Heart failure & MI

Question 1

Right sided HF
PERIPHERAL SYMPTOMS/REST OF THE BODY

Answer 1

‘DR. BED’
Distended Jugular vein
Retaining fluid (weight gain)
Big liver/spleen (hepatomegaly)
Edema: lower extremities, hands, ankles, sacrum
Distended abdome (ascites)
Elevated liver enzymes

Question 2

Left sided heart failure
Lung problems

Answer 2

‘DO CHAP’
Dyspnea
Orthopnea
Crackles (bibasilar)
Hemoptysis (pink/frothy sputum)
Anxiety
Pulmonary congestion (cough)

S3 heart sound (gallop)
Decreased urine output

Question 3

Cardiac enzymes in MI

Answer 3

-Myoglobin: 2-3 hrs following MI, lasts 24 hrs
-Creatinine Kinase: 3-6hrs following MI, lasts 2-3 days
-Troponin I: 2-3 hrs following MI, lasts 7-10 days
-Troponin T: 2-3 hrs following MI, lasts 10-14 days

Question 4

Steps to take when someone presents w/ MI

Answer 4

MONA
Morphine: decrease pain/anxiety
Oxygen
Nitroglycerine: decrease O2 demand, vasodilation improves blood flow
Aspirin: decreases clot formation

Question 5

Expected findings in Acute coronary syndrome

Answer 5

Findings: ischemia, high troponin, palpitations, loc.
-Lesions in the coronary arteries like atherosclerosis

Question 6

Post op care of pt who has had pacemaker insertion

Answer 6

Assess for hiccups (can indicate generator is pacing diaphragm)
-Inspect skin under electrodes for thermal burns
-Always carry ID
-Do not raise arm above shoulder 1-2 weeks (ATI)
6 weeks (harmon)
-Do not lift more than 10lb for 4 weeks (ATI)
-Never place items that generate magnetic filed (phone, strong magnets)

Question 7

Treatment for HF

Answer 7

Ace inhibitors (PRILS); vasodilator, lowers BP cause dry cough

-Beta blockers (LOLs); decreases work load, increases potassium levels

-Digoxin:check apical pulse, monitor for K+ levels
-CC blockers: relaxes vessels to lower BP

-Vasodilators (nitrates) dilates vessels to decrease pre/afterload

-Diuretics: potassium wasting (ide)
Potassium sparing ( spironolactone)