sustained hypertension effects beyond hemodynamics organ involvement
What 2 major mechanisms of tissue damage can occur with having complicated hypertension?
Ischemia (decrease O2 to certain areas)
Edema (swelling of tissues/organs and fluid seeps out)
If we have decreased blood flow, we also have
decreased O2
Complicated HTN occurs commonly in
Kidneys (renal disease) - uncontrolled HTN
Brains - Strokes and vision
Heart (myocardium and coronary arteries)
Lower extremity vessels
When the ventricle’s walls thicken then
less blood goes into the heart
heart now has to work harder to pump out more blood
What lab/test can evaluate hypertension?
none
- looking for underlying reason but not dx
When is hypertension usually dx?
when pt comes in for something else
Log of BP for a month to see a trend and come back
Hx - smoking, diet, listen to lungs
If you see a patient who has one high BP, do you dx them now?
no, only after several months of BPs
What is the most accurate way of evaluating BP
auscultation manual
sit/laying down quietly for 5 mins
arm at heart level
appropriate size
White Coat Syndrome
BP will be high in a Dr’s office
Hypertension Treatment
fix the systolic, then the diastolic will follow
Goal is 130/80
- treat preexisting conditions
1st - lifestyle modifications (DASH)
- moderate exercise and alcohol consumption
- stop smoking
What diet should Hypertensive patients be on?
- rich in fiber and potassium, low in dietary sodium and saturated fats including fruits and veggies, low in dairy and total fat and carbs
- encourages the intake of whole grain products, fish, poultry, and nuts
- limits red meats and sweets recommended
DASH (Dietary Approaches to Stop Hypertension)
Any drugs used to treat the patient are also accompanied by the nurse
educating the pt on lifestyle modifications
- combine with diet and exercise
Antihypertensive Drugs
Ace Inhibitors
Beta Blockers
Calcium Antagonists
ACE Inhibitors end in
pril
Beta Blockers end in
olol
Calcium Antagonists have what in the name
Ca
Alpha-Adrenergic Antagonists (Alpha - Blockers)
Side Effects
orthostatic hypotension
vertigo
tachycardia
sexual dysfunction
Alpha Blockers end in
osin
Furosemide is also known as
Lasix
How long can furosemide stay in the body
LA sts SIX hours
usually during the day (if night, get up often for bathroom)
Side effects of Furosemide
Dysrrhthmias
due to a decrease K
decrease BP
increase blood glucose
sunburn very easily
Furosemide is used for
too much fluid
(edema, hypertension, ascites)
Hydrochlorothiazide is used
diuretic used to lower BP (mild diuretic)
What is the downside of HCTZ?
Important nurse assessment?
electrolyte loss
Monitor electrolyte balance
Which diuretic is used mainly for hypertension but a mild version of a diuretic than furosemide?
HCTZ
Hypertension Nursing Interventions
daily weight
I&O accuracy
Urine output
BP response
Electrolytes
Pulses
Ischemic Episodes (TIA)
4 C Complication
TIA means
Transient Ischemic Attack
4 C’s Complications of hypertension
Coronary Artery Disease
Chronic Renal Failure
Congestive Heart Failure
Cerebral Vascular Accident (stroke)
Success in Tx for Hypertension depends on
compliance (tell them to continue meds despite fatigue)
6 weeks and give them power by checking BP
Orthostatic Hypotension is also known as
Postural Hypotension
Orthostatic Hypotension is considered
Systolic = drop of 20 mmHg or greater
Diastolic = drop of 10 mmHg or greater
when standing up
Acute Orthostatic Hypotension reasons
Altered electrolytes
New med
Prolonged immobility
starvation
physical exhaustion
vol depletion
venous pooling
elderly - esp. falls**
Chronic Orthostatic Hypotension
Secondary to specific disease
- endocrine, metabolic, CNS, PNS
Idiopathic
no known cause
Idiopathic Orthostatic Hypotension
generalized degeneration of the CNS
1/3 of elderly affected (postprandial - after meals)
Orthostatic Hypotension has a significant
fall risk
S/S of orthostatic hypotension
dizzy
blurred loss of vision
syncope
fainting
after meals in elderly
Monitoring Orthostatic BP
lying/sitting/standing BP
3-4 times a day
more than 20
How do you diagnose orthostatic hypotension?
tilt table test
Tx of Orthostatic hypotension
- PRIMARY FALL PRECAUTIONS
- assist pt when moving and repositioning
- supportive devices
- eliminate the cause (meds, volume, electrolyte)
T/F: Vasoconstriction leads to increased blood pressure readings.
