MISC Flashcards
1
Q
What is heart failure (HF)?
A
HF is a clinical syndrome that occurs when the heart is unable to pump enough blood to meet the body’s needs.
It can arise from systolic dysfunction or diastolic dysfunction and is often chronic and progressive.
2
Q
What are the primary causes of heart failure?
A
Direct damage to the heart.
Precipitating causes increase the workload of the ventricles.
3
Q
List common risk factors for heart failure.
A
- Hypertension
- Coronary artery disease (CAD)
- Valve disease
- Cardiotoxicity
- Genetic predisposition
- Increasing age
- Post-inflammatory processes (e.g., COVID-19)
4
Q
What is the difference between systolic heart failure (HFrEF) and diastolic heart failure (HFpEF)?
A
HFrEF involves weakened heart muscle with reduced ejection fraction; HFpEF involves stiff heart muscle with preserved ejection fraction.
HFrEF is caused by impaired contractility, while HFpEF is associated with left ventricular hypertrophy.
5
Q
What is mixed heart failure?
A
Involves both systolic and diastolic dysfunction, often seen in dilated cardiomyopathy with poor EFs and high pulmonary pressures.
6
Q
What are compensatory mechanisms in heart failure?
A
- Activation of the sympathetic nervous system (SNS)
- Neurohormonal responses
- Ventricular remodeling
- Dilation
- Hypertrophy
7
Q
What are common clinical manifestations of acute pulmonary edema?
A
- Anxiety
- Pale and cyanotic skin
- Dyspnea
- Orthopnea
- Cough with frothy blood-tinged sputum
- Crackles
- Wheezes
- Hypotension or hypertension
8
Q
What general symptoms are associated with chronic heart failure?
A
- Fatigue
- Limitation of activities
- Chest congestion/cough
- Edema
- Shortness of breath
- Dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Tachycardia
9
Q
What should be monitored in nursing assessments for heart failure?
A
- Skin color and temperature
- Edema
- Respiratory rate and sounds
- Frothy sputum
- Heart rate and sounds
- Abdominal distention
- Changes in level of consciousness
- Serum electrolytes, BUN, creatinine
- Liver function tests
- NT-proBNP or BNP
- Chest x-ray
- Echocardiogram
- ECG
- O2 saturation
10
Q
What are complications of heart failure?
A
- Pleural effusion
- Dysrhythmias
- Left ventricular thrombus
- Hepatomegaly
- Renal failure
- Thromboembolism
- Cardiogenic shock
- Pericardial effusion
- Cardiac tamponade
- Pulmonary embolism
11
Q
What role do ACE inhibitors play in heart failure management?
A
They provide vasodilation, diuresis, and decreased afterload; monitor for hypotension, hyperkalemia, and renal function changes.
12
Q
Fill in the blank: The NYHA Functional Classification Class II indicates symptoms with _______ but comfortable at rest.
A
ordinary activity
13
Q
What is the purpose of patient self-checks in heart failure management?
A
To monitor for symptoms such as dry hacking cough, worsening shortness of breath, increased swelling, sudden weight gain, and trouble sleeping.
14
Q
What are important nursing interventions for managing fluid volume excess in heart failure?
A
- Assess for fluid overload
- Monitor daily weights
- Monitor intake and output
- Administer diuretics
- Implement fluid and sodium restrictions
15
Q
What is the expected outcome of interventions for heart failure?
A
To manage symptoms, prevent complications, and improve quality of life.
16
Q
True or False: Heart failure is always a reversible condition.
A
False
17
Q
What is angina pectoris?
A
A syndrome characterized by episodes of pain or pressure in the anterior chest caused by insufficient coronary blood flow
Common symptom of coronary artery disease (CAD) triggered when the heart’s demand for oxygen exceeds the supply.
18
Q
What is the primary cause of angina?
A
Myocardial ischemia due to a reduction in blood flow to the heart muscle, most often caused by atherosclerosis
Atherosclerosis is the accumulation of lipid deposits and fibrous tissue within arterial walls.
19
Q
What are the common triggers of angina?
