Final Exam Cardiovascular

Question 1

Cardiac Enzymes (Cardiac Markers)

Answer 1

Are released into the bloodstream when the heart muscle suffers ischemia. They are a specific marking in diagnosing an MI. Indications include angina, MI, heart disease, and hyperlipidemia.

Question 2

Troponin T

Answer 2

Expected 0.2ng/L. Elevated levels are first detectable 3-5 hours after myocardial injury. They stay elevated for 14-21 days following injury.

Question 3

CK-MB

Answer 3

30-170 units/L. Elevated levels are first detectable 4-6 hours after myocardial injury and stay elevated for 3 days.

Question 4

Troponin I

Answer 4

Expected levels are 0.03ng/L. Elevated levels are detectable 3 hrs after injury and stay elevated for 7-10 days.

Question 5

Myoglobin

Answer 5

Expected <90mcg/L. Elevated levels are detectable 2 hours after injury and stay elevated for 24 hours.

Question 6

Cholesterol

Answer 6

Expected range is <200 mg/dL. Purpose is screening for heart disease.

Question 7

HDL

Answer 7

Expected range is >40mg/dL. This is the good cholesterol produced by the liver.

Question 8

LDL

Answer 8

Expected range is <130 mg/dL. This is the bad cholesterol (can be up to 70% of total cholesterol)

Question 9

Triglycerides

Answer 9

Expected range is <150mg/dL. Purpose is to evaluate for atherosclerosis.

Question 10

Echocardiogram

Answer 10

An ultrasound of the heart. The test is used to dx valve disorders and cardiomyopathy. It can be used to determine blood flow insufficiency, cardiac tissue damage, and valve disorders. It can also be used to measure the size and depth of the heart, ejection fraction, and cardiac output.

Question 11

Nursing Actions for Echocardiogram

Answer 11

Explain the reason for the test to pt. It is pain free and take up to an hour. Position pt on left side with the HOB elevated 15-20* and instruct them to remain still.

Question 12

Stress Test (Exercise Electrocardiography)

Answer 12

Verify that informed consent has been obtained. Pts are to fast 2-4 hrs before procedure, avoid alcohol, tobacco, and caffeine. Postop pts are monitored by EKG and BP checked frequently until they are stable.

Question 13

Angiography

Answer 13

AKA cardiac catheterization is used to evaluate the presence and degree of coronary artery blockage. Contrast media is used.

Question 14

Nursing Actions for Angiography

Answer 14

Verify consent. NPO for at least 8 hrs. Check for iodine/shellfish allergy. Educate pts that they can feel warm and flushed when the dye is inserted. Postop check VS q15min for an hour, q30min for an hour, and every hour after that. Check groin at same times for bleeding, hematoma, thrombosis, and document pedal pulse, color, and temperature. Maintain bedrest with HOB flat or 30-45*.

Question 15

Coronary Artery Disease

Answer 15

Impaired blood flow to the heart, with atherosclerotic plaque in the coronary arteries being the primary cause. It can lead to angina, acute coronary syndrome, mycoardial infarction, dysrhythmias, heart failure, and sudden death.

Question 16

Atherosclerosis

Answer 16

The vessel wall inflames (smoking, diabetes, obesity, increased lipid levels), the body sends out histamine and WBCs to fix the wall, scar tissue forms leaving a weakened wall and lipids stick to the vessel wall. Increased risk for anuerysms and clots.

Question 17

Interventions for CHD/CAD

Answer 17

Stop smoking and exercise (improves HDL and lowers LDL, reduces blood viscosity) Diet (reduce saturated fat, increase monosaturated and omega-3, vit 6, vit b12.

Question 18

Medications for Hyperlipidemia

Answer 18

Statins, Bile Acid Sequestrants, Nicotinic Acid, Fibronates

Question 19

Statins

Answer 19

Most common. First line. Work in the liver (give at night), can cause myopathy and increased liver enzymes. Assess CPK and muscle pain, dark urine. Assess for dig toxicity if pt on digoxin.

Question 20

Bile Acid Sequestrants

Answer 20

Work in the intestine. Used with combination therapy. Cause constipation. Mix powder with water or juice. Assess for GI bleeding. Increase fluid intake. These combine with cholesterol and remove it in the stool.

Question 21

Nicotinic Acid

Answer 21

Used as combination drug with statins. Give with meals due to GI upset. Caution with pts dx with gout, type 2 diabetes, peptic ulcer disease.

Question 22

Fibronates

Answer 22

Tx high triglycerides used with statins. May have rebound with decreasing effect in 2-3 months of tx. Take with meals. Use birth control. Report flu like symptoms. Monitor liver, renal, CMP, CBC and glucose

Question 23

Beta Blockers

Answer 23

First line tx in STABLE angina. Reduce the HR and contractility. Not used in pts with asthma, COPD, or Prinzmetals angina because it could worsen these

Question 24

Ca Channel Blockers

Answer 24

Reduce contractility, coronary vasodilators. Assess HR and hold if below 50. ASA is given to prevent thrombus formation due to the narrowing of coronary vessels. (if we block Ca then the heart cant contract as well)

Question 25

Left Sided Heart Failure

Answer 25

Results in inadequate left ventricle output and consequently in inadequate tissue perfusion. Left sided = Lung problems

Question 26

Right Sided Heart Failure

Answer 26

Results in inadequate right ventricle output and systemic venous congestion (peripheral edema)

Question 27

VS showing Decreased Cardiac Output

Answer 27

Decreased O2 sat, increased HR and BP initially and then decreased BP and increased RR