EXAM 2

Question 1

Contraindications of propranolol to treat angina:

Answer 1

Contraindicated in asthma

Question 2

Nitroglycerin:

Answer 2

Place under tongue, if pain unrelieved in 5 min call 911 and take another tab.

3 tabs, 5 min apart, total of 15 minutes

Headache is a common adverse effect d/t vasodilation (blood rushing back to the head too fast)

Question 3

Risk factors for atherosclerosis:

Answer 3

Non modifiable- age, gender, family hx, genetics
Modifiable- smoking, diet, lifestyle

Question 4

Rationale of drawing troponin for patient c/o chest pain:

Answer 4

Troponin is a protein found in the heart muscle, troponin indicates any damage to heart tissue or cardiac muscle damage and EKG monitoring

Question 5

MONA for angina:

Answer 5

Morphine - for moderate to severe pain
Oxygen
Nitroglycerin - vasodilator
Aspirin - stoke prevention/anti-platelet

Question 6

Normal sinus rhythm:

Answer 6

P wave comes before every QRS complex

Question 7

Sinus bradycardia:

Answer 7

Treat only if experiencing symptoms (fatigue, dizziness) athletes will usually be Brady so know baseline.

If symptomatic, give anticholinergic ATROPINE and transcutaneous pacing (pace the heart to offer adequate number of beats to pump blood to major organs)

Question 8

Pre-ventricular contractions:

Answer 8

Ventricular bigeminy is PVC with every other beat

Continuous PVCs is VTACH. If yes, check if they have a pulse cause they have pulseless VTACH

Question 9

VFIB:

Answer 9

HR rapid and is unorganized, rhythm irregular, P wave unidentifiable, PR interval not measurable, QRS bizarre.

Treatment - CHECK PULSE, START CPR, O2, DEFIBRILLATE/SHOCK

Question 10

Pulseless electrical activity:

Answer 10

Electrical activity on the monitor but patient has NO PULSE or heartbeat so DO CHEST COMPRESSIONS ASAP

Question 11

A Flutter:

Answer 11

HR 250-350, P wave saw tooth appearance.

Treatment - if unstable and symptomatic, immediate cardio version.
Control ventricular rate with Beta blockers, CCB.
Maintain NSR with anti arrhythmias and cardiac ablation

Question 12

Pericarditis treatment and patient education:

Answer 12

Pericarditis: inflammation of the pericardium

Treatment: NSAIDS (Tylenol not an NSAID), Colchicine, Indomethacin, Prednisone (corticosteroids)

Educate: contact MD if chest pain occurs

Question 13

Pericardial effusion and diagnostic test:

Answer 13

Pericardial effusion is the accumulation of excess fluid in the pericardial sac.

Diagnostic test: pericardiocentesis to drain the fluid out.

Question 14

Risk factors for hypertrophic cardiomyopathy:

Answer 14

Cardiomyopathy is a disease that affects the heart muscle that affects the pumping mechanisms of the heart = decreased cardiac output and decreased oxygen/blood supply to the body.

Hypertrophic = thick heart muscles in ventricles = ventricles can’t stretch well enough = trouble with diastole and filling.

Risk factors: GENETICS

Question 15

Dilated cardiomyopathy pathophysiology:

Answer 15

Distended ventricles = thin heart muscle and lose muscle walls to contract.

Question 16

Left sided HF manifestations “Left Lung”:

Answer 16

Dyspnea, SOB, tachypnea, cough, crackles, cyanosis, low oxygen, restless, confused, elevated PAWP

Question 17

Right sided HF “Rest of the body”:

Answer 17

Blood pools in the body (dependent edema), ascites, enlarged liver and spleen, JVD, increased weight, increased peripheral venous pressure

Question 18

Effect of Dobutamine on a patient with HF and how you’ll know med is effective:

Answer 18

Increase contractility and improve cardiac output

Med effectiveness: increased urine output and increased perfusion

Question 19

Understand pressure analysis as it relates to HF:

Answer 19

You want the radial and apical pulse to be the same, but for someone with AFIB it might not be the same.

Question 20

Pulses paradoxus and how it relates with cardiac tamponade:

Answer 20

An abnormal drop in BP during inhalation/inspiration. Characterized by a decrease in SBP > 10mmhg, this is usually seen in CARDIAC TAMPONADE patients

Question 21

Cardiac tamponade, expected findings, treatment, and improvement?

Answer 21

Cardiac tamponade is a life threatening condition where blood, fluid, or air fill in the pericardial space that encases the heart. This pressure creates extremes compression of all 4 chambers of the heart, causing trouble pumping blood to major organs.

Manifestations: Muffled heart sounds, Becks triad (Hypotension, muffled heart sounds, JVD) tachypnea, tachycardia, chest pain, sob, anxiety, restlessness, fainting.

Treatment (medical emergency): Pericardiocentesis (a needle and a catheter are used to drain the fluid).

Improvement in patient condition: Improved cardiac output, stable BP

Question 22

Abdominal aortic aneurysm manifestations and how can you tell for impending cardiac arrest?

