Medsurg hesi 3 cardiac Flashcards
If a pharmacological stress test is prescribed, a medication such as ____ or ____ is given to stress the heart instead of walking on the treadmill
adenosine or dobutamine
before a cardiac stress test, the client should
fast for 2 hours (including caffeine)
involves special indwelling catheters, which provide information about blood volume and perfusion, fluid status, and how well the heart is pumping.
Hemodynamic monitoring
Hemodynamic monitoring involves special indwelling catheters, which provide information about blood volume and perfusion, fluid status, and
how well the heart is pumping
Hemodynamic monitoring: Arterial lines provide continuous information about
changes in blood pressure
Hemodynamic monitoring: Arterial lines permit the
withdrawal of samples of arterial blood
Hemodynamic monitoring: Arterial lines are not used for
IV fluid administration
Hemodynamic monitoring: The PA catheter is inserted into a large vein and threaded through the
right atria and ventricle into a branch of the pulmonary artery.
Hemodynamic monitoring: PA catheters have multiple lumens, ports, and components that allow for various hemodynamic measurements, blood sampling, and
infusion of IV fluids
CABG
coronary artery bypass graft
Hemodynamic monitoring: The intravascular volume in older adult clients is often reduced. Therefore, the nurse should anticipate
lower hemodynamic values, particularly if dehydration is a complication
Hemodynamic monitoring: Line insertion: position the client
supine or trendelenburg
hemodynamic pressure lines must be calibrated to read __ atmospheric pressure.
zero
Increased or decreased preload: Crackles in lungs
increase
Increased or decreased preload: JVD
increase
Increased or decreased preload: Hepatomegaly
increase
Increased or decreased preload: Peripheral edema
increase
Increased or decreased preload: Taut skin turgor
increase
Increased or decreased preload: Poor skin turgor
Decreased
Increased or decreased preload: Dry mucous membranes
Decreased
Increased or decreased AFTERload: Cool extremities
increase
Increased or decreased AFTERload: Weak peripheral pulses
increase
Increased or decreased AFTERload: Warm extremities
Decreased
Increased or decreased AFTERload: Bounding peripheral pulses
Decreased
Place the client in ___ position prior to recording hemodynamic values.
supine (Head of bed can be elevated 15° to 30°)
Hemodynamic monitoring: Administer vasopressors (___) for vasodilation secondary to sepsis
dopamine
Hemodynamic monitoring: Plaque or a clot can become dislodged during the procedure: Use __ for flushing system.
NS
also called a cardiac catheterization
coronary angiogram
an invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage
coronary angiogram (cardiac catheterization)
coronary angiogram (cardiac catheterization) is an invasive diagnostic procedure used to
evaluate the presence of coronary artery blockage
In addition to a heart assessment, Angiography also can be done on the lower extremities to determine
blood flow and areas of blockage
Angiography involves the insertion of a catheter into a ____ vessel and threading it into the right or left side of the heart
femoral (sometimes a brachial)
Angiography involves the insertion of a catheter into a femoral (sometimes a brachial) vessel and
threading it into the right or left side of the heart
coronary angiogram (cardiac catheterization): Coronary artery narrowings and/or occlusions are identified by the
injection of contrast media under fluoroscopy.
coronary angiogram (cardiac catheterization): after the procedure, position the leg
straight
coronary angiogram (cardiac catheterization): anesthesia
local anesthetic
coronary angiogram (cardiac catheterization): Pressure (a sandbag) can be placed on the incision to
prevent bleeding
can result from fluid accumulation in the pericardial sac
Cardiac tamponade
Cardiac tamponade: Manifestations include hypotension, jugular venous distention, muffled heart sounds, and
paradoxical pulse
paradoxical pulse
variance of 10 mm Hg or more in systolic blood pressure between expiration and inspiration
variance of 10 mm Hg or more in systolic blood pressure between expiration and inspiration
paradoxical pulse
coronary angiogram (cardiac catheterization): if after the procedure the patient has flank pain and hypotension, they may have ___ ___
Retroperitoneal Bleeding
Vascular Access: Using veins in the ___ is not appropriate for older adult clients.
