E x a m #1 Flashcards
Hypertension diet
- low sodium
- low fat
- low cholesterol
- alcohol/smoking cessation
Types of angina
Stable: exercise/emotional stress. Relieved by rest/nitroglycerin
Unstable: “ , increases in occurrence, severity, overtime. Tight squeezing, heavy pressure, or constriction in chest. Pain can radiate to jaw, neck, or arm.
Nursing considerations for angio/cardiac catherization
Pre: assess allergies, mark pedal pulses. Consent form signed. Renal function. NPO 6-8 hours. pre - medications (Solu-medrol)
Intra: local anesthesia, awake and sedated. warm and flushed when dye is inserted.
Post: direct pressure on incision (groin), monitor for bleeding/hematomas, thrombosis. continuous cardiac monitoring. analgesics. monitor urine output and rate of hydration.
Vtach
Lower chambers of heart beat very quickly.
Chest discomfort, fainting, dizziness, SOB
TX: Antidysrhythmic drugs (lidocaine)
Vfib
Heart beats w/ rapid, erratic electrical impulses. Occurs due to untreated Vtach. Life threatening.
TX: defibrillation, CPR
Afib
Abnormal rhythm, rapid, & irregular
Fatigue, SOB, angina
TX: antidysrhythmic drugs, anticoagulants, cardioversion. WARFARIN, ASPIRINS, defib.
Aflutter
Atria beats too quickly
Mild dyspnea, palpitations, fatigue, hypotension
TX: Medications (anticoagulants)
PVC (premature ventricular contractions)
Extra, abnormal heartbeats that begin in one of the heart’s two lower chambers
Hypotension, hypoxia, weakness, SOB, fainting
TX: antiarrythmia meds (amiodarone), eliminate caffeine/stress if no heart disease
Asystole rhythm strips
Cardiac arrest rhythm w/ no electrical activity on the EKG monitor.
Angina before arrest.
Tx: CPR
Myocardial infarction causes
- male
- family history
- increased age
- obesity
- smoking/alcohol/drug abuse
- stress
- HTN
- high cholesterol
- hyperlipidemia
- coronary artery stenosis
S/S and reasons (for MI)
- persistent, crushing, substernal chest pain (radiates to left arm, jaw, neck, shoulder)
- diaphoresis
- SOB
- heartburn, N/V
- dizziness
- decreased LOC
- pallor, cool, & clammy skin
- anxiety
Cardiac enzymes - use
A specific marker in diagnosing a MI. Released into bloodstream when heart muscle suffers ischemia.
Cardiac kinase - importance
Enzyme specific to cells of brain (CK - BB), myocardium (CK - MB), & skeletal muscle (CK - MM)
Elevated = heart attack, damage, or condition that produce damage to skeletal muscles/brain
Correct use of defibrillator, pad placement
Yell “clear” before administering shock
Make sure Pt is dry
Place pad on right center of chest above nipple, other bad slightly under other nipple & left of rib cage.
S/S of Right - sided HF
- fatigue
- peripheral venous pressure
- ascites
- enlarged liver & spleen
- distended jugular veins
- weight gain
- gi distress
- dependent edema
S/S of Left - sided HF
- dyspnea
- fatigue
- altered mental status
- oligura
- pulmonary congestion
- tachycardia
- elevated pulmonary capillary wedge pressure
How to monitor HF:
daily weights, I&O, lung sounds, ABG’S, electrolytes, SAO2, chest xray
P wave
contraction of atria, electrical pulse is generated
Q wave
first negative deflection and represents initial ventricular septal contraction
early ventricular depolarization
R wave
first positive deflection and may be small, large, or absent depending on the lead
early ventricular depolarization
S wave
negative deflection following the R wave and not present in all leads
T wave
repolarization of the ventricles
How to apply & perform on ECG
To record the electrical activity of the heart overtime
Application:
- position patient supine w/ chest exposed
- wash skin
- attach one electrode to each of the client’s extremities by applying electrodes to flat surfaces above the wrists and ankles and the other six electrodes to the chest, avoiding chest hair
PT education:
- get rest
- remain still and breathe normally
Cardiac tamponade - findings
fluid accumulation compresses the heart. widened mediastinum and cardiomegaly. low amplituded QRS complexes. elevated right atrial pressure, right ventricular diastolic pressure, CVP. pericardial effusion w/ signs of compression.
