CVPV Flashcards
1
Q
What is the amount of blood pumped in one minute called?
A
cardiac output
2
Q
Lower cardiac output means
A
poor perfusion
3
Q
Hypertension is the cause of
A
every other heart problem
1/8 death in the world
3rd leading cause of death
4
Q
Hypertension BP is usually
A
140/90 or higher
5
Q
What is the most common primary diagnosis in the US?
A
Hypertension
6
Q
What is the most common modifiable risk factor for CV disease?
A
Hypertension
7
Q
As hypertension gets higher, the cardiovascular disease
A
it gets worse
8
Q
Hypertension Crisis
A
180/120
- a lot of concern (stroke, perfusion)
9
Q
Why is there more and accelerating hypertension in the US?
A
obesity (poor diet and exercise) - sitting
10
Q
Causes of hypertension
A
- increase in cardiac output (too much fluid)
increase heart rate and stroke volume - increase peripheral resistance (hypothermia/stress)
increase viscosity, vasoconstriction
11
Q
Vasoconstriction
A
decrease in vessel diameter (shrink)
12
Q
Vasodilation
A
increase in vessel diameter (expand)
13
Q
Primary hypertension
A
not caused by identifiable disease/cause
- overactive sympathetic nervous system (RAAS, too much sodium)
14
Q
Secondary hypertension
A
caused by another disease, stress
- renal vascular disease
- valve disorders
- sleep apnea
- pregnancy
- thyroid disorders
- drugs (oral contraceptives, antihistamines, corticosteroids)
15
Q
If a patient has secondary hypertension, how should it be treated?
A
treat the cause
16
Q
Secondary hypertension can be caused by what types of drugs?
A
oral contraceptives
antihistamines
corticosteroids
17
Q
What does continued HTN do to the blood vessels?
A
Hypertrophy (enlarge)
Hyperplasia (replicate)
inflammatory
due to stress and stretching of vessels causes damage
macrophages will come to help but only narrow the vessels
18
Q
Hypertrophy
A
enlargement of cells
19
Q
Hyperplasia
A
replicate
20
Q
What 2 things happen to the cells during the inflammatory response?
A
Hypertrophy
Hyperplasia
21
Q
Risk factors Hypertension and cardiovascular disease
A
family hx
cig smoking
obesity
- high sodium, low potassium, calcium, and magnesium
heavy alcohol consumption
African American and age
diabetes
22
Q
Men are at a higher risk factor of hypertension in what age range?
Women?
A
early to middle adulthood
over 50
23
Q
What is considered the “silent killer”?
A
hypertension
- early stage no s/s other than gradually increasing B/P
- only noticed in crisis
24
Q
S/S of hypertension
A
asymptomatic
HA
blurry vision
chest pain
dizzy
epistaxis
flushed face
25
Epistaxis
nose bleeds
26
Complicated Hypertension
sustained hypertension effects beyond hemodynamics **organ involvement**
27
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)
28
If we have decreased blood flow, we also have
decreased O2
29
Complicated HTN occurs commonly in
**Kidneys** (renal disease) - uncontrolled HTN
Brains - **Strokes** and vision
Heart (myocardium and coronary arteries)
Lower extremity vessels
30
When the ventricle's walls thicken then
less blood goes into the heart
heart now has to work harder to pump out more blood
31
What lab/test can evaluate hypertension?
none
- looking for underlying reason but not dx
32
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
33
If you see a patient who has one high BP, do you dx them now?
no, only after several months of BPs
34
What is the most accurate way of evaluating BP
auscultation manual
sit/laying down quietly for 5 mins
arm at heart level
appropriate size
35
White Coat Syndrome
BP will be high in a Dr's office
36
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**
37
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)
38
Any drugs used to treat the patient are also accompanied by the nurse
educating the pt on lifestyle modifications
- combine with diet and exercise
39
Antihypertensive Drugs
Ace Inhibitors
Beta Blockers
Calcium Antagonists
40
ACE Inhibitors end in
pril
41
Beta Blockers end in
olol
42
Calcium Antagonists have what in the name
Ca
43
Alpha-Adrenergic Antagonists (Alpha - Blockers)
Side Effects
orthostatic hypotension
vertigo
tachycardia
sexual dysfunction
44
Alpha Blockers end in
osin
45
Furosemide is also known as
Lasix
46
How long can furosemide stay in the body
**LA** sts **SIX** hours
usually during the day (if night, get up often for bathroom)
47
Side effects of Furosemide
**Dysrrhthmias**
**due to a decrease K**
decrease BP
increase blood glucose
sunburn very easily
48
Furosemide is used for
too much fluid
(edema, hypertension, ascites)
49
Hydrochlorothiazide is used
diuretic used to lower BP (mild diuretic)
50
What is the downside of HCTZ?