hand
___ catheters are appropriate for any fluids due to rapid hemodilution
Central
Tunneled and implanted catheters require ___ removal.
surgical
Nontunneled percutaneous central catheter: Length of use
short term only
Peripherally inserted central catheter: Length of use
up to 1 year
PICC insertion: Apply an initial dressing of gauze and replace with a ____ dressing within 24 hr.
transparent
Tunneled central catheter: Length of use
long term
Tunneled central catheter: dressing
none is needed (the skin forms a barrier)
Vascular access: comprised of a small reservoir covered by a thick septum
implanted port
Implanted port: Access with a ___ (Huber) needle
noncoring
cordlike
Phlebitis
Nontunneled catheters require an intact ____ ___ (tunneled catheters do not)
sterile dressing
Phlebitis tx: discontinue IV and apply
warm compress
Catheter Thrombosis/Emboli: to flush it use a __ mL or larger syringe to avoid excess pressure per square inch (PSI) that could cause catheter fracture/rupture
10 ml
Infiltration is fluid leaking into surrounding subcutaneous tissue, and extravasation is unintentional infiltration of a
vesicant medication that causes tissue damage
Putting pressure on the vein just beyond the tip of the catheter should stop the IV flow. If
flow is not affected,
the fluid is probably going into the subcutaneous tissue
Do not use hand veins for ___ medication
vesicant
Have the client hold breath while the tubing is changed to avoid
air embolism
If the client has sudden shortness of breath, place in ____ on ___ side, give oxygen, and notify the provider (to trap and aspirate air).
Trendelenburg on left side
Vascular access: When removing the dressing, pull from
distal to proximal (to prevent dislodging of the catheter)
Apply a ___ monitor if the client is on a telemetry unit and/or needs continuous cardiac monitoring
Holter
a fault within the heart’s natural pacemaker due to some kind of obstruction in the electrical conduction system of the heart.
heart block
DYSRHYTHMIA: Bradycardia: medication: A____ and I_____
Atropine and isoproterenol
DYSRHYTHMIA: Atrial fibrillation, supraventricular tachycardia (SVT) or ventricular tachycardia with pulse: medications
Amiodarone, adenosine, and verapamil
DYSRHYTHMIA: A fib: Meds: A__ A___ and V___
Amiodarone, adenosine, and verapamil
DYSRHYTHMIA: supravent tacy: Meds: A__ A___ and V___
Amiodarone, adenosine, and verapamil
DYSRHYTHMIA: Ventricular tachy with pulse: meds: A__ A___ and V___
Amiodarone, adenosine, and verapamil
Which dysrhythmias are treated with defibrillation:
Ventricular tachy with no pulse and V fib
DYSRHYTHMIA: Ventricular tachy with no pulse and V fib: meds: A___ L___ E___
Amiodarone
lidocaine
epinephrine
the delivery of a direct countershock to the heart synchronized to the QRS complex.
Cardioversion
Cardioversion is the delivery of a direct countershock to the heart synchronized to the
QRS complex
the delivery of an unsynchronized, direct countershock to the heart
Defibrillation
Defibrillation is the delivery of an
unsynchronized, direct countershock to the heart
Defibrillation stops all
electrical activity of the heart, allowing the SA node to take over and reestablish a rhythm
Elective treatment of atrial dysrhythmias, supraventricular tachycardia, and ventricular tachycardia with a pulse
Cardioversion
for 4 to 6 weeks prior to cardioversion therapy, clients who have atrial fibrillation of unknown duration must receive
anticoagulation (to prevent dislodgement of thrombi)
____ is held for 48 hr prior to elective cardioversion.
Digoxin
___ is indicated for cardiac asystole or other pulseless rhythms
CPR
Defibrillate the client immediately for ____
V fib
Cardioversion can dislodge blood clots, potentially causing
embolism
Decreased cardiac output and heart failure: Provide medications to increase output (____ agents)
inotropic
Complications of Cardioversion
embolism
heart failure
It is used only in emergency resuscitation of a client who does not have pacing wires inserted.