True
Orthostatic hypotension is defined as a drop of __________ or more when going from supine to standing. Select all that apply.
a. 10 mmHg systolic
b. 20 mmHg systolic
c. 10 mmHg diastolic
d. 20 mmHg diastolic
b. 20 mmHg systolic
c. 10 mmHg diastolic
The coronary artery supplies blood to the
heart muscle
Preload
stretch of the heart filling up with blood
caused by the pressure created by the volume of blood within the ventricle
Afterload
the amount of resistance to the ejection of blood from the ventricle
In terms of a slingshot, explain preload and the afterload
Preload is the stretch before the shot
Once let go the afterload kicks the blood out
Atherosclerosis
accumulation of lipid (fatty substance) in vessel walls
- inflammatory response
- fibrous cap forms
- ischemia
Atherosclerosis is more common in what vessels
coronary arteries
bc of tiny turns
In simple terms, explain atherosclerosis
A tiny injury attracts cells to fix it
Inflammation occurs and plaque causes narrowing
Blood clots cause complicated lesions when caught into the injury
preload increases in
hypervolemia
regurgitation of cardiac valves
Post-catheter femoral pt what do you do with a dressing
Look and palpate (hematoma) at the site
Check pulse distal to the site (pedal)
If you see bleeding, circle
2-6 hours leg straight
HOB at or less than 30 degrees
fluid to flush dye out
In a Post-op FEM-POP bypass graft surgery patient, how often do you check the foot’s pulse, color, temp, and Doppler?
every hour for 8 hours
then every 4 hours for the rest of the 24-hour period
Why do you not give asthma pts Beta blockers?
cause bronchospasms or make theirs worse
What Beta blocker would you give an asthma pt?
Metoprolol (less of bronchospasms)
ST depletion is a sign of
ischemia
ST elevation is a sign of
infarction or injury
When discharge teaching a pt with CHF, what is the most important thing they should check?
daily weight (call if over 3 pounds in a day)
How often do you check VS on a pt post-op from surgery?
1st hour = every 15 mins
2nd hour = every 30 mins
3-4th hour = every hour
What does infarction mean?
lost blood flow to the area so lost O2 content
In myocardial ischemia, what should you do regarding Oxygen
give them O2 to make the heart work more effectively and slowly
- such as ACE and Metoprolol
Intermittent claudication is associated with what disease?
Peripheral Artery Disease
Pre-op on a FEM-POP bypass, how should the patient sit?
dangling legs
help blood flow
Post-op on a FEM-POP bypass, how should the patient’s leg be situated?
elevated
decrease pressure
If you see blood on a dressing after a patient is post-op from surgery, what should the nurse do?
reinforce with dressing
DO NOT REMOVE
make a circle and palpate for hematoma
What lab is the most specific to identifying myocardiac damage
Troponin
Diagnostic test for angina
stress test (Thalium)
- also with an Echo (dye shows block)
- possible Cath Lab
What test is used to monitor heparin?
AntiXa every 6 hours
Non-modifiable risk of atherosclerosis
age
gender
family hx
ethnicity
Modifiable risk factors of atherosclerosis
Obesity (High cholesterol and inactivity)
smoking
hypertension
hyperglycemia
stress
What type of cholestrol is good to be high?
HDL
What types of cholesterols need to be low?
LDL, total, and triglycerides
What is the #1 killer of women?
