MED/SURG EXAM #1 Flashcards
Differentiate the anatomic location and function of the following structures of the heart: pericardial layers, atria, ventricles, and valves.
_______________
Objective #1
Pericardial layers:
Atria layers:
Ventricles:
Valves:
Stages of development in atherosclerosis
Chronic endothelial injury which leads to…
1) Fatty streak
2) Fibrous plaque
3) Complicated lesion
NOTE: when the patient becomes symptomatic, the disease process usually is well advanced
Relate the coronary circulation to the areas of heart muscle supplied by the major coronary arteries.
_____________
Objective #2
Differentiate the structure and function of arteries, veins, capillaries, and endothelium.
__________
Objective #3
Describe the mechanism involved in the regulation of blood pressure
_________
Objective #4
Relate the various waveforms on a normal electrocardiogram to the associated cardiac events
_________
Objective #5
Obtain significant subjective and objective assessment data related to the cardiovascular system from a patient and/or caregiver
________
Objective #6
Perform a physical assessment of the cardiovascular system using the appropriate techniques
___________
Objective #7
Differentiate normal from abnormal finding s of a physical assessment of the cardiovascular system
_______
Objective #8
Link the age-related changes of the cardiovascular system to the differences in assessment findings
________
Objective #9
Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the cardiovascular system
________
Objective #10
- Relate the pathophysiologic mechanisms associated with primary hypertension to the clinical manifestations and complications
- Select appropriate strategies for the prevention of primary hypertension
- Describe the interprofessional care for primary hypertension, including drug therapy and lifestyle modification.
- Explain the interprofessional care of the older adult with primary hypertension.
- Prioritize the nursing management of the patient with primary hypertension
- Describe the nursing and interprofessional care of a patient with a hypertensive crisis.
- Relate the etiology and pathophysiology of coronary artery disease (CAD) and acute coronary syndrome (ACS) to the clinical manifestations of each disorder.
- Describe the nursing role in the promotion of therapeutic lifestyle changes in patients at risk for CAD
- Differentiate the precipitating factors, clinical manifestations, interprofessional care, and nursing management of the patient with CAD and chronic stable angina
- Explain the clinical manifestations, diagnostic studies, complications, and interprofessional care of the patient with ACS
- Evaluate commonly used drug therapy in treating patients with CAD and ACS
- Prioritize key components to include in the rehabilitation of patients recovering from ACS and coronary revascularization procedures
- Differentiate the precipitating factors, clinical presentation, and interprofessional care of patients who are at risk for or have experienced sudden cardiac death.
- Compare the pathophysiology of systolic and diastolic heart failure (HF).
- Relate the compensatory mechanisms involved in HF to the development of acute decompensated heart failure (ADHF) and chronic HF.
- Select appropriate nursing and interprofessional care to manage the patient with ADHF.
- Select appropriate nursing and interprofessional care to manage the patient with HF.
- Describe the indications for heart transplantation and the nursing care of transplant recipients.
Verapamil:
Class
Adverse effects
What to monitor?
Class: Calcium Channel Blockers (CCB)
Adverse effects: atrial fibrillation
What to monitor?: NO GRAPEFRUIT JUICE
HCTZ:
Class
Adverse effects:
What to monitor?
Class: Thiazides (ends in -ides)
Adverse effects: Orthostatic hypotension, hypovolemia, HYPONa, HYPERglycemia
What to monitor?: decrease in K+ (leg cramps, fatigue, tachycardia), K+-rich foods (dark leafy greens)
Beta Adrenergic Blockers
Class
Adverse effects
What to monitor?
Class:
Adverse effects: masked HYPOglycemia effects (e.g. Metoprolol); Bradycardia
What to monitor?:
Teaching for a patient newly Dx’d with heart failure
— exercise
— watch changes in sleep patterns
— Check fluid volume for overload (HYPONa+ & NSAIDS can cause weight gain)
Purpose of taking Warfarin + what to monitor? + Antidote?
Prevent blood clots (anticoagulants)
— Labs: PT, INR
Antidote = Vitamin K
Purpose of taking Heparin + what to monitor? + Antidote?
Purpose: does NOT dissolve the clot, but prevents
— Labs: PTT
Antidote = Protamine Sulfate
Identify Iron (Fe) rich foods
— Nuts
— Dried fruits: apricots, raisins
— Legumes: lentils, mixed/baked beans, chickpeas
— Dark leafy greens: spinach, silver beet, broccoli
— Oats
— Tofu
— Fortified cereals, breads and pastas
— Red meat, pork, poultry
— Peas
How to read an ECG + determine interval durations
P-wave: atrial depolarization
PR segment:
QRS complex:
ST segment:
T-wave:
Troponins + difference b/w L/R-sided heart failure
Difference in a pacemaker when spiked at the Q/P
— When spiked @ the Q —> V-paced (ventricular)
— When spiked @ before the P-wave —> A-paced (atrial)
The purpose of determining capillary refill?
To determine arterial sufficiency
What are the shockable rhythms?
— Pulseless VTach
— VFIB
ABCs related to Cardiovascular
What is the proper treatment for the S/Sx’s of severe bradycardia?
ATROPINE
Dosage:
Interventions/Teaching when taking Nitroglycerine (NTG)
1 dose, wait 5 minutes. If doesn’t work, do another dose
Max dose: 3 within a 15 minute time period; If that doesn’t work, GO TO THE HOSPITAL!!
—If a patch, make sure to place on in the AM, and take OFF at night/bedtime (stays on for no more than 12-14 hours)
Teaching when taking Digoxin
DO NOT TAKE IF HR <60bpm
— HYPOkalemia
— Increase risk for Digoxin toxicity (0.8-2)
MEDS TO STUDY: Heparin, Lisinopril, Warfarin, NTG, Digoxin, Dobutamin, ASA, Atenolol, Aloe Vera
Herbals that impact someone with CAD
— Feverfew:
— Aloe vera
— Flax seed
Right-sided heart failure vs. Left-sided heart failure
RSHF:
LSHF:
Non-modifiable risk factors of coronary artery disease (CAD)
— age
— gender: 45+ for men, 55+ for women (highest incidence among white middle-aged men)
— ethnicity (women are more likely to die after 1st MI, but is most prevalent in black women)
— genetics: predisposed = key factor
Modifiable risks factors of coronary artery disease
LIPIDS:
— cholesterol >200mg/dL
— triglycerides >150mg/dL
— LDL cholesterol >130mg/dL (think: “lethal”; low down dirty shame)
— HDL cholesterol <40mg/dL (men), <50mg/dL (women) (think: “healthy”)
— DM
— Tobacco use
— Physical inactivity
— Obesity: weight circumference >102cm or >40 in (men), >88cm/>35in (women)
— Psychosocial risk factors (e.g. depression, hostility)
— HIGH homocysteine levels
— Substance abuse
Stage differences with hypertension
Normal: <120/80
PreHTN: 120-139/80-89
Stage 1: 140-159/90-99
Stage 2:>160/>100
Differences between systolic vs. diastolic pressure
Systolic (top #): pressure when the heart contracts blood to pump to the rest of the body
Diastolic (bottom #): pressure when the heart relaxes b/w beats
Amount of protein needed for someone with cardiac conditions
— 5-6oz/day
NG Question about difference between STABLE vs UNSTABLE angina
Differences between NSTEM vs. STEMI on the EKG