A
Physical exertion or emotional stress
Triggers increase myocardial oxygen demand, which narrowed coronary vessels cannot meet.
20
Q
How is angina typically described?
A
Tightness, choking, or heavy sensation in the chest, often retrosternal
Pain may radiate to the neck, jaw, shoulders, back, or arms, usually the left.
21
Q
What are the types of angina?
A
- Stable Angina
- Unstable Angina
22
Q
What characterizes Stable Angina?
A
Predictable episodes of chest pain with a consistent pattern and relief with rest or nitroglycerin (NTG)
Pain frequency, severity, duration, and precipitating factors remain consistent.
23
Q
What characterizes Unstable Angina?
A
Increased frequency and severity of chest pain not relieved by rest or NTG, requiring medical intervention
It indicates coronary ischemia but does not show evidence of acute myocardial infarction (MI) on ECG.
24
Q
What is a key nursing diagnosis for patients with angina?
A
Risk for decreased cardiac tissue perfusion
Other diagnoses include anxiety related to cardiac symptoms and deficient knowledge about the disease.
25
What is the primary goal of angina treatment?
To decrease myocardial oxygen demand and increase oxygen supply
## Footnote
Treatment may involve medications and controlling risk factors.
26
What medications are commonly used to treat angina?
* Nitroglycerin
* Beta-adrenergic blocking agents
* Calcium channel blocking agents
* Antiplatelet and anticoagulant medications
27
What should patients do when experiencing angina?
Stop all activity and rest in a semi-Fowler's position
## Footnote
Vital signs should be assessed, and medications like NTG may be administered.
28
What are the key manifestations of a myocardial infarction (MI)?
* Chest pain
* Shortness of breath (SOB)
* Indigestion
* Nausea
* Anxiety
* Skin changes
* Changes in vital signs
29
How does the chest pain in an MI differ from that in stable angina?
MI pain is severe, occurs suddenly, and is not relieved by rest or nitroglycerin
## Footnote
It may be described as tightness, choking, or a heavy sensation.
30
What is the acronym MONA used for?
Immediate treatment priorities for MI: Morphine, Oxygen, Nitrates, Aspirin
31
What does VOMIT summarize?
Important interventions for MI: Vitals, Oxygen, Monitor, IV access, Time to decision
32
Fill in the blank: The drug for heparin overdose is _______.
Protamine sulfate
33
What are atypical symptoms of CAD that may occur in women?
Women may experience less typical symptoms, which can include fatigue or weakness rather than classic chest pain
## Footnote
Atypical symptoms can lead to misdiagnosis.
34
What are conditions associated with MI?
* Acute pulmonary edema
* Heart failure
* Cardiogenic shock
* Dysrhythmias and cardiac arrest
* Pericardial effusion and cardiac tamponade
35
What is a significant consideration for older adults regarding angina symptoms?
Older adults may have diminished pain perception and may experience 'silent' CAD
## Footnote
They need to recognize 'chest pain-like' symptoms, such as weakness.
36
What is sinus tachycardia?
Sinus tachycardia occurs when the sinoatrial (SA) node discharges at a rate of 101 to 200 beats per minute.
37
List some causes of sinus tachycardia.
* Exercise
* Fever
* Pain
* Hypotension
* Hypovolemia
* Anemia
* Hypoxia
* Hypoglycemia
* Myocardial ischemia
* Heart failure
* Hyperthyroidism
* Anxiety
* Fear
38
What medications can increase heart rate leading to sinus tachycardia?
* Epinephrine
* Norepinephrine
* Atropine
* Caffeine
* Theophylline
* Hydralazine
* Pseudoephedrine
39
What are common manifestations of sinus tachycardia?
* Dizziness
* Dyspnea
* Hypotension
* Angina (in CAD patients)
40
What is the primary treatment approach for sinus tachycardia?
Treatment is guided by the underlying cause, such as treating pain, and may include vagal maneuvers and beta-adrenergic blockers.
41
What is sinus bradycardia?
Sinus bradycardia occurs when the SA node fires at a rate less than 60 beats per minute.
42
List some causes of sinus bradycardia.
