Med Surg Exam 3 Flashcards
1
Q
What does ischemia mean?
A
reduced blood flow
2
Q
What does infarction mean?
A
blood flow is blocked completely
3
Q
What doe HONESST hearts mean?
A
HONESST Hearts are
Healthy Hearts
H-Heritage
O-Obesity
N-Nicotine
E-Exercise (Lack of)
S- Systolic blood
pressure
S-Sugar
T-
Triglycerides/Cholester
ol
RISK FACTORS FOR CORONARY
ARTERY DISEASE (CAD)
4
Q
What are four modifiable risk factors for artery diseases?
A
cholesterol abnormalities,
tobacco use, HTN, and
diabetes
5
Q
What should our LDL be?
A
less than 100
6
Q
What diet do people with cardiovasc disease eat?
A
Mediteranean diet
7
Q
How much exercise should we get?
A
30 minutes a day, 5 days a week
8
Q
What intesnity exercise should we get?
A
moderate intesnity
can talk, can’t sing
9
Q
How do we prevent CAD?
A
control cholesterol
diet measures
physical activity
medications
cessation of tobacco
manage HTN
control diabetes
10
Q
When are -statin meds indicated?
A
Indicated for coronary disease despite cholesterol levels.
11
Q
What are adverse effects of -statins?
A
leg cramps
myalgias
liver issues
12
Q
What is stable angina?
A
predictable and consistent pain that occurs on exertion
relieved by rest/nitroglycerin
13
Q
What is untstable angina?
A
increase infrequency and severity;may not be relived with rest or NTG
14
Q
What is intractable or refractory angina?
A
severe chest pain
15
Q
What is variant angina?
A
pain at rest with reversible ST-segment elevation
caused by coronary artery vasospasm
16
Q
What is silent ischemia?
A
evidence of ischemia(ECG chagnes with stress), but no pain
17
Q
How often can you give NTG?
A
5 under the tongue
3 times
18
Q
What are antiplatelets used for?
what structure?
A
arteries
19
Q
What are anticoagulants used for?
What structure?
A
veins
20
Q
What 3 labs are pertinent to the heart (for MI)
A
troponin
creatine kinase
myoglobin
(all 3 go up)
21
Q
What is the most cardiac specific lab?
A
troponin
22
Q
How long before cardiac labs are positive?
A
6 hours
23
Q
What are the interventiosn for a pt with MI?
A
supplement O2
NTG
morphine
apsirin
beta blocker
angiotensin converting enzyme within 24 hrs
anticoagulant (platelet inhibitor/ heparin)
statin
(MONA BASH)
24
Q
What are the treatment guidelines for MI?
Different from the big list (nitro, O2 etc.)
A
rapid transit to the hospital (not private)
obtain 12 lead ECG in 10 min
obtain blood specimens
obtain other diagnostics
25
How much aspirin for MI?
325mg chew
26
What is shock?
body is getting poor tissue perfusion
27
Why would we administer norepinephrine? (for cardiac)
To increase BP
28
What vessels may be used in a CABG?
saphenous vein
internal mammory
29
Which of the following is the primary pacemaker for the
myocardium?
A. Atrioventricular junction
B. Bundle of His
C. Purkinje fi bers
D. Sinoatrial node
D.
30
What is atherosclerosis?
Atherosclerosis is the abnormal
accumulation of lipid deposits and
fibrous tissue within arterial walls
and lumen
31
The nurse is caring for a patient who has severe chest pain
after working outside on a hot day and is brought to the
emergency center. The nurse administers nitroglycerin to help
alleviate chest pain. Which side effect should concern the
nurse the most?
A. Dry mucous membranes
B. Heart rate of 88 bpm
C. Blood pressure of 86/58 mm Hg
D. Complaints of headache
C
32
What is depolarization?
Depolarization: electrical activation of cell caused by
infl ux of sodium into cell while potassium exits cell
33
What is reploarization?
Repolarization: return of cell to resting state caused
by reentry of potassium into cell while sodium exits
34
What is the effective refractory period?
Eff ective refractory period: phase in which cells are
incapable of depolarizing
35
What is the relative refractory period?
Relative refractory period: phase in which cells require
stronger-than-normal stimulus to depolarize
36
What is the formula for CO?
SV x HR = CO
37
What is cardiac output?
amount of blood pumped by ventricle
38
What is stroke volume?
Stroke volume (SV): amount of blood ejected with
each heartbeat
39
What is preload?
Preload: degree of stretch of cardiac muscle fi bers at end of
diastole
40
What is afterload?
Afterload: resistance to ejection of blood from ventricle
41
What is contractibility?
Contractility: ability of cardiac muscle to shorten in
response to electrical impulse
42
What controls heart rate?
Autonomic nervous system, baroreceptors
43
Which of the following best defi nes stroke volume?