hypotension, jugular venous distention, muffled heart sounds, paradoxical pulse
Risks for HTN
- African americans
- obesity
- stress
- family history
- alcohol/smoking
- renal disease
Classifications for HTN - values **
Pre hypertension: S 120 - 139 D 80 - 89
Stage 1: S 140 - 159 D
Classifications for HTN - values **
Pre hypertension: S 120 - 139 D 80 - 89
Stage 1: S 140 - 159 D 90 - 99
Stage 2: S equal or >160 D equal or >100
Low cholesterol diet
- fish
- whole/multi grains
- fruit & veggies
- omega - 3 fatty acids
- nuts
restricted animal fats and saturated fats
Electrolyte imbalances that can affect cardiac status
Potassium 3.5 - 5.9
Calcium 9 - 10.5
Risk factors for CAD (coronary artery disease)
- family history
- age
- sex
- culture/ethnicity
- smoking
- HTN
- hyperlipidemic
- DM
- obesity
- oral contraceptives
- psychosocial issues
Labs needed to be monitored for heparin/Coumadin - expectances and ranges
- aPPT: 30-45
- PT: 11-12.5 sec
- INR: 0/7-1.8
- Platelet 150,000-400,00
- CBC
Labs needed to be monitored for heparin/Coumadin - expectances and ranges
- aPPT: 30-45
- PT: 11-12.5 sec
- INR: 0/7-1.8
- Platelet 150,000-400,00
- CBC
Purpose of taking anticoagulants/blood thinners in different disorders
prevent further blood clots, inhibits vit k
Cardioversion
the delivery of a direct counter shock to the heart synchronized to the QRS complex.
For clinical manisfestation of dysrhythmias
Includes: atrial dysrhythmias, supraventricular tachycardia, v tach w/ pulse, a fib
S/S of hyper/hypokalemia
Normal range: 3.5-5.0
Hyperkalemia: muscle weakness, tingling, nausea, bradycardia
Hypokalemia: muscle weakness, tremors, muscle cramps, constipation
Pacemaker - how to assess
battery operated device that electrically stimulates the heart when the SA node of the heart fails to maintain an acceptable rhythm
Battery failure: syncope, dizziness, hypotension
Call cardiologist prior to surgeries, remind clients to carry a copy of pacemaker settings and to wear a medic alert
How it affects ECG: when it fires, a spike is seen on the ecg
Stress electrocardiogram
cardiac muscle is exercised by clients on treadmill, testing workload of the heart
Echocardiogram - pt education
non-invasive ultrasound test to diagnose valve disorders and cardiomyopathy. used to measure size and depth of heart, ejection fraction, cardiac output. lie on left side w/ HOB elevated.
Artherosclerosis
type of arteriosclerosis that involves the formation of plaque w/in the atrial wall and is the leading risk factor for cardioV disease
*hardening & narrowing of the arteries – silently/slowly blocks arteries, putting blood flow at risk
Nonmodifier factors: family history, age, sex, culture, ethnicity
Modifiable factors: smoking, hyperlipidemia, HTN, DM, obesity, sedentary, stress, oral contraceptives, psychosocial
Diet: help obtain or maintain healthy levels of cholesterol and fatty molecules called lipids
A&P of heart. Location/names of arteries & veins throughout the body
located in the thoracic cavity in the mediastinal space. endocardium, myocardium, epicardium, pericardium. right atrium –> veins –> right ventricle –> pulmonary artery (deoxygenated blood) pulmonary veins (oxygenated blood) left atrium –> left ventricle –> aorta & out of body
*watch video
Factors that affect BP
- family history
- sodium intake
- sedentary
- obesity
- hyperlipidemia
- alcohol/smoking
- stress
- African american
Labs that indicate HTN & S/S
elevated BUN, creatinine
elevated serum corticoids
ecg, chest xray
S/S: headaches, visual changes (dizziness, fainting), epistaxis (nose bleed), bruits, flushed face, nocturia, edema
Vessels & valves of the heart + auscultation
To auscultate: erb’s point (3rd left left sternal border), pulmonic valve area (2nd left intercostal space, left sternal border), triscuspid valve area (4th ics, Lsb)
Coronary artery bypass graft (CABG) + nursing considerations
invasive surgical procedure, most common cardiac surgery. used to restore vascularization of the myocardium. most effective when client has sufficient ventricular function. 40-50% ejection fraction = success.
NC: monitor vs, chest tubes, hemodynamic pressures, pain, fluids & electrolytes. informed consent. preoperative meds: anxiolytics (diazepam, lorazepam)
Donor site: graft vein/artery is taken from a healthy blood vessel in body. graft is then surgically attached above and below obstructed/poorly functioning artery
Percutaneous transluminal coronary angioplasty
invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle
extracardiac vein.
post procedure NC: monitor vs 15 min x 4, 30 min x 2, 1 hr x 4. monitor groin site. check CMST. position: supine w/ leg straight. administer aspirin, heparin, lovenox
HDL & LDL
high density cholesterol “good” HDL
>40
low density cholesterol “bad” LDL
<100
Pulmonary edema
abnormal buildup of fluid in lungs = SOB
often caused by congestive HF.
Nitrates (nitroglycerin)
relaxes smooth muscle layer of blood vessels in stable angina. relaxes spasms of coronary arteries.
S/S: headache, flushing, nausea/vomiting, hypotension
NC: avoid alcohol, don’t operate heavy machinery
Dosage: q12h patch & sublingually
Diuretics use & action
block reabsorption of sodium and chloride and to prevent reabsorption of water
Loop d’s - side effects
dehydration
hyponatremia
hypotension
hypokalemia
K+ sparing d’s - side effects
hyperkalemia
menstrual cycle irregularities, gynecomastia
Thiazides - medical interactions
NSAIDS
Bblockers
Beta blockers - side effects and pre assessments
bradycardia decreased cardiac output orthostatic hypotension bronchoconstriction assess HR, BP
Calcium channel blockers
Side effects: weight gain, edema in lower extremities, dizziness, appetite increase, constipation, tingling/numbness, gi discomfort
Contra: systolic dysfunction. 2nd/3rd degree heart block. wolfe-parkinson white syndrome. CHF, CAD.