* Normal physiological response (e.g., athletes, sleep)
* Vagal stimulation (e.g., carotid sinus massage)
* Medications (e.g., beta-adrenergic blockers)
* Hypothyroidism
* Increased intracranial pressure
* Hypoglycemia
* Inferior myocardial infarction
43
What are common symptoms of sinus bradycardia?
* Hypotension
* Pale, cool skin
* Weakness
* Angina
* Dizziness or syncope
* Confusion or disorientation
* Shortness of breath
44
What is the treatment for sinus bradycardia?
Treatment may include atropine, a pacemaker if severe, or stopping offending medications.
45
What does NYHA stand for in heart failure classification?
NYHA stands for New York Heart Association.
46
How is heart failure classified according to the NYHA?
* Class I: No symptoms with regular activity
* Class II: Symptoms with activity, comfortable at rest
* Class III: Symptoms with minor activity, comfortable at rest
* Class IV: Symptoms at rest and with any activity
47
What is the difference between systolic and diastolic heart failure?
* Systolic HF: Inability to pump blood forward, often with decreased left ventricular ejection fraction (EF)
* Diastolic HF: Impaired ability to relax and fill, often with preserved EF
48
What are the manifestations of left-sided heart failure?
* Pulmonary congestion
* Crackles
* S3 heart sound
* Dyspnea on exertion
* Low oxygen saturation
* Dry, nonproductive cough
* Oliguria
49
What are the manifestations of right-sided heart failure?
* Viscera and peripheral congestion
* Jugular venous distention (JVD)
* Dependent edema
* Hepatomegaly
* Ascites
* Weight gain
50
What is the classification of heart failure stages?
* Stage A: High risk for HF, no structural heart disease
* Stage B: Structural heart disease, no symptoms
* Stage C: Structural heart disease with symptoms
* Stage D: Refractory HF
51
What characterizes hypertrophic cardiomyopathy?
Hypertrophic cardiomyopathy is characterized by increased muscle mass and cardiac wall thickness.
52
What are the consequences of hypertrophic cardiomyopathy?
* Poor contractility
* Increased oxygen needs
* Poor coronary artery circulation
* Increased risk for ventricular dysrhythmias
53
What characterizes dilated cardiomyopathy (DCM)?
Dilated cardiomyopathy is characterized by enlargement of the heart chambers.
54
What are the key differences between hypertrophic and dilated cardiomyopathy?
* Hypertrophic: Increased muscle mass, poor contractility, systolic heart failure
* Dilated: Enlargement of chambers, poor filling and emptying, mixed heart failure
55
What is the normal range for INR in a patient on warfarin?
INR = 2.0-3.0
56
What are the primary manifestations of left-sided heart failure?
* Pulmonary congestion, crackles
* S3 or 'ventricular gallop'
* Dyspnea on exertion (DOE)
* Low O2 saturation
* Dry, nonproductive cough initially
* Oliguria
## Footnote
Left-sided heart failure primarily results in pulmonary symptoms due to fluid buildup in the lungs.
57
What are the primary manifestations of right-sided heart failure?
* Viscera and peripheral congestion
* Jugular venous distention (JVD)
* Dependent edema
* Hepatomegaly
* Ascites
* Weight gain
## Footnote
Right-sided heart failure primarily results in systemic symptoms due to fluid buildup in organs and tissues throughout the body.
58
True or False: Heart failure can present with mixed symptoms of both left- and right-sided failure.
True
## Footnote
Both left- and right-sided heart failure can lead to low blood pressure, low cardiac output, and poor renal perfusion.
59
What should be monitored for immediately following the insertion of a permanent pacemaker?
* ECG monitoring for malfunction
* Insertion site for bleeding and infection
* Complications such as infection, hematoma, pneumothorax
* Vital signs frequently
* Pain assessment
## Footnote
Monitoring is crucial to ensure proper function and to detect any complications early.
60
Fill in the blank: A primary goal for patients with CAD is to control _______.
[cholesterol]
61
What dietary recommendations should be followed for managing elevated cholesterol levels?
* Low-fat diet
* High-fiber diet
* Fresh fruits and vegetables
## Footnote
These dietary measures are crucial for controlling cholesterol levels and preventing coronary artery disease (CAD).