Coronary Artery Disease
- >55 y/o CAD is equal to men
Myocardial Ischemia pathology
interfere with blood flow through the coronary arteries
not enough O2
narrowing of vessels = not enough blood flow/O2
What are the 3 possible causes of Myocardial Ischemia
vasoconstriction
atherosclerosis
thrombus formation
- narrowing by 50% greater risk
Myocardial Ischemia either has
decreased supply
increase demand
of blood flow/O2
In Myocardial Ischemia, the demand _________ supply.
exceeds
After ___ secs, the heart will become ischemic due to coronary occlusion, and after a few ________ the heart cells lose the ability to contract
What needs to be done before that time?
10 secs; minutes
- get blood flow/O2 back to the area
Heart cells only remain viable for ____ mins in an ischemic condition.
20 (Time is Muscle)
If perfusion is not restored, then ___________ will begin after 20 mins
infarction
Angina pectoris is just
chest pain
Angina Pectoris is caused by
myocardial ischemia(not enough O2 to heart)
Turbulent blood makes it more likely for
blood to stick and bounce off walls and cause blood clots
- leads to myocardial infarction
Factors causing anginal pain
- physical exertion
- exposure to cold
- eating heavy meal
- stress
Stable angina
predictable pain on exertion
- lasts 3-5 mins with pain relieved at rest/nitrates
- no damage if blood flow restored
Prinzmetal Angina
unpredictable caused by vasospasm
- at rest
Prinzmetal angina is treated with
Calcium channel blockers (CA in name)
help with spasms of the vessel walls
Silent ischemia is a type of
angina
Silent ischemia is known by
EKG changes with no pain or symptoms
- ST changes indicating MI
Unstable angina is also known as
preinfarction
Unstable angina occurs
at rest or minimal activity
increasing severity or frequency
Unstable angina could be with exertion but
does not stop the pain when sitting or treating
Unstable angina (20%)can lead up to
MI (myocardial infarction)
What treatment could possible treat stable angina
nitrates
What pain would we expect pts to feel leading up to a heart attack?
Unstable angina
Modifiable risk factors for coronary artery disease include which of the following?
Select all that Apply.
High cholesterol
Hyperglycemia
Ethnicity
Physical inactivity
Smoking
High cholesterol
Hyperglycemia
Physical inactivity
Smoking
What is the preventative actions and treatment options of angina?
Diet
Exercise (realistic goals and stop with chest pain)
Medications
Tobacco cessation
Managing HTN
Controlling DM
Managing stress
Evaluation of chest pain includes
cardiac assessment (auscultation, when started, rapid or extra sounds)
EKG
Labs
S/S of angina
indigestion
choking or heavy pressure on the sternum
radiate pain to neck, jaw, arms(left)
weak or numb in the upper extremity
SOB, pale, sweating, dyspnea
Dizzy, N/V
Angina/MI pts symptoms can vary greatly with
elderly and women
DIABETICS (neuropathy)
Elderly pts will complain of what s/s of angina AND MI
dyspnea
Women will complain about what s/s of angina and MI
Fatigue (major)
Acute Coronary Syndrome
umbrella term for unstable angina and myocardial infarction
What is used to diagnose ST elevation (myocardial ischemia) or depression (myocardial infarction)?
12 Lead EKG
Diagnose and evaluate CHF
BNP - released with overstretched ventricular tissue
If a pt shows up in the ED, c/o chest pain (angina). What lab should you anticipate being done?
If the lab is high?
Troponin (want it to be 0 or close to it)
If high, indicates progressing to MI
CK-MB stands for
Creatinine and kinase myocardial band
Troponin stays in the body for
up to 14 days
Cholesterol does what
transport system to walls and into cells
fried and fatty foods
HDL is primarily
hereditary (protective to excrete to livers)
Triglycerides are stored
unused ingested calories in the fats cells
later used as energy
sweets and carbs
Lipid Lowering Drugs (Manage cholesterol)
Statins (atorvastatin)
Niacin
Fibrates (gemfibrozil)
Statins purpose
decrease significantly elevated LDL and triglyceride levels
Raise the HDL
What do you need to monitor with statin drugs?