A. The amount of blood ejected with each heartbeat
B. Amount of blood pumped by the ventricle in liters
per minute
C. Degree of stretch of the cardiac muscle fi bers at the
end of diastole
D. Ability of the cardiac muscle to shorten in response
to an electrical impulse
QUESTION #2
A. The amount of blood ejected with each heartbeat
Rationale: Stroke volume is the amount of blood ejected
with each heartbeat. Cardiac output is the amount of
blood pumped by the ventricle in liters per minute.
Preload is the degree of stretch of the cardiac muscle
fi bers at the end of diastole. Contractility is the ability
of the cardiac muscle to shorten in response to an
electrical impulse.
ANSWER TO QUESTION #2
44
What are common s/s of cardiovascular problems?
Chest pain/discomfort
Pain/discomfort in other areas of the upper body
SOB/dyspnea
Peripheral edema, weight gain, abdominal distention
Palpitations
Unusual fatigue, dizziness, syncope, change in LOC
45
What do you assess for cardiac problems?
| think about pts body
General appearance
Skin and extremities
Pulse pressure
Blood pressure; orthostatic changes
Arterial pulses
Jugular venous pulsations
Heart inspection, palpation, auscultation
Assessment of other systems
46
What is an exercise stress test?
Patient walks on treadmill with intensity progressing
according to protocols
ECG, V/S, symptoms monitored
Terminated when target HR is achieved
47
What is a pharmacological stress test?
Vasodilating agents given to mimic exercise
CARDIAC STRESS TESTING
48
What is echocardiography used for?
* Measure the ejection fraction
* Examine the size, shape, and motion of cardiac structures
49
What is a heart cath used for?
Invasive procedure used to diagnose structural and
functional diseases of the heart and great vessels
50
What interventions are used for a heart cath?
* Observe cath site for bleeding, hematoma
* Assess peripheral pulses
* Evaluate temperature, color, and capillary refi ll of
* aff ected extremity
* Screen for arrhythmias
* Maintain bed rest 2 to 6 hours
* Instruct patient to report chest pain, bleeding
* Monitor for contrast-induced nephropathy
* Ensure patient safety
51
Central venous pressure (CVP) is a measurement of the
pressure in which area of the heart?
A. Left ventricle
B. Vena cava or right atrium
C. Pulmonary artery
D. Left atrium
B. Vena cava or right atrium
Rationale: CVP is a measurement of the pressure in the
vena cava or right atrium. The pressure in the vena
cava, right atrium, and right ventricle is equal at the
end of diastole; thus, the CVP also refl ects the fi lling
pressure of the right ventricle (pre-load). The normal
CVP is 2 to 6 mm Hg.
52
The nurse is preparing a male patient to have a 12-lead ECG
performed. When prepping the skin the nurse notices that the
patient has abundant chest hair. What is the most appropriate
nursing intervention to improve adhesion of the ECG leads?
A. Use alcohol swabs to clean the skin before applying the
leads
B. Clip the chest hair with the patient’s permission before
applying the leads
C. Apply the leads to the arms and legs only
D. Reschedule the ECG
QUESTION #1
B. Clip the chest hair with the patient’s permission before
applying the leads
Rationale: Clipping the patient’s hair would provide access to
the skin to assist with adhesion. Alcohol should not be used to
prep the skin because it increases the skin’s electrical
impedance, thereby hindering the detection of the cardiac
electrical signal. The ECG would not be performed correctly if
the leads were only placed on the extremities, and there is no
need to reschedule the ECG at this time
ANSWER TO QUESTION #1
53
What are parameters for sinus tachycardia?
* Ventricular and atrial rate >100 but less than 120
* Always has a P wave before the QRS
* PR Interval is constant
54
What type of dysrhythmia is this?
* Ventricular and Atrial rate: 60-100
* Irregular
* QRS Shape is usually normal, but may be regularly abnormal.
* P wave-normal, always before the QRS
* PR interval is constant
* No significant hemodynamic
* affects and generally not treated
sinus arrhythmias
55
What type of arrhythmia is this?
Ventricular and Atrial rate:
<60 bpm
Regular Rhythm
QRS: Usually normal
P wave: Normal
PR Interval: Constant
Same as NSR, except for
RATE
Sinus bradycardia
56
What type of dysrhthmia is this?
Irregular rhythm
QRS follows each p wave
An early/different P wave may be
seen
If <6 per minute, generally not
treated.
premature atrial contractions
57
What type of dysrhythmia does this represent?
Atrial tissue is asynchronous
with ventricular.
Rhythm: Irregular.
Atrial rate 300-600. Ventricular
rate is usually 120-200 in
untreated cases.
PR interval CANNOT be
obtained
atrial fibrillation
58
What dysrhythmia do these symptoms represent?
Atrial rate: 250-400
Vent rate: 75-150
P waves: saw tooth,
cannot calculate PR
interval
atrial flutter "saw tooth"
59
What are parameters for PVC?