Important nurse assessment?
electrolyte loss
Monitor electrolyte balance
51
Which diuretic is used mainly for hypertension but a mild version of a diuretic than furosemide?
HCTZ
52
Hypertension Nursing Interventions
**daily weight**
I&O accuracy
Urine output
BP response
**Electrolytes**
Pulses
Ischemic Episodes (TIA)
4 C Complication
53
TIA means
Transient Ischemic Attack
54
4 C's Complications of hypertension
Coronary Artery Disease
Chronic Renal Failure
Congestive Heart Failure
Cerebral Vascular Accident (stroke)
55
Success in Tx for Hypertension depends on
compliance (tell them to continue meds despite fatigue)
6 weeks and give them power by checking BP
56
Orthostatic Hypotension is also known as
Postural Hypotension
57
Orthostatic Hypotension is considered
Systolic = drop of 20 mmHg or greater
Diastolic = drop of 10 mmHg or greater
when standing up
58
Acute Orthostatic Hypotension reasons
Altered electrolytes
New med
**Prolonged immobility**
starvation
physical exhaustion
vol depletion
**venous pooling**
**elderly** - esp. falls**
59
Chronic Orthostatic Hypotension
**Secondary to specific disease**
- endocrine, metabolic, CNS, PNS
60
Idiopathic
no known cause
61
Idiopathic Orthostatic Hypotension
generalized degeneration of the CNS
1/3 of elderly affected (postprandial - after meals)
62
Orthostatic Hypotension has a significant
fall risk
63
S/S of orthostatic hypotension
dizzy
blurred loss of vision
syncope
fainting
after meals in elderly
64
Monitoring Orthostatic BP
lying/sitting/standing BP
3-4 times a day
more than 20
65
How do you diagnose orthostatic hypotension?
tilt table test
66
Tx of Orthostatic hypotension
- **PRIMARY FALL PRECAUTIONS**
- **assist pt when moving and repositioning**
- **supportive devices**
- eliminate the cause (meds, volume, electrolyte)
67
T/F: Vasoconstriction leads to increased blood pressure readings.
True
68
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
69
The coronary artery supplies blood to the
heart muscle
70
Preload
stretch of the heart **filling up** with blood
caused by the pressure created by the **volume of blood within the ventricle**
71
Afterload
the amount of **resistance** to the **ejection** of blood from the ventricle
72
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
73
Atherosclerosis
accumulation of lipid (fatty substance) in vessel walls
- inflammatory response
- fibrous cap forms
- ischemia
74
Atherosclerosis is more common in what vessels
coronary arteries
bc of tiny turns
75
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
76
preload increases in
hypervolemia
regurgitation of cardiac valves
77
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
78
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
79
Why do you not give asthma pts Beta blockers?
cause bronchospasms or make theirs worse
80
What Beta blocker would you give an asthma pt?
Metoprolol (less of bronchospasms)
81
ST depletion is a sign of
ischemia
82
ST elevation is a sign of
infarction or injury
83
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)
84
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
85
What does infarction mean?
lost blood flow to the area so lost O2 content
86
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
87
Intermittent claudication is associated with what disease?
Peripheral Artery Disease
88
Pre-op on a FEM-POP bypass, how should the patient sit?
dangling legs
help blood flow
89
Post-op on a FEM-POP bypass, how should the patient's leg be situated?
elevated
decrease pressure
90
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
91
What lab is the most specific to identifying myocardiac damage
Troponin
92
Diagnostic test for angina
stress test (Thalium)
- also with an Echo (dye shows block)
- possible Cath Lab
93
What test is used to monitor heparin?
AntiXa every 6 hours
94
Non-modifiable risk of atherosclerosis
age
gender
family hx
ethnicity
95
Modifiable risk factors of atherosclerosis
Obesity **(High cholesterol and inactivity)**
smoking
**hypertension**
hyperglycemia
stress
96
What type of cholestrol is good to be high?
HDL
97
What types of cholesterols need to be low?
LDL, total, and triglycerides
98
What is the #1 killer of women?