Liver function tests
Statins can cause what to the body as a side effect and need to stop taking
muscle tenderness or weakness
hepatotoxicity
Niacin purpose
B vitamin for minimal cholesterol levels or with statin
What is the big side effect of Niacin?
flushing of redness or hotness in the face
but take aspirin 30 mins before helps
Fibrates purpose
decrease LDL by stopping synthasis
When starting someone on cholesterol medicine, have them come back every
6 weeks for the 1st six months or until goal reached
Fibrates purpose
decrease LDL by stopping synthesis
When should you take your Statin drugs during the day?
an evening meal or at bedtime
Which of the following laboratory values needs to be closely monitored in a patient taking atorvastatin?
Liver function tests
Renal panel
White blood cell count
Troponin
Liver function tests
Echocardiogram shows
effective pump and enough cardiac output
Nusing Interventions and Tx for angina
make the heart work smarter, not harder
- OXYGEN 1st
- Pain assessment
- VS
- Respiratory
- 12 Lead
- Nitroglycerin
What would you give the 1st thing to give pt to treat angina?
give supplemental O2
If a patient has angina, what medication would we give to treat that?
Nitroglycerin
How does giving O2 help tx angina?
The pt has angina because not enough O2 is getting to the heart causing the heart to work harder
But giving the O2 causes the heart to work efficiently not intensely (decreases BP, P, and left ventricular vol and helps with the contractibility)
ALWAYS initiate ____ at the onset of chest pain
O2
- monitor pulse ox, rate and rhythms
If a patient comes in with chest pain, what system do you always assume is affected until proven otherwise?
cardiac
Nitroglycerin does what to the body
decrease BP, pulse, and left ventricular volume
assist with contractility
reduces myocardial O2 consumption
= decreases ischemia and relieves pain
What is a commonly known nitrate
nitroglycerin
If Nitroglycerin does not sting when SL, then
it is expired
Nitroglycerin is very sensitive to
sun light
If pain persists after 3 tablets of Nitroglycerin at 5-minute intervals, then
call 911
If pain persists while giving the pt Nitroglycerin, what is the protocol for at home?
3 tabs at 5 minute intervals
if still persists 911
If you take this drug, you can not have nitroglycerin
erectile dysfunction
Nitroglycerin is a potent
vasodilator opens all the blood vessels
A side effect of Nitroglycerin
Headache almost always
flushing
Beta Blockers
- smarter not harder
- tx chest pain
- help slow down the heart (hr, bp, and contractions) to have an effective contract by reducing myocardial O2 consumption
What medication do you never stop abruptly and if NPO still give with ice chips or little water?
Metoprolol
- or rebound hypertension could occur
If a pt has had an MI before, they are
at an increased risk of another MI
Beta-blockers can alternatively affect
blood glucose (hypoglycemia mimics)
Beta-blockers can be used for
BP decrease
chest pain
CHF
test anxiety/high-stress situations
valve issues
If a patient heart rate is below 60, would you give metoprolol?
no, unless written otherwise
A patient with a new prescription for metoprolol is told it should never be stopped abruptly. Why?
Stopping a beta blocker abruptly can cause hypoglycemia.
Stopping a beta blocker abruptly can cause rebound hypertension.
Stopping an ace inhibitor abruptly can cause an irritating cough.
Stopping a calcium channel blocker abruptly can cause a rapid decrease in heart rate.
Stopping a beta blocker abruptly can cause rebound hypertension.
T/F: Nitroglycerin primarily dilates veins but at higher doses dilates arteries as well?
True
Calcium Channel Blockers
-
slows electrical impulses, pulse, and O2 demand
relaxes blood vessels (improve perfusion) - great for Prinzmetal angina and invasive coronary
Do not take ___________ _______ with a calcium channel blocker.