External (transcutaneous) pacemaker
Pacemaker leads are attached directly to the heart during open-heart surgery
Epicardial pacemaker
Epicardial pacemaker: Wires run externally through the chest incision and may be attached to an
external impulse generator if needed
pacemaker that’s commonly used during and immediately following open-heart surgery.
Epicardial pacemaker
Pacing wires are threaded through a large central vein (subclavian, jugular, or femoral) and lodged into the wall of the right ventricle (ventricular pacing), right atrium (atrial pacing), or both chambers (dual chamber pacing)
Endocardial (transvenous)
Pacemaker modes: Fixed rate (asynchronous) – Fires at a constant rate without
regard for the heart’s electrical activity
Pacemaker modes: Demand mode (synchronous) – Detects the heart’s electrical impulses and fires at a preset rate only
if
the heart’s intrinsic rate is below a certain level
Temporary pacemaker: after the procedure the client is not permitted to
shower (the box must stay dry)
The pacemaker battery will last about __ years
10
ECG: Assess the client for ___, which may indicate that the generator is pacing the diaphragm
hiccups
Wear ___ when handling pacemaker leads
gloves
Insulate pacemaker terminals and leads with nonconductive material when not in use
(i.e. ___ ___).
rubber gloves
____ pacemakers are used only in a controlled facility with telemetry for continuous ECG monitoring
Temporary
Notify the provider if heart rate is less than ___ ___ ___ the pacemaker rate.
five beats below
pacemaker orders for sexual activity
Resume sexual activity as desired, avoiding positions that put stress on the incision site
Never place items that generate a ____ field directly over the pacemaker generator.
magnetic
Pacemakers: some dx tests, like ___ might be contraindicated
MRI
Causes of pacemaker malfunction include insufficient pacemaker settings, lead wire placement and function, battery function, myocardial damage, and
electrolyte imbalance.
Pacer spikes should be adequate in number and occur
directly before P or QRS complexes.
Pacer spikes that occur on the _ ___ can cause life-threatening arrhythmias
T wave
Pace maker: Unintended electrical stimulation of chest muscles results in hiccups and muscle twitching and may lead to ___ ____
cardiac tamponade
Atherectomy – used to break up and remove
plaques within cardiac vessels
placement of a mesh-wire device to hold an artery open and prevent restenosis
stent
involves inflating a balloon to dilate the arterial lumen and the adhering plaque, thus widening the arterial lumen.
angioplasty,
the goal of angioplasty
widen the artery (using a balloon)
angioplasty can include
the use of a stent
PCI (which includes angioplasty, stent, atherectomy) is most effective when performed
within 90 minutes of chest pain
PCI (which includes angioplasty, stent, atherectomy) may be used as an alternative to
CABG
Before PCI, administer premedications as prescribed (____ medications)
antiplatelet
a short hollow tube placed inside the artery or vein at the insertion site
The catheter sheath
After angioplasty, the catheter sheath may be left in for access, so that
the angioplasty may be repeated, if needed (for restenosis or perforation).
Client who had a stent placement receives anticoagulation therapy for
6 to 8 weeks
Client who had a PCI: A___ D___
Artery dissection
Artery dissection can be a complication of
PCI
Perforation of an artery by the catheter may cause cardiac tamponade or require emergency bypass surgery
Artery dissection
Cardiac tamponade: Administer IV fluids to manage
hypotension
post PCI: External bleeding at the insertion site: position the leg
straight
Retroperitoneal bleeding after PCI: assess for ___ and ___ pain
hypotension and flank pain
CABG does not alter the ____ process
atherosclerotic
CABG is most effective when a client has sufficient ____ function
ventricular
Post CABG: Instruct the client to ___ the ___ when coughing and deep breathing
splint the incision
Medications frequently discontinued for CABG: ____ 2 to 3 days before surgery
Diuretics
amiodarone
antidysrhythmic
diltiazem
CCB
Before CABG: clients who have diabetes and are insulin-dependent usually receive
half the regular insulin dose
CABG: A cardioplegic solution is used to
stop the heart
Post CABG: Assist the client to a chair within
24 hours
Post CABG: Ambulate the client 25 to 100 ft by
first postoperative day.