Coronary Artery Disease
- >55 y/o CAD is equal to men
99
Myocardial Ischemia pathology
interfere with blood flow through the coronary arteries
**not enough O2**
**narrowing of vessels = not enough blood flow/O2**
100
What are the 3 possible causes of Myocardial Ischemia
vasoconstriction
atherosclerosis
thrombus formation
- narrowing by 50% greater risk
101
Myocardial Ischemia either has
decreased supply
increase demand
of blood flow/O2
102
In Myocardial Ischemia, the demand _________ supply.
exceeds
103
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
104
Heart cells only remain viable for ____ mins in an ischemic condition.
20 (Time is Muscle)
105
If perfusion is not restored, then ___________ will begin after 20 mins
infarction
106
Angina pectoris is just
chest pain
107
Angina Pectoris is caused by
myocardial ischemia(not enough O2 to heart)
108
Turbulent blood makes it more likely for
blood to stick and bounce off walls and cause blood clots
- leads to myocardial infarction
109
Factors causing anginal pain
- physical exertion
- exposure to cold
- eating heavy meal
- stress
110
Stable angina
**predictable pain on exertion**
- lasts **3-5 mins** with pain **relieved at rest**/nitrates
- no damage if blood flow restored
111
Prinzmetal Angina
**unpredictable** caused by **vasospasm**
- **at rest**
112
Prinzmetal angina is treated with
Calcium channel blockers (CA in name)
help with spasms of the vessel walls
113
Silent ischemia is a type of
angina
114
Silent ischemia is known by
EKG changes with **no pain or symptoms**
- ST changes indicating MI
115
Unstable angina is also known as
preinfarction
116
Unstable angina occurs
at rest or minimal activity
increasing severity or frequency
117
Unstable angina could be with exertion but
does not stop the pain when sitting or treating
118
Unstable angina (20%)can lead up to
MI (myocardial infarction)
119
What treatment could possible treat stable angina
nitrates
120
What pain would we expect pts to feel leading up to a heart attack?
Unstable angina
121
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
122
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
123
Evaluation of chest pain includes
cardiac assessment (auscultation, when started, rapid or extra sounds)
EKG
Labs
124
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
125
Angina/MI pts symptoms can vary greatly with
elderly and women
DIABETICS (neuropathy)
126
Elderly pts will complain of what s/s of angina AND MI
dyspnea
127
Women will complain about what s/s of angina and MI
Fatigue (major)
128
Acute Coronary Syndrome
umbrella term for **unstable angina and myocardial infarction**
129
What is used to diagnose ST elevation (myocardial ischemia) or depression (myocardial infarction)?
12 Lead EKG
130
Diagnose and evaluate CHF
BNP - released with overstretched ventricular tissue
131
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
132
CK-MB stands for
Creatinine and kinase myocardial band
133
Troponin stays in the body for
up to 14 days
134
Cholesterol does what
transport system to walls and into cells
fried and fatty foods
135
HDL is primarily
hereditary (protective to excrete to livers)
136
Triglycerides are stored
unused ingested calories in the fats cells
later used as energy
sweets and carbs
137
Lipid Lowering Drugs (Manage cholesterol)
Statins (atorvastatin)
Niacin
Fibrates (gemfibrozil)
138
Statins purpose
**decrease significantly elevated LDL** and triglyceride levels
**Raise the HDL**
139
What do you need to monitor with statin drugs?
Liver function tests
140
Statins can cause what to the body as a side effect and need to stop taking
muscle tenderness or weakness
hepatotoxicity
141
Niacin purpose
B vitamin for minimal cholesterol levels or with statin
142
What is the big side effect of Niacin?
flushing of redness or hotness in the face
but take aspirin 30 mins before helps
143
Fibrates purpose
decrease LDL by stopping synthasis
144
When starting someone on cholesterol medicine, have them come back every
6 weeks for the 1st six months or until goal reached
145
Fibrates purpose
decrease LDL by stopping synthesis
146
When should you take your Statin drugs during the day?
an evening meal or at bedtime
147
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
148
Echocardiogram shows
effective pump and enough cardiac output
149
Nusing Interventions and Tx for angina
**make the heart work smarter, not harder**
- OXYGEN 1st
- Pain assessment
- VS
- Respiratory
- 12 Lead
- **Nitroglycerin**
150
What would you give the 1st thing to give pt to treat angina?
**give supplemental O2**
151
If a patient has angina, what medication would we give to treat that?