Why?
grapefruit juice
increases Calcium Channel Blocker levels
calcium Channel Blockers Names (Very Nice Drugs)
Verapamil
Nifedipine
Diltiazem
Calcium Channel Blockers is not a good choice for patients with
Heart failure
Aspirin
prevents platelet activation
prevent blood clots
81 baby and 325 full of cardiac issue
clopidogrel (Plavix)
bleeding and GI upset with both
antiplatelet
What is the number 1 concern for a pt with antiplatelet drugs?
bleeding out
Watch platelet counts for what meds
Heparin
Enoxaparin
Heparin is monitored by what test
AntiXa (for specific dose)
Enoxaparin
What pts should probably not get it?
low molecular wt heparin
- do not have to monitor lab
not good for kidney pts
HOw do patient’s manage angina at home?
- reduce painful activities
- avoid temp extremes
- monitor BP
- avoid antihistamines
- stop smoking
- take ASA and beta blockers
- Carry Nitro at all times in original container and bag
T/F: Prinzmetal angina is predictable pain that is relieved by rest.
False
vasospasm occurring at rest
Myocardial Infarction (MI)
abruptly deprived of O2
- cells begin to necrose after 20 mins of occlusion
-longer occluded more extensive damage to the heart
S/S of Myocardial Infarction
sudden onset of chest pain with no response to rest or nitro
SOB, dyspnea
N/V
decrease urine output
cool, clammy, sweaty, and pale
anxiety, restless, fear
What system is a direct indicator of heart cardiac output unless a specific disease?
urine output
The urine output should have how many mL of fluid per hour?
30 mL/hr
What nursing care should be done for a MI pt?
bed rest
stool softeners to not strain
educate diet, caffeine, stop smoking, exercise
S/S of recurrent MI
The goal of managing MI
minimize damage and preserve function
PTCA and meds
PTCA
percutaneous transluminal coronary angioplasty
- stent
What are the medications to give for an MI? MONA
Morphine - decreases the workload
Oxygen - #1
Nitrates - vasodilator
Asprin - antiplatelet
ALSO
ACE inhibitor
Beta-blockers
Cardiac Rehab
- extend and improve quality of life
lifestyle modifications
limit atherosclerosis
prevent another attack
If a patient asks after having an MI, when I can have sex again what do you say?
when they can do light exercise and a conversation at the same time
Which of the following is not included in the characteristic assessment of chest pain?
A. When did the pain begin?
B. Where is the pain?
C. What type of pain is it? Stabbing, crushing, etc
D. How quickly is intervention taken (i.e. nitro given, O₂ applied?)
D. How quickly is intervention taken (i.e. nitro given, O₂ applied?)
Cath Lab reason
- usually radial or femoral
- insert dye to find a blockage
- if blockage then stent and balloon
Nursing Care Pre-Op Cath Lab
NPO 8-12 hours
consent
good IV access (Versed)
prepare expectations (surgeons)
Post-Op Cath Lab
look and palpate the site for bleeding or hematoma
check distal pulse, color, temp
monitor dysrhythmias
Bed rest 2-6 hours
leg straight
HOB not higher than 30 degrees
encourage fluids to flush out dye
The patient returns to the unit shortly after cardiac catheterization. What important teaching should occur during this time of recovery? Select all that apply.
Drink a lot of fluids
Call the nurse if feel a pop or dampness at the catheter insertion site
Notify the nurse if chest pain occurs.
Keep affected extremities straight
Ambulate to the restroom if needed
Drink a lot of fluids
Call the nurse if feel a pop or dampness at the catheter insertion site
Notify the nurse if chest pain occurs.
Keep affected extremities straight
What is the minimum time to hold pressure on an insertion site when the catheter is removed from the cath lab?
20 mins
CABG
Coronary Artery Bypass Graft
- goes around the occlusion
After a CABG, what precautions need to be in place?
Why?
turning and lifting precautions
fear of tearing sternal wires
Which urinary output demonstrates to the nurse renal perfusion is being maintained following cardiac surgery?