62
What lifestyle modifications are important for a patient with a history of atherosclerosis?
* Regular physical activity
* Weight reduction
* Smoking cessation
* Moderate alcohol consumption
* Caffeine in moderation
## Footnote
These modifications help manage cholesterol and reduce CAD risk.
63
What is a compensatory pause in the context of premature ventricular contractions (PVCs)?
A pause following a PVC before the next normal beat, allowing the heart to reset.
## Footnote
This pause disrupts normal rhythm and causes irregularity in the pulse.
64
What is a pulse deficit?
The difference between the apical and radial pulse rates.
## Footnote
A pulse deficit occurs because some PVCs may not generate a peripheral pulse, leading to a lower radial pulse rate.
65
What are the potential effects of PVCs on pulse intensity?
* Irregular rhythm
* Variable intensity
* Potential for tachycardia or bradycardia
## Footnote
The intensity may vary due to inadequate ventricular filling and weakened contractions.
66
What should the nurse assess in a patient experiencing lightheadedness with PVCs?
* Hemodynamic status
* Other manifestations such as hypotension
* Monitor for more serious dysrhythmias
## Footnote
Lightheadedness in a patient with PVCs may indicate decreased cardiac output.
67
What does the P wave on an EKG represent?
Atrial depolarization
## Footnote
Depolarization is the electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell.
68
What is the normal appearance of a P wave on an EKG?
Typically the first deflection, positive (upward) waveform, upright in Lead II
## Footnote
The P wave should also have a normal shape and duration.
69
What does the P wave precede in an EKG?
Each QRS complex
## Footnote
The QRS complex represents ventricular depolarization.
70
What might a distorted P wave indicate?
An ectopic signal starting in the atria
## Footnote
This can occur rather than the sinoatrial (SA) node initiating the signal.
71
True or False: Depolarization refers to the return of the cell to its resting state.
False
## Footnote
Depolarization is the electrical activation of a cell, while repolarization is the return to the resting state.
72
What does ST segment depression indicate?
Myocardial ischemia
## Footnote
It signifies that heart muscle cells receive less oxygen than needed.
73
What is the significance of ST segment depression being at least 1 mm below the isoelectric line?
It is significant for indicating myocardial ischemia
## Footnote
This level of depression suggests a reduced oxygen supply to the heart.
74
What should a nurse do if a patient has ST segment depression after a PTCA?
Notify the provider immediately
## Footnote
This change could indicate a complication requiring prompt intervention.
75
What vital signs should a nurse assess in a patient with ST segment depression?
Heart rate, blood pressure, oxygen saturation, respiratory rate
## Footnote
These assessments can indicate decreased cardiac output due to ischemia.
76
Fill in the blank: ST segment depression may resolve if adequate _______ is restored to the myocardium.
[blood flow]
77
What are some signs of decreased cardiac output to assess for?
Dizziness, lightheadedness, confusion, altered level of consciousness
## Footnote
These can indicate poor perfusion and potential complications.
78
What additional assessments should be conducted for a patient with ST depression?
Check peripheral pulses, evaluate for bleeding, assess tissue perfusion
## Footnote
This includes monitoring skin color, temperature, and capillary refill.
79
What is the importance of prompt action in response to ST segment depression?
Prevents progression to acute coronary syndrome (ACS), myocardial infarction (MI), or dysrhythmias
## Footnote
Quick intervention can address potential serious conditions.
80
What interventions may be ordered by a provider for a patient with ST segment depression?
Repeat ECG, blood tests for cardiac markers, administer oxygen, medications
## Footnote
Medications may include nitroglycerin, beta-adrenergic blockers, and anticoagulants.
81
What is the primary action of aspirin for a client with a history of myocardial infarction (MI)?
Inhibit platelet aggregation
## Footnote
Aspirin acts primarily as an antiplatelet medication, reducing the ability of platelets to clump together.
82
How does aspirin help prevent thrombus formation in patients with MI?
By inhibiting platelet aggregation
## Footnote
Thrombus formation typically occurs due to the rupture of atherosclerotic plaque within a coronary artery.
