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Med Surg 2 > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

Describe how acute coronary syndrome starts

A

start with:
atherosclerosis
stable angina
unstable angina
heart attack (NSTEMI and STEMI)

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2
Q

What is stable angina?

A

chest pain with exercise or stress, but chest pain goes away with rest

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3
Q

What is unstable angina? What is the treatment?

A

chest pain with exercise or at rest, but increases with occurrence, severity, and duration

tx: nitroglycerin every 5 minutes for 3 doses

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4
Q

What is NSTEMI?

A

non-ST-segment elevation MI

least dangerous
no changes in EKG
decreased cardiac tissue, won’t see damage
decreased cardiac output (HR shows)

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5
Q

What is STEMI?

A

ST-segment elevation MI

emergency
EKG changes - ST elevation

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6
Q

What are the causes of acute coronary syndrome?

A

SODDA

S - stress, smoking, stims
O - obesity (BMI >25)
D - diabetes / HTN
D - diet (high cholest)
A - african male/ age (over50)

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7
Q

What are the clinical manifestations of acute coronary syndrome?

A

Pain - jaw, back, shoulder, heartburn, substernal “crushing”
SOB
N/V
Diaphoresis
Pale cool skin
Anxiety

starts w/ brady then goes to tachy
HTN

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8
Q

Who experiences silent MIs?

A

older white females

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9
Q

What are the diagnostic studies for acute coronary syndrome?

A

Troponin
CK-MB, myoglobin

Stress test
Echocardiogram
Coronary angiogram

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10
Q

Troponin

A

I or T : any + value indicates damage to cardiac tissue

High sensitivity cardiac troponin (HSCT) : important to measure during heart attack

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11
Q

What are the two types of stress test?

A
  1. exercise - treadmill
  2. pharmacologic - Lexiscan
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12
Q

Describe the pharmacologic stress test

A

radionuclide myocardial perfusion imaging

pt given Lexiscan if they are unable to run

shows which portion of the heart is having trouble perfusing

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13
Q

What is Lexiscan?

A

regadenoson

vasodilates the coronary arteries and induces cardiac hyperemia

increases cardiac output

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14
Q

What is an echocardiogram?

A

EKG
ultrasound of the heart
shows damage of heart attack and ejection fraction %

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15
Q

What is a coronary angiogram (cardiac catheterization)?

A

invasive procedure where a catheter is threaded into artery balloon inflates and stent is left = opening artery

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16
Q

What are people with stent given to take?

A

anticoagulants
- eliquis (apixaban)
- xarelto (rivaroxaban)

aspirin

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17
Q

What are therapeutic procedures for acute coronary syndrome?

A

angioplasty
stent
coronary artery bypass graft

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18
Q

What are the nursing interventions for a heart attack?

A
  • morphine, oxygen, nitro, aspirin (MONA)
  • semi or full-fowler
  • monitor VS and EKG
  • IV access
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19
Q

What should you ask a patient before giving nitroglycerin? Why?

A

if they are taking sexual enhancing drugs (sildenafil)

it can lead to shock

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20
Q

What medications are used after heart attacks?

A
  • morphine (pain and slow down breathing)
  • ACE inhibitors (-pril)
  • anticoagulants
  • antidysrhythmics
  • antilipemic
  • beta blockers (-lol)
  • Ca channel blockers (-dipine, -zem, - amil)
  • stool softener
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21
Q

What ACE inhibitor is given after heart attacks? Why?

What is an adverse effect when taking this? What is expected?

A

lisinopril (chill pril)
- first choice
- treats heart failure after attack

precaution: angioedema (STOP)
expected: cough

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22
Q

What antilipemic is given after heart attacks?

What is seen if the patient is taking the medication short term vs long term?

A

atorvastatin

decrease calcium absorption

short: joint pain, muscle pain
long: osteoporosis, decrease bone density

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23
Q

What beta blockers are given after heart attacks? Why?

What are precautions when taking this?

A

sedalol - antiarrhythmic
metoprolol - cardioselective

Lol = sLOws down HR and BP

Precautions: BBB
Bad for CHF
Bradycardia (<60)
Breathing - asthma

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24
Q

What calcium channel blockers are given after heart attacks? Why?

What is an adverse effect when taking this?

A

nifeDIPINE - declined BP and HR
diltiaZEM - zen yoga for heart
verapAMIL - chill heart

calms BP and HR from dysrhythmias after heart attack

adverse: BLE edema

25
Q

What stool softener is giving after heart attacks? Why?

A

docusate sodium
prevents from straining because the pt can bear down which results in decreased HR (valsalva maneuver)

26
Q

What are post heart attack complications?

A

DARTH VADER

Death
Arrhythmias (dysrhythmias)
Ruptures
Tamponade
Heart failure (Right vs Left Acute vs Chronic)

Valvular disease
Aneurysm
Dressler’s Syndrome
Embolism
Recurrence

27
Q

What are examples of dysrhythmias? What do they mean?