30 mL/hr
Mitral Valve Prolapse
leaflets go upward into the atrium
- most common valve disorders
S/S of Mitral Valve prolapse
often asymptomatic
fatigue/lethargy
murmurs
dyspnea
weak
chest pain
If a mitral valve prolapse, then avoid
hypovolemia
bc volume is needed to help perfusion
Tx mitral valve prolapse
regular physician assessments
avoid hypovolemia
if more severe valve replacement
Stenosis
valve is stiff, blood is trickle through
constricted or narrowed
blood flow through valve **not efficiently*
Regurgitation
leaflets fail to close completely
blood backflow
Both stenosis and regurgitation can cause
hypertrophy of muscles
damage to myocardium
tightened walls
impairs fill time
How to manage valve disorders (regurgitation and stenosis) with what meds?
diuretics
cardiac glycoside (digoxin)
beta-blockers
prophylactic antibiotics
valve replacement (xeno, homo, auto)
If the patient has a valve replacement, you should watch closely for the development of
heart failure
The nurse is assessing a client recovering from heart surgery. What elements can be used during bedside assessment to assess cardiac output?
auscultation of heart sounds, monitor level of pain
fluid intake, serum sodium and potassium values
proper body positioning, presence of bruising
strength of pulses, skin temperature, urine output
strength of pulses, skin temperature, urine output
A client is being evaluated for chest pain. Which of the following lab values is most reliable in evaluating damage to cardiac muscle?
Troponin
A patient is presenting with aortic valve stenosis. The nurses understand this means the aortic valve is
so stiff is doesn’t open completely
Heart failure in summary is
inability to pump sufficient blood to meet the needs of tissues
Heart Failure is caused by
stress on heart
CAD
HTN
Valve disorders
systemic issues
Heart failure is treatable but not
curable
Left Heart Failure
pulmonary congestion
- dyspnea on exertion
- dry cough to bloody
- decrease O2, crackles
- extra sound
- orthopnea
- Paroxysmal nocturnal dyspnea (sudden gasp while resting)
- low urine output
- decrease LOC
Left Sided Heart Failure typically lay in the
RECLINER
left sided heart failure is more commonly
pulmonary symptoms
Pulomonary edema is found through the
lung assessment
In CHF pts prioritize what system
respiratory assessments every 4 hours
dyspnea, dry cough, fatigue, wt gain
Right-sided heart failure
JVD
Dependent edema - hallmark
Hepatomegaly (large liver)
Ascites
weak, anorexia, wt gain
Right-sided heart failure is mostly __________ symptoms
systemic
What test confirms congestive Heart Failure?
Echocardiogram
- give ejection fraction and heart function (below 50 worry)
What is the go-to lab for congestive heart failure?
BNP
The higher the BNP, the higher
the failure/damage
The nursing management of CHF
Daily weight same time and the same scale
I&O accurate
Lung assessment
elevate edema and pressure ulcers
- possible fluid restriction
If a patient has gained more than ___ pounds a day, then contact HCP
3
Medications for CHF
- ACE: promote vasodilation and diuresis
- ARB: if intolerant to ACE
- Beta-blockers: with ACE, bradycardia, hypoglycemia
- Digoxin
- Diuretics
- Anticoagulants
- Low sodium diet
ACE inhibitors are a
vasodilator and diuretic
When should you contact the HCP on an ACE inhibitor?
dry presistent cough
A patient with heart failure is beginning therapy with captopril, an ACE inhibitor. What nursing intervention is indicated prior to giving the first dose?
A. Provide the medication 1 hour before meals
B. Offer the medication with food
C. Review recent lab values for hypokalemia
D. Instruct the patient to call for assistance when getting out of bed
D. Instruct the patient to call for assistance when getting out of bed
Dizziness and orthostatic hypotension
Afib and flutter cause the
atria to quiver and blood pools and clots
Digoxin
cardiac glycoside used for systolic heart failure a fib and flutter
- increase contraction and cardiac output
- promotes diuresis
Afib and flutters have no what on an EKG
P wave with irregular rhythm
What is common in heart failure pts?
a fib
With Digoxin Toxicity, what lab needs to be monitored
Potassium
What needs to be checked for digoxin?
If lower than 60,
apical pulse
don’t give
What is an antidote for Digoxin Toxicity?