Impulse that starts in the
ventricle
Can occur in healthy people
R/T Caffeine, alcohol, nicotine
Electrolyte imbalances, digitalis
toxicity, acidosis, hypoxia
“Wide & Bizarre”
60
What is this dysrhythmia?
Most common pulseless cardiac dysrhythmia
* Ventricular rate is >300 min
* Irregular
* Patient is unresponsive, rhythm not
sustainable with life: They are dead
* EVERY minute in delay of defibrillation, the
survival rate decreases by 7-10%
v-fib
61
The nurse is assessing a patient admitted with a heart block.
When placed on a monitor, the patient’s electrical rhythm
displays as progressively longer PR durations until there is a
nonconducted P wave. Which type of heart block does the
nurse expect that this patient has?
A. First-degree
B. Second-degree, type 1
C. Second-degree, type 2
D. Third-degree
B. Second-degree, type 1
Rationale: In second-degree, type 1 AV block, the PR interval
becomes longer with each succeeding ECG complex until
there is a P wave not followed by a QRS. The changes in the
PR interval are repeated between each “dropped” QRS,
creating a pattern in the irregular PR interval measurements.
In first-degree heart block, the PR is constant but greater than
0.20 seconds. Second-degree AV block, type 2 has a constant
PR interval and the presence of more P waves than QRS
complexes. Third-degree AV block presents with irregular PR
intervals.
ANSWER TO QUESTION #2
62
How do you use a defibrillator?
Ensure good contact between
skin, pads, and paddles
Use conductive medium, 20 to
25 pounds of pressure
Place paddles so they do not
touch bedding or clothing and
are not near medication
patches or oxygen flow
If cardioverting, turn
synchronizer on
If defibrillating, turn
synchronizer off
Do not charge device until
ready to shock
Call “clear” three times; follow
checks required for clear
Ensure no one is in contact
with patient, bed, or equipment
63
What is cardioversion?
Synched with QRS
Sedation ?
Generally initiated at
50-100 joules
MUST be in synch
mode!
64
What is defibrillation?
V. Fib and Pulseless V.
Tach
Emergency
No pulse!
Biphasic defibrillator
started at 120 Joules
Monophasic: 360
Joules
No longer stack shocks
NOT in synch mode!
| Stops hearts abnormal rythm
65
What is a pacemaker?
Electronic device that
provides electrical
stimuli to heart muscle
Types
Permanent
Temporary
66
What are indications for a pacemaker?
Symptomatic
bradycardia
Complete heart block
Sick sinus syndrome
Sinus arrest
Asystole
Atrial
tachydysrhythmias
67
What are indications for an ICD?
Ventricular
tachydysrhythmias
MI with left ventricular
dysfunction
INDICATIONS FOR
PACEMAKER/ICD PLACEMENT
68
What are complications of a pacemaker?
Infection
Bleeding or hematoma
formation
Dislocation of lead
Skeletal muscle or
phrenic nerve
stimulation
Cardiac tamponade
Pacemaker
malfunction
69
What is an ICD?
Device that detects and
terminates life-
threatening episodes of
tachycardia and
fibrillation
70
What medication can be used for Bradycardia (any rhythm
less than 60 bpm)?
Atropine; Dopamine or
epinephrine infusion if
unresponsive to atropine
71
What electrical management can be used for bradycardia?
Pacemaker
72
What are medications that treat Atrial Fibrillation
Supraventricular
Tachycardia
Ventricular Tachycardia
with a pulse?
Amiodarone; adenosine,
and verapamil
73
What does nitro do?
primarily dilate veins
lesser extent; the arteries
74
What are beta blockers mostly used for?
Reduction of myocardial oxygen consumption by blocking beta-adrenergic stimulation of the heart
75
What are calcium channel blockers used for?
Negative inotropic effects; indicated in patients not responsive to beta-blockers; used as primary treatment for vasospasm
76
What are antiplatelet meds used for?
Prevention of platelet aggregation
77
What are anticoagulant meds used for?
Prevention of thrombus formation
78
Can echocardiograms see coronary arteries?
No
79
What does a-fib put you at risk for?
stroke
80
T or F, you can have caffeine or beta blockers before a stress test
False
81
What drug is used during a stress test?
lexiscan
82
What is inserted into a large vein, and threaded through the right atria and ventricle into the branch of the PA?
pulmonary artery catheter
83
Where does a PA catheter end?
the pulmonary artery
84
Where does a central line end?
right atrium
85
What are indications for a PA catheter?
HF
post CABG
ARDS
86
What is pre load for the right side of the heart?
central venous pressure
87
What is pre load for the left side of the heart?
pulmonary artery pressure
88
What is afterload for the right side of the heart?
pulmonary vascular pressure
89
What is afterload for the left side of the heart?
systemic vascular resistance