Post CABG: Monitor chest tube drainage: Volume exceeding ___ mL/hr could be a sign of possible hemorrhage and should be
reported to the surgeon.
150
Post CABG: Anginal pain often radiates and is unaffected by
breathing
Post CABG: Walking one block or climbing two flights of stairs symptom-free generally indicates that
it is safe for the client to resume normal sexual activity.
Hypothermia can cause metabolic
acidosis
Hypothermia tx: Administer ____ if prescribed.
vasodilators
Post CABG: Assure the client that ____ing is common following surgery.
shivering
cardiac tamponade tx: Pericardiocentesis is avoided because
blood may have clotted
peripheral Bypass graft surgery aims to restore adequate blood flow to the
areas affected by peripheral artery disease.
If peripheral bypass surgery fails to restore circulation, the client may need to undergo
amputation of the limb
after peripheral bypass surgery: Throbbing pain is experienced due to
an increase in blood flow to extremity
after peripheral bypass surgery: Ischemic pain is often difficult to relieve with
opioid administration
after peripheral bypass surgery: to prevent reocclusion administer
anticoagulants (warfarin, heparin, etc)
after peripheral bypass surgery: Maintain bed rest for
18 to 24 hr
after peripheral bypass surgery: Discourage the client from ___ for long periods of time.
sitting for long periods of time.
after peripheral bypass surgery: Apply antiembolic stockings to
promote venous return.
after peripheral bypass surgery: Assess for worsening pain, swelling, and tense or taut skin. This could indicate
compartment syndrome
The continuum from angina to myocardial infarction (MI) is termed
acute coronary syndrome
Research shows improved outcomes following an MI in clients treated with aspirin, ___ __, and ___ ___
beta blockers and ace inhibitors
angina that occurs with exercise or emotional stress
stable
stable angina is best relieved by
nitro
angina is due to a coronary artery spasm, often occurring during periods of rest.
variant
Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates an MI from
angina
Ischemia is ____. An infarction results in ____ damage.
reversible
permanent
_______ MIs are more common in older adults, women, and clients who have diabetes mellitus.
non-Q-wave MI
MI is relieve by ___ medications
opioid
Angina symptoms last less than
15 min
Associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis
MI
enzymes released with cardiac muscle injury: Earliest marker of injury to cardiac or skeletal muscle
Myoglobin
enzymes released with cardiac muscle injury: Levels no longer evident after 24 hr.
Myoglobin
enzymes released with cardiac muscle injury: Any positive value indicates damage to cardiac tissue and should be reported
Troponin I or T
ECG findings that indicate ischemia
ST depression or T wave inversion
ST-segment elevation indicates
injury
abnormal Q-wave indicates
necrosis
Also known as exercise electrocardiography
stress test
Radioisotopes cannot reach areas with decreased or absent perfusion, and the areas appear as “cold spots.”
Thallium scan
MI patient: cluster nursing interventions to
conserve the patient’s energy
_____ is a common side effect of nitro
headache
Remind the client to notify the provider immediately if shortness of breath, edema, weight gain, or cough occur. What med is this?
beta blocker
Thrombolytic agents: For best results, give within _ hr of infarction.
6
Thrombolytic agent contraindication: h/o
CVA
____ prevents vasoconstriction. Due to this and antiplatelet effects, it should be administered with nitroglycerin at the onset of chest pain.
aspirin
taking aspirin: Tell the client to report
ringing in the ears.
Heart failure: administration of vasopressors and/or positive inotropes to
increase cardiac output and to maintain organ perfusion
Heart failure: administration of morphine, diuretics, and/or nitroglycerin to
decrease preload
Ischemic mitral regurgitation – evidenced by development of a new ___ ___
cardiac murmur
An inferior wall MI may lead to an injury to the AV node, resulting in bradycardia and
second-degree AV heart block
An anterior wall MI may lead to an injury to the ventricle, resulting in premature ventricular contractions, bundle branch, or
complete heart block