83
What are the cardiovascular events that aspirin reduces the risk of?
* Another myocardial infarction (MI)
* Stroke
* Other thrombotic complications
## Footnote
Aspirin's antiplatelet action is crucial for preventing these events.
84
What is included in the 'MONA' protocol for initial treatment of acute coronary syndrome (ACS)?
* Morphine
* Oxygen
* Nitrates
* Aspirin
## Footnote
Aspirin is a standard medication used in the treatment of ACS.
85
True or False: Aspirin increases the risk of bleeding.
True
## Footnote
Patients taking aspirin should be educated on precautions to prevent bleeding.
86
What are the ECG findings characteristic of atrial fibrillation (AFib)?
* Irregular rhythm
* Absence of P waves
* Narrow QRS complex
* Variable ventricular rate
## Footnote
AFib is characterized by a rapid and highly irregular rhythm.
87
What clinical manifestations may indicate atrial fibrillation?
* Palpitations
* Shortness of breath
* Dizziness/syncope
* Fatigue
* Chest pain
* Pulmonary edema
* Asymptomatic
## Footnote
Some patients with AFib may be asymptomatic.
88
What can cause a decrease in cardiac output in atrial fibrillation?
Ineffective atrial contractions
## Footnote
Blood pooling in the atria increases the risk of stroke and leads to ineffective ventricular contractions.
89
What nursing intervention should be taken immediately if new-onset AFib is detected?
Notify the provider
## Footnote
Immediate notification is crucial for patient management.
90
What medication is administered for symptomatic bradycardia after cardiopulmonary arrest?
Atropine
## Footnote
Atropine is used to increase the heart rate in cases of symptomatic bradycardia.
91
What symptoms characterize symptomatic bradycardia?
* Hypotension
* Pale, cool skin
* Weakness
* Angina
* Dizziness
* Syncope
* Confusion
* Shortness of breath
## Footnote
These symptoms arise when the heart rate is slower than 60 bpm.
92
What is the purpose of a pacemaker in the context of bradycardia?
To regulate the heart rate by delivering electrical impulses
## Footnote
A pacemaker may be necessary if atropine is ineffective or if bradycardia is persistent.
93
Fill in the blank: Atrial fibrillation can lead to an increased risk of _______ due to thrombus formation.
Stroke
## Footnote
The disorganized electrical signals in AFib increase the risk of stroke.
94
What should be assessed in a patient with suspected atrial fibrillation?
* Auscultation of the apical pulse
* Blood pressure
* Oxygen saturation
## Footnote
These assessments help determine the hemodynamic status of the patient.
95
What are other medications used in the treatment of cardiac arrest besides atropine?
* Epinephrine
* Vasopressin
## Footnote
These medications are used to restore cardiac electrical activity.
96
What is a transthoracic echocardiogram (TTE)?
The most common type of echocardiogram, involving placing a transducer on the chest to obtain images of the heart.
97
What is a transesophageal echocardiogram (TEE)?
A more invasive echocardiogram that involves inserting a probe with a transducer down the esophagus for detailed images.
98
What is the purpose of a stress echocardiogram?
To assess how well the heart functions under stress, either through exercise or medication.
99
What preparations are required for a TEE?
The patient must not eat or drink for 6 hours prior to the test and will receive a sedative via IV.
100
What key information can an echocardiogram provide?
It can measure ejection fraction, provide details about cardiac structures, and detect heart valve abnormalities.
101
What is ejection fraction (EF)?
The percentage of blood ejected from the left ventricle with each heartbeat.
102
After a TTE, when can a patient resume normal activities?
Immediately.
103
What should a patient do after a TEE?
Be monitored before being discharged and should not drive or operate machinery for the rest of the day.
104
What is the purpose of an exercise stress test?
To evaluate heart function during increased oxygen demand, mimicking physical exertion.
105
What is the most common method for performing an exercise stress test?
Walking on a treadmill with gradually increasing intensity.
106
What should patients avoid before an exercise stress test?
Heavy meals; a light meal is advisable but avoid large meals within a few hours before the test.