Digibind
S/S of Digoxin Toxicity
fatigue, depression, malaise
N/V, anorexia
PVCs
Treating CHF UNLOAD FAST
Upright position
Nitrates
Lasix
Oxygen
ACE inhibitors
Digoxin
Fluids (decrease)
Afterload (decrease)
Sodium restrict
Test (BNP)
A heart failure client is being discharged home. How should the nurse instruct the client to assess fluid balance?
Daily weight
CHF pts physical activity is
warm up cool down
talk during exercise
stop if SOB
A patient is experiencing fluid volume excess with dependent edema. The health care provider places the patient on a 1,500ml/day fluid restriction. Which nursing intervention is most important?
Provide frequent oral care
Assess amount of edema each shift
Weigh patient every Monday
D. Keep the legs lower than the heart
Assess amount of edema each shift
P wave
atria
QRS
ventricles
T wave
rest and start again
There should be ___ P wave before one QRS in a normal sinus rhythm
1
PVCs
premature ventricular contractions
PVCs need to have what monitored
electrolytes
Bigeminal
PVC on every 2nd beat
Trigeminal
PVC on every 3rd beat
When do PVCs become a problem?
frequency increases and becomes regular
Which of the following are symptoms of left heart failure? Select all that apply.
Paroxysmal nocturnal dyspnea (PND)
Peripheral edema
Jugular venous distention (JVD)
Crackles in the lungs
Shortness of breath upon exertion
Paroxysmal nocturnal dyspnea (PND)
Jugular venous distention (JVD)
Crackles in the lungs
Shortness of breath upon exertion
Which of the following are symptoms of right heart failure? Select all that apply.
Jugular venous distention (JVD)
Hepatomegaly
Wheezing
Ascites
Shortness of breath on exertion
Jugular venous distention (JVD)
Hepatomegaly
Ascites
PAD
Peripheral Artery Disease
- narrowing and blood flow decreases in atherosclerosis
What sign is associated primarily with PAD
Intermittent claudication
PAD S/S
Intermittent Claudication- pain in legs
pain in extremities with exercise
relieved by rest
If have PAD, then relieve the pain by
dangling legs
increase perfusion
If the patient has calf pain from PAD reflect on
femoral or popliteal artery ischemia
Appearance of PAD
cool and pale
white blanched
intermittent claudication
no pulse, drainage, or edema
round smooth sores
toes and feet eschar
cyanosis
loss of hair and brittle nails
dry, shiny, scaly
ulcerations or bruits
doppler to detect flow
Factors of PAD
smoking
high lipids
HTN
diabetes
stress
obesity
Interventions for PAD
LOWER EXTREMITY
- proper foot care
avoid cold
- med for vasodilation
PVD and PAD most also have
diabetes
antiplatelets
and cholesterol meds
Surgeries for PAD
Bypass grafts (FEM-POP)
Post-op on Fem-Pop bypass assess
pulse
color
temp
doppler
How long do you monitor for a post-op fem-pop bypass
every hour for 8 hours
then every 4 hours for remaining 24
What is the primary nursing intervention when caring for a patient after peripheral artery bypass surgery?
Encourage bed rest for the first three days post surgery
Encourage dangling of legs to promote circulation to the new peripheral vessel grafts
Assess and document pulses every hour for the first 8 hours after surgery
Encourage fluids to flush out radiopaque dye
Assess and document pulses every hour for the first 8 hours after surgery
Signs and symptoms of peripheral arterial disease (PAD) include which of the following? Select all that apply.