A

atrial fibrillation - ventricular tachycardia - ventricular fibrillation - asystole (death)

hearts last effort to save itself

28
Q

What is the treatment for ventricular fibrillation?

A

defibrillation

29
Q

What should a nurse ask a pt who has afib?

A

smoking hx

30
Q

What is a person at risk for who has afib?

A

cerebrovascular accident (CVA)

left atria can’t pump blood - clot can form - clot can cause embolic stroke

31
Q

What is the treatment of heart failure?

A

ACE inhibitors

32
Q

What is the difference between left and right sided heart failure?

A

HF = heart failure (heavy fluid)

Right
- ROCKS body with fluid
- peripheral edema

Left
- LUNG fluid
- pulmonary edema

33
Q

What is pericarditis? What causes it?

A

inflammation outside the heart - heart gets compressed and can’t pump

less cardiac OUTput = less oxygen OUT

causes: HAIR
- Heart attack
- Autoimmune disorders
- Infection
- Renal failure

34
Q

What are the clinical manifestations of pericarditis?

A
  • pericardial friction rub
  • pulsus paradoxus (> 10mmHg BP systolic drop while pt holds breath)
  • pleuritic chest pain (rib cage)
  • dyspnea
  • fever (>100.4)
35
Q

What diagnostic studies can be done for pericarditis?

What will the labs show?

A

ECG (ejection fraction)
Blood culture (infection in blood)
Throat culture (strep)
CXR, CT scan
Pericardiocentesis (drains fluid or blood in heart sac)

Labs:
- increased WBC (>10,000)
- increased troponin
- increased ESR and c-reactive protein (markers for inflammation)

36
Q

What indicates that a pericardiocentesis worked?

What should be monitored after?

A

increase in BP = increase in cardiac output

signs of pneumothorax

37
Q

What medications are used for pericarditis?

A

NSAIDS
Corticosteroid
Colchicine
Antibiotic

38
Q

What NSAID is given for pericarditis? Why?

A

indomethacin

decrease inflammation

39
Q

What corticosteroids are given for pericarditis? Why?

A

methylprednisolone
solumedrol
prednisone

treats inflammation

40
Q

What is colchicine? How is it used for pericarditis? What should be monitored?

A

plant poison used for gout

treats inflammation

monitor N/V and diarrhea

41
Q

What is endocarditis?

A

inflammation inside the heart, heart valves can’t fully close

infective = bacteria, mold on heart valves
noninfective = no bacteria, only inflammation

less cardiac output = less oxygen out

42
Q

What are causes of endocarditis?

A
  • dirty needles (IV drug abuse)
  • heart sx (prosthetic valves or CABG) bacteria easily comes
  • untreated strep throat
43
Q

How is endocarditis treated?

A

Antibiotics (blood culture first then broad spectrum antibiotics)

Valve repair or replacement

44
Q

What are the clinical manifestations for endocarditis?

A

fever
murmur (aortic/mitral valves)
tachycardia
Roth spots (eyes)
petechiae (capillary rupture)
splinter hemorrhages (nailbed)
Osler nodes (raised bumps fingers/toes)
Janeway lesions (bruises palms/soles)

45
Q

What are the diagnostic studies for endocarditis?

What will the lab show?

A

Blood culture
CXR
ECG
Cardiac catheterization

Lab:
Increased WBC, ESR, C-reactive protein

46
Q

What are the nursing interventions for endocarditis?

A

MOLD

Monitor for infection and s/s of stroke (neuro check)
Oral care
Let all providers know Hx of endocarditis
Dental tx: antibiotics prior to tx

47
Q

What is cardiomyopathy? What are the 3 types?

A

physical change in heart muscle that leads to decreased cardiac output = uncontrolled BP

dilated
restrictive
hypertrophic

48
Q

Describe dilated cardiomyopathy

A

distended (thinned) heart muscle

heart chamber can fill, but can’t push blood out

49
Q

What are the clinical manifestations of dilated cardiomyopathy?

A

Low oxygen
- restlessness
- dizzy
- SOB

Left sided HF (lung fluid)

50
Q

What medications are used to treat dilated cardiomyopathy?

A

ACE inhibitors (prils)
digoxin

51
Q

Describe hypertrophic cardiomyopathy

A

Huge trophy like heart muscle (enlarged)

obstruction to aortic outflow

heart can push, but no blood to push

52
Q

What are the clinical manifestations of hypertrophic cardiomyopathy?

A

Low oxygen
- restlessness
- syncope
- dyspnea
- fatigue (common)

Left sided HF (lung fluid)

53
Q

What medications are used to treat hypertrophic cardiomyopathy?

A

Beta blockers (lol)
- lower BP and slows heart down

Calcium channel blockers

54
Q

What are the nursing interventions for hypertrophic cardiomyopathy?

A

Syncope