Nitroglycerin
152
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)
153
ALWAYS initiate ____ at the onset of chest pain
O2
- monitor pulse ox, rate and rhythms
154
If a patient comes in with chest pain, what system do you always assume is affected until proven otherwise?
cardiac
155
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**
156
What is a commonly known nitrate
nitroglycerin
157
If Nitroglycerin does not sting when SL, then
it is expired
158
Nitroglycerin is very sensitive to
sun light
159
If pain persists after 3 tablets of Nitroglycerin at 5-minute intervals, then
call 911
160
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
161
If you take this drug, you can not have nitroglycerin
erectile dysfunction
162
Nitroglycerin is a potent
vasodilator opens all the blood vessels
163
A side effect of Nitroglycerin
Headache almost always
flushing
164
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**
165
What medication do you never stop abruptly and if NPO still give with ice chips or little water?
Metoprolol
- or rebound hypertension could occur
166
If a pt has had an MI before, they are
at an increased risk of another MI
167
Beta-blockers can alternatively affect
blood glucose (**hypoglycemia mimics**)
168
Beta-blockers can be used for
BP decrease
chest pain
CHF
test anxiety/high-stress situations
valve issues
169
If a patient heart rate is below 60, would you give metoprolol?
no, unless written otherwise
170
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.
171
T/F: Nitroglycerin primarily dilates veins but at higher doses dilates arteries as well?
True
172
Calcium Channel Blockers
- **slows electrical impulses**, pulse, and O2 demand
**relaxes blood vessels** (improve perfusion)
- great for **Prinzmetal angina** and invasive coronary
173
Do not take ___________ _______ with a calcium channel blocker.
Why?
grapefruit juice
increases Calcium Channel Blocker levels
174
calcium Channel Blockers Names (Very Nice Drugs)
Verapamil
Nifedipine
Diltiazem
175
Calcium Channel Blockers is not a good choice for patients with
Heart failure
176
Aspirin
prevents platelet activation
**prevent blood clots**
81 baby and 325 full of cardiac issue
177
clopidogrel (Plavix)
bleeding and GI upset with both
antiplatelet
178
What is the number 1 concern for a pt with antiplatelet drugs?
bleeding out
179
Watch platelet counts for what meds
Heparin
Enoxaparin
180
Heparin is monitored by what test
AntiXa (for specific dose)
181
Enoxaparin
What pts should probably not get it?
low molecular wt heparin
- do not have to monitor lab
**not good for kidney pts**
182
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**
183
T/F: Prinzmetal angina is predictable pain that is relieved by rest.
False
vasospasm occurring at rest
184
Myocardial Infarction (MI)
**abruptly deprived of O2**
- cells begin to **necrose after 20 mins** of occlusion
-**longer occluded more extensive damage to the heart**
185
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**
186
What system is a direct indicator of heart cardiac output unless a specific disease?
urine output
187
The urine output should have how many mL of fluid per hour?
30 mL/hr
188
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**
189
The goal of managing MI
minimize damage and preserve function
PTCA and meds
190
PTCA
percutaneous transluminal coronary angioplasty
- stent
191
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
192
Cardiac Rehab
- extend and improve quality of life
**lifestyle modifications**
limit atherosclerosis
**prevent another attack**
193
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
194
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?)
195
Cath Lab reason
- usually radial or femoral
- insert dye to find a blockage
- if blockage then stent and balloon
196
Nursing Care Pre-Op Cath Lab
NPO 8-12 hours
consent
good IV access (Versed)
prepare expectations (surgeons)
197
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**
198
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
199
What is the minimum time to hold pressure on an insertion site when the catheter is removed from the cath lab?
20 mins
200
CABG
Coronary Artery Bypass Graft
- goes around the occlusion
201
After a CABG, what precautions need to be in place?
Why?
turning and lifting precautions
fear of tearing sternal wires
202
Which urinary output demonstrates to the nurse renal perfusion is being maintained following cardiac surgery?
30 mL/hr
203
Mitral Valve Prolapse
leaflets go upward into the atrium
- most common valve disorders
204
S/S of Mitral Valve prolapse
**often asymptomatic**
**fatigue/lethargy**
murmurs
dyspnea
weak
**chest pain**
205
If a mitral valve prolapse, then avoid
hypovolemia
bc volume is needed to help perfusion
206
Tx mitral valve prolapse
regular physician assessments
**avoid hypovolemia**
if more severe valve replacement
207
Stenosis
valve is **stiff**, blood is trickle through
**constricted or narrowed**
blood flow through valve **not efficiently*
208
Regurgitation
leaflets fail to close completely
blood backflow
209
Both stenosis and regurgitation can cause
hypertrophy of muscles
damage to myocardium
tightened walls
impairs fill time
210
How to manage valve disorders (regurgitation and stenosis) with what meds?