Rubor in dependent extremities
Strong, regular pulses
Intermittent claudication
Dry, tight, shiny skin on extremities
Non-healing, painful ulcers
Rubor in dependent extremities
Intermittent claudication
Dry, tight, shiny skin on extremities
Non-healing, painful ulcers
When assessing a client with peripheral arterial disease, the nurse anticipates signs and symptoms of ischemia, including
Warm, pink extremities
Intermittent claudication
Increased pulse pressure
Increased hair production on affected extremities
Intermittent claudication
When assessing a client with peripheral arterial disease, the nurse anticipates signs and symptoms of ischemia, including
Warm, pink extremities
Intermittent claudication
Increased pulse pressure
Increased hair production on affected extremities
Intermittent claudication
PVD S/S
chronic venous stasis - backflow from valves
edema
brownish discoloration (venule rupture)
pain
PVD Management
ELEVATE EXTREMITIES
pump foot
compression stockings
assessment of peripheral neurovascular and skin integrity
Appearance of PVD
EDEMA lower leg
dull achy
ankles sores with irregular borders
yellow slough
redness
DVT Virchow’s triad (perfect storm)
venous stasis
vessel wall injury
altered blood coagulation
Assessment of DVT
LIMB PAIN IN CALF
swelling
tenderness
difference in leg size
venous doppler
High risk for DVTs
major surgery, trauma
oral contraceptives
diabetics, smoking, sedentary, travels
recurrent DVTs
DVTs pts are on
bedrest
Prevention of DVTs
compression stockings
leg exercises
ambulation
TCDB
enoxaparin or heparin
bed rest
The antidote of heparin IV infusion
protamine sulfate
Enoxaparin platelet levels need to be above
100,000
Antidote for Warfarin
Viatmin K (not potassium) or FFP (fresh frozen plasma)
Monitor what for Warfarin
PT/INR every day before dose
For Warfarin and Heparin need to be careful about
bleeding
OTC, alcohol, dont stop
Warfain education
avoid food with excessive Vitamin K (green and leafy)
avoid alcohol, OTC
don’t stop unless directed
ID bracelet
T/F: The antidote for heparin is protamine sulfate.
True
A patient presents to the cardiac clinic 3 weeks post-op aortic valve replacement to monitor PT/INR for warfarin therapy. The nurse can assume the client had which kind of valve replacement?
Homograft
Allograft
Tissue
Mechanical
Mechanical
have to be on anticoagulant for rest of their lives
T/F: The lab value used to monitor the efficacy of warfarin is the partial thromboplastin time (PTT).
False, PT/INR
DVT procedure
Greenfield filter to catch the clot
cause easily clot
What is the amount of blood pumped in one minute
cardiac output
The most common primary dx in the US
HTN
What is it called when HTN is not caused by another disease process
Primary HTN
This is when HTN has caused damage to other organs
ComplicatED HTN
Which part of the heart pushes blood to the rest of the body
Left ventricle
Side effects of this medication include orthostatic hypotension, sexual dysfunction, vertigo, and tachycardia
Alpha Blockers
It is especially important to monitor Potassium levels with this med
Furosemide
What is a diuretic that is used primarily treat HTN?
HCTZ
What is problem when blood pressure decreases by more than 20 systolic or more than 10 diastolic when standing
Orthostatic HTN
- PREVENT FALLS
T/F: Vasoconstriction can lead to increase BP
True
Accumulation of lipid or fatty substances in the vessel walls is called
Atherosclerosis
What are age, gender, and ethniciety?
Non-modifiable risk factors
What cholestrol level do we want to be high?
HCL
Inadequate blood flow or O2 content
If cut off completely
Ischemia
Infarction
Predictable chest pain on exertion
Stroke angina
EKG finding of injury or infarction
ST elevation
- want to catch at depression ischemia
Most specific lab indicates cardiac injury
Troponin
Most specific lab test for heart failure
BNP
Diagnostic test used to look at heart wall motion
Echo
Common side effects of Nitroglycerin
HA give tylenol
Do not give if the patient has recently taken an erectile dysfunction med
nitroglycerin
What lab is monitored when giving enoxaparin
platelet
Acronym used to guide tx of MI
MONA
Pt’s output is how many mL/hr if not call HCP
30
When a heart valve never really closes and blood continues to flow even when the valve is not supposed to be open
Regurgitataion
Vitamin K antidote for what med
Warfarin
Classic signs of this issue focus on pulmonary issues
Left sided HF
Classic sign of right sided heart failure
edema
Asthma pts should avooid cardiac med
Beta Blockers
If a heart failure client is being discharged how would you instruct the pt to monitor fluid balance
daily weight
Leg pain induced by walking and subsides at rest
Intermittent claudication (PAD)
This med puts pts at risk of DVT
Oral contraceptives