107
What is a pharmacologic stress test?
An alternative to exercise stress tests where medications are given to mimic the effects of exercise.
108
What should patients wear for an exercise stress test?
Comfortable clothing and supportive athletic shoes.
109
What should patients do if they experience symptoms during an exercise stress test?
Report any symptoms such as chest pain, dizziness, or severe shortness of breath.
110
What is the key function of an implantable cardioverter defibrillator (ICD)?
To monitor heart rhythm and deliver a shock if a dangerous dysrhythmia is detected.
111
What components make up an ICD?
* Lead system
* Battery-powered generator
* Sensing system
112
What should patients do if their ICD delivers a shock?
Sit down and rest; if they feel unwell or if it fires multiple times, contact emergency services.
113
What activity restrictions should patients with an ICD follow?
Limit arm and shoulder activity on the ICD side and avoid direct blows to the ICD site.
114
Can patients with an ICD use microwaves?
Yes, they can use microwave ovens safely.
115
What should patients with an ICD do regarding medical alert identification?
Wear a medical alert ID or bracelet and carry an ICD identification card.
116
What lifestyle changes should patients with an ICD adopt?
* Follow a heart-healthy diet
* Engage in regular exercise
* Avoid tobacco products
117
True or False: Patients with an ICD should avoid MRI unless approved.
True.
118
What should caregivers of patients with an ICD learn?
CPR.
119
What emotional considerations should be discussed with ICD patients?
Fear of body image changes, fear of recurrent dysrhythmias, and anxiety about going home.
120
What is the target heart rate formula for exercise stress tests?
220 minus the patient's age, then multiply by 0.75.
121
What kind of monitoring occurs during an exercise stress test?
Continuous ECG monitoring, blood pressure, and vital signs.
122
What should patients report to their healthcare provider after an ICD implantation?
Changes in pulse, sudden weight gain, and symptoms like shortness of breath, swelling, or chest pain.
123
What laboratory tests should the nurse anticipate for a patient with chest pressure and shortness of breath?
Laboratory tests to assess cardiac damage, inflammation, and contributing factors
## Footnote
Key tests include cardiac biomarkers, blood chemistry, hematology, liver function tests, and lipid profile.
124
What are cardiac biomarkers essential for?
Detecting myocardial injury
## Footnote
Key markers include troponin, creatine kinase (CK), and myoglobin.
125
What does an elevated troponin level indicate?
Damage to the heart muscle
126
Which laboratory test is used to assess renal function in heart failure patients?
BUN and Creatinine
127
What does a Complete Blood Count (CBC) help identify?
Anemia, infection, or inflammation
128
What is the significance of a Lipid Profile in patients with chest pain?
Evaluates risk factors for coronary artery disease (CAD)
129
What are NT-proBNP and BNP used for?
Assessing the presence and severity of heart failure
130
What does high-sensitivity CRP (hs-CRP) indicate?
Increased risk of cardiovascular disease
131
What lab results should be prioritized for a client with heart failure?
Serum electrolytes, BUN and creatinine, NT-proBNP or BNP, cardiac enzymes, liver function tests
132
What is a major risk associated with heparin therapy in a client with AFib?
Bleeding
133
What laboratory value is monitored to ensure therapeutic heparin levels?
Activated Partial Thromboplastin Time (aPTT)
134
What are the signs of bleeding to assess for in a client on heparin?
Gums, nosebleeds, bruising, gastrointestinal bleeding, hematuria
135
What is the priority intervention for a client in ventricular fibrillation?
Immediate Cardiopulmonary Resuscitation (CPR)
136
What is the recommended treatment for pulseless ventricular fibrillation?
Rapid Defibrillation
137
What should be done immediately after delivering the first shock in defibrillation?
Resume CPR
138
What may be necessary for airway management during ACLS?
Intubation
139
What medications may be administered during a cardiac arrest scenario?
Epinephrine and vasopressin
140
True or False: Ventricular fibrillation is a non-life-threatening dysrhythmia.
False
141
Fill in the blank: Elevated levels of _______ have been linked to increased risk of cardiovascular disease.
Homocysteine