Importance of salt substitutes w/ ACE inhibitors
reduces effects, may cause retained potassium
Angiotensin II receptor blockers - adverse effects
dizziness headache n/v/d/ hyperkalemia hypotension muscle/bone pain rash
Anti - dysrhythmias purpose
treat dysrhythmias
Inotropics - effect of K+ w/ digoxin
digoxin competes w/ K+. toxicity. changes the force/speed of muscle contractions.
Anti-hyperlipidemics
Tx for high levels of fats
Statins
Major side effects: muscle pain, liver damage, DM, neuro (confusion, memory loss)
Contra: pregnancy, breastfeeding, liver disease, elevated liver enzymes
Anti - anginals goal
relieve ischemia, reducing frequency & severity of angina attack, & preventing a heart attack
Furosemide (Lasix)
loop diuretic - edema due to HF, HTN.
side effects: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, metabolic alkalosis
contra: hepatic coma, anuria, liver disease
NC: assess for skin rash, fluid & electro, change positions slowly, report muscle weak, cramps, nausea, tingling
Digoxin
inotropics, antiarrhythmics for HF, afib/flutter, paroxysmal atrial tachycardia
Side effects: headache, weakness, blurred vision, yellow/green vision, ecg changes, electrolyte imbalances
Contra: av block, constrictive pericarditis, uncontrolled ventricular arrhythmias
NC: monitor ecg, monitor bp, apical pulse. take pulse and report. first sign of digoxin toxicity is change in HR in children
Aldactone (spironolactone)
potassium sparing diuretics for edema, HTN, hypokalemia
Side effects: hyperkalemia
Contra: anuria, acute renal insufficiency, hyperkalemia, Addison’s disease.
NC: assess for rash, check BP weekly.
Propanalol, atenolol
antiarrhythmic, antiHTN, beta adrenergic blocker manage HTN
Side effects: anxiety, fatigue, fever, abd. pain, vomiting, muscle weakness
NC: monitor BP & I&O daily. instruct pt to take @ same time everyday. report SOB.
Verapamil
antiHTN, antiarrhythmic, phenylalklylamine derivative to treat chronic angina
Side effects: confusion, hypo/hypertension, tachycardia, edema, diarrhea
NC: maintain ecg monitoring, assess for bradycardia & hypotension, encourage fiber increase
Lidocaine
antiarrhythmic, aminoacetamide to treat ventricular tachycardia or ventricular fibrillation
Side effects: confusion, bradycardia, nausea, lethargy, paresthesia
Hydrochlorothiazide, chlorothiazide
AntiHTN, diuretic, benzothiadiazide to manage HTN
Side effects: fever, headache, hypotension, abd. cramps, diarrhea, vertigo
NC: monitor fluid I&O, daily weights, BP, BUN & creatinine. take drug in morning and early evening to avoid awakening to urinate late at night
Captopril, lisinopril
AntiHTN, ACE inhibitor to control HTN
Side effects: fever, chest pain, orthostatic hypotension, angioedema, tachycardia
NC: monitor BP, instruct pt to take drug 1hr before meals. avoid sunlight. change positions slowly to minimize orthostatic hypotension
Coumadin, Plavix, lovenox
Anticoagulant, platelet aggregation inhibitor to prevent/treat pulmonary embolism, venous thrombosis
Side effects: weakness, abd. cramps, vomiting, loss of consciousness
NC: monitor INR, avoid alcohol. take consistent amnts of vit K (dark leafy greens)
Nifedipine (Procardia)
antiHTN, antianginal, dihydropyridine derivative to manage angina
Side effects: anxiety, chest pain, confusion, headache, muscle cramps, weakness
NC: monitor I&O, daily weight. fluid retention may lead to heart failure, do not take drug w/in 1hr of high fat meal or w/ grapefruit
Vytorin (Simvastatin/ezetimibe)
antihyperlipidemic to treat hyperlipidemia
Side effects: fatigue, abd. pain, headache, N/V
NC: obtain liver function prior to therapy, urge pt to take drug in evening, follow low fat, cholesterol diet. avoid grapefruits.
Losartan
antiHTN, ARB to manage HTN
Side effects: hypotension, diarrhea, vomiting, fatigue, headache
NC: African descent w/ hypertension may not benefit from losartan to reduce stroke risk, monitor bp and renal function, avoid potassium containing salt. avoid exercising.
Eplerenone (Inspra)
AntiHTN, methyl ester to improve left ventricular systolic dysfunction and congestive HF after an acute MI
Side effects: dizziness, fatige, abd. pain, diarrhea, elevated BUN + creatinine
NC: monitor BP, monitor K+ every 2 weeks for the first month. do not use potassium-containing salt.