Answer 22

May be asymptomatic. Pulsing sensation on the abdominal, deep low back pain, tachycardia, hypotension, presence of bruits, deep pain in the abdomen or flank, sob, cough, angina.

Impending cardiac arrest: patient will be drowsy, fatigue, hypotensive, heart rate slowing down, GET CRASH CART READY

Question 23

Increased ICP early/late manifestations, pharm/non pharm/surgical interventions.

Answer 23

ICP 5-10 mmHg

Earl signs: severe headache, nausea, vomiting, restless

Late sings: Severe HTN, Cushing triad (wide pulse pressure, irregular respirations, bradycardia- these indicated neuro status unstable and ICP increasing), pupil changes.

Meds: Mannitol (osmotic diuretic), sedatives, hypertonic solution 5% NS (pull out extra fluid in the brain) so monitor sodium levels, can be HYPERnatremic. Very damaging to veins so give in central line.

Non pharm interventions: HOB elevated 30 degrees to reduce ICP to promote venous drainage, avoid flexion/extension/rotation of the head and maintain body in MIDLINE NEUTRAL position, educate to avoid straining (coughing, suctioning) if we have to suction, we clamp the drain and unclamp after.

Surgical interventions: craniotomy or craniectomy (removes a piece of a skull/bone flap to remove swelling and place on patients abdomen). MAKE SURE PATIENT HAS A HELMET WHEN BEING MOVED

Question 24

Subarachnoid hemorrhage, s/s, interventions, major complications.

Answer 24

Subarachnoid hemorrhage: ruptured blood vessel in the brain = extra blood taking extra space in the skull = patient will herniate

S/S: worst headache of your life (possible stroke or embolism stroke- Take patient to CT)

Interventions: Monitor BP closely cause it can cause an aneurysm to rupture (coil or clip before it ruptures)

Complications: rebelled of aneurysm (pt will be kept in ICU for 30 days) and Cerebral vasospasm (narrowing of blood vessels in the brain) Give Nimodipine.

Question 25

Subarachnoid hemorrhage, s/s, interventions, major complications.

Answer 25

Subarachnoid hemorrhage: ruptured blood vessel in the brain = extra blood taking extra space in the skull = patient will herniate

S/S: worst headache of your life (possible stroke or embolism stroke- Take patient to CT)

Interventions: Monitor BP closely cause it can cause an aneurysm to rupture (coil or clip before it ruptures)

Complications: rebelled of aneurysm (pt will be kept in ICU for 30 days) and Cerebral vasospasm (narrowing of blood vessels in the brain) Give Nimodipine.

Question 26

How do we monitor for delirium in the ICU? Interventions?

Answer 26

Confused Assessment Method (CAM)

Interventions: reorient patient to surroudnings

Pharmacy interventions: Precedex (anxiolytic), Haldol, stay away from sedatives as much as possible.

Question 27

Risk factors for Alzheimer’s, interventions?

Answer 27

Previous head injury or any alteration of perfusion in the brain (Stroke), advanced age.

Interventions: reorient, keep in a familiar environment, bring something from home like a favorite picture or anything familiar to them, avoid restraints as much as possible, sitter at bedside, close to nurses station.

Question 28

Right hemisphere of the brain function:

Answer 28

Creative, artistic, emotions, visual and spatial awareness and proprioception.

FEEBIE ANSWER- POOR IMPULSE CONTROL ON THE RIGHT SIDE

Question 29

Left hemisphere of the brain function:

Answer 29

Language, math skills, analytical thinking.

Question 30

Complications related to a stroke:

Answer 30

Dysphasia (keep this patient NPO, eat on unaffected side, HOB elevated, avoid distractions, small bites, eat slow, CHIN TO CHEST TO FACILITATE SWALLOWING, HAVE SUCTIONING AT BEDSIDE)

Aspiration pneumonia

Communication impairements

Contractures

DVT

Unilateral neglect (loss of awareness of the side affected by the stroke)

Question 31

Homonymous hemianopsia and patient education:

Answer 31

Loss of the same visual field in both eyes. Instruct the patient to use a scanning technique (turning head from the direction of the unaffected side to the affected side) when eating and ambulating. Place personal supplies within reach on the unaffected side. DON’T NEGLECT OPPOSITE SIDE THATS IMPAIRED

Question 32

FREEBIES:

Answer 32

1. Muffled heart sounds- PERICARDIAL EFFUSION LEADING TO CARDIAC TAMPONADE
2. Warfarin lab to monitor for therapeutic effect- PT
3. Dilated cardiomyopathy- DISTENDED ventricles
4. Stroke patient R hemisphere- POOR IMPULSE CONTROL ON THE RIGHT SIDE
5. Acute MI meds for pain and anxiety- MORPHINE
6. Suspected cardiac tamponade diagnostic test to order first- ECHOCARDIOGRAM
7. Propranolol contraindication- ASTHMA
8. MI as the damage has been done correct nursing response for cardiac rehab- CARDIAC REHAB WILL NOT UNDO THE DAMAGE BUT IT WILL GET YOU CLOSE TO YOUR PREVIOUS LEVEL OF FUNCTION.