**diuretics
cardiac glycoside (digoxin)
beta-blockers**
prophylactic antibiotics
valve replacement (xeno, homo, auto)
211
If the patient has a valve replacement, you should watch closely for the development of
heart failure
212
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
213
A client is being evaluated for chest pain. Which of the following lab values is most reliable in evaluating damage to cardiac muscle?
Troponin
214
A patient is presenting with aortic valve stenosis. The nurses understand this means the aortic valve is
so stiff is doesn't open completely
215
Heart failure in summary is
inability to pump sufficient blood to meet the needs of tissues
216
Heart Failure is caused by
**stress on heart**
CAD
**HTN**
Valve disorders
systemic issues
217
Heart failure is treatable but not
curable
218
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
219
Left Sided Heart Failure typically lay in the
RECLINER
220
left sided heart failure is more commonly
pulmonary symptoms
221
Pulomonary edema is found through the
lung assessment
222
In CHF pts prioritize what system
respiratory assessments every 4 hours
dyspnea, dry cough, fatigue, wt gain
223
Right-sided heart failure
**JVD**
**Dependent edema - hallmark**
Hepatomegaly (large liver)
**Ascites**
weak, anorexia, wt gain
224
Right-sided heart failure is mostly __________ symptoms
systemic
225
What test confirms congestive Heart Failure?
Echocardiogram
- give ejection fraction and heart function (below 50 worry)
226
What is the go-to lab for congestive heart failure?
BNP
226
The higher the BNP, the higher
the failure/damage
227
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
228
If a patient has gained more than ___ pounds a day, then contact HCP
3
229
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
230
ACE inhibitors are a
vasodilator and diuretic
231
When should you contact the HCP on an ACE inhibitor?
dry presistent cough
232
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
233
Afib and flutter cause the
atria to quiver and blood pools and clots
234
Digoxin
cardiac glycoside used for systolic heart failure **a fib and flutter**
- increase contraction and cardiac output
- promotes diuresis
235
Afib and flutters have no what on an EKG
P wave with irregular rhythm
236
What is common in heart failure pts?
a fib
237
With Digoxin Toxicity, what lab needs to be monitored
**Potassium**
238
What needs to be checked for digoxin?
If lower than 60,
apical pulse
don't give
239
What is an antidote for Digoxin Toxicity?
Digibind
240
S/S of Digoxin Toxicity
fatigue, depression, malaise
N/V, anorexia
**PVCs**
241
Treating CHF **UNLOAD FAST**
Upright position
Nitrates
Lasix
Oxygen
ACE inhibitors
Digoxin
Fluids (decrease)
Afterload (decrease)
Sodium restrict
Test (BNP)
242
A heart failure client is being discharged home. How should the nurse instruct the client to assess fluid balance?
Daily weight
243
CHF pts physical activity is
warm up cool down
talk during exercise
stop if SOB
244
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
245
P wave
atria
246
QRS
ventricles
247
T wave
rest and start again
248
There should be ___ P wave before one QRS in a normal sinus rhythm
1
249
PVCs
premature ventricular contractions
250
PVCs need to have what monitored
electrolytes
251
Bigeminal
PVC on every 2nd beat
252
Trigeminal
PVC on every 3rd beat
253
When do PVCs become a problem?
frequency increases and becomes regular
254
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
255
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
256
PAD
Peripheral Artery Disease
- narrowing and blood flow decreases in atherosclerosis
257
What sign is associated primarily with PAD
Intermittent claudication
258
PAD S/S
**Intermittent Claudication- pain in legs**
pain in extremities with exercise
relieved by rest
259
If have PAD, then relieve the pain by
dangling legs
increase perfusion
260
If the patient has calf pain from PAD reflect on
femoral or popliteal artery ischemia
261
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
262
Factors of PAD
smoking
high lipids
HTN
diabetes
stress
obesity
263
Interventions for PAD
**LOWER EXTREMITY**
- proper foot care
avoid cold
- med for vasodilation
264
PVD and PAD most also have
diabetes
antiplatelets
and cholesterol meds
265
Surgeries for PAD
Bypass grafts (FEM-POP)
266
Post-op on Fem-Pop bypass assess
pulse
color
temp
doppler
267
How long do you monitor for a post-op fem-pop bypass
every hour for 8 hours
then every 4 hours for remaining 24
268
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
269
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
270
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
271
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
272
PVD S/S
chronic venous stasis - backflow from valves
edema
brownish discoloration (venule rupture)
pain
273
PVD Management
**ELEVATE EXTREMITIES**
**pump** foot
**compression stockings**
assessment of peripheral neurovascular and skin integrity
274
Appearance of PVD
**EDEMA** lower leg
dull achy
**ankles sores with irregular borders**
yellow slough
**redness**
275
DVT Virchow's triad (perfect storm)
venous stasis
vessel wall injury
altered blood coagulation
276
Assessment of DVT
**LIMB PAIN IN CALF**
**swelling**
tenderness
**difference in leg size**
venous doppler
277
High risk for DVTs
major surgery, trauma
oral contraceptives
diabetics, smoking, sedentary, travels
recurrent DVTs
278
DVTs pts are on
bedrest
279
Prevention of DVTs
compression stockings
leg exercises
ambulation
TCDB
**enoxaparin or heparin**
**bed rest**
280
The antidote of heparin IV infusion
protamine sulfate
281
Enoxaparin platelet levels need to be above
100,000
282
Antidote for Warfarin
Viatmin K (not potassium) or FFP (fresh frozen plasma)
283
Monitor what for Warfarin
PT/INR every day before dose
284
For Warfarin and Heparin need to be careful about
bleeding
OTC, alcohol, dont stop
285
Warfain education
avoid food with excessive Vitamin K (green and leafy)
avoid alcohol, OTC
don't stop unless directed
ID bracelet
286
T/F: The antidote for heparin is protamine sulfate.
True
287
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
288
T/F: The lab value used to monitor the efficacy of warfarin is the partial thromboplastin time (PTT).
False, PT/INR
289
DVT procedure
Greenfield filter to catch the clot
cause easily clot
290
What is the amount of blood pumped in one minute
cardiac output
291
The most common primary dx in the US
HTN
292
What is it called when HTN is not caused by another disease process
Primary HTN
293
This is when HTN has caused damage to other organs
ComplicatED HTN
294
Which part of the heart pushes blood to the rest of the body
Left ventricle
295
Side effects of this medication include orthostatic hypotension, sexual dysfunction, vertigo, and tachycardia
Alpha Blockers
296
It is especially important to monitor Potassium levels with this med
Furosemide
297
What is a diuretic that is used primarily treat HTN?
HCTZ
298
What is problem when blood pressure decreases by more than 20 systolic or more than 10 diastolic when standing
Orthostatic HTN
- PREVENT FALLS
299
T/F: Vasoconstriction can lead to increase BP
True
300
Accumulation of lipid or fatty substances in the vessel walls is called
Atherosclerosis
301
What are age, gender, and ethniciety?
Non-modifiable risk factors
302
What cholestrol level do we want to be high?
HCL
303
Inadequate blood flow or O2 content
If cut off completely
Ischemia
Infarction
304
Predictable chest pain on exertion
Stroke angina
305
EKG finding of injury or infarction
ST elevation
- want to catch at depression ischemia
306
Most specific lab indicates cardiac injury
Troponin
307
Most specific lab test for heart failure
BNP
308
Diagnostic test used to look at heart wall motion
Echo
309
Common side effects of Nitroglycerin
HA give tylenol
310
Do not give if the patient has recently taken an erectile dysfunction med
nitroglycerin
311
What lab is monitored when giving enoxaparin
platelet
312
Acronym used to guide tx of MI
MONA
313
Pt's output is how many mL/hr if not call HCP
30
314
When a heart valve never really closes and blood continues to flow even when the valve is not supposed to be open
Regurgitataion
315
Vitamin K antidote for what med
Warfarin
316
Classic signs of this issue focus on pulmonary issues
Left sided HF
317
Classic sign of right sided heart failure
edema
318
Asthma pts should avooid cardiac med
Beta Blockers
319
If a heart failure client is being discharged how would you instruct the pt to monitor fluid balance
daily weight
320
Leg pain induced by walking and subsides at rest
Intermittent claudication (PAD)
321
This med puts pts at risk of DVT
Oral contraceptives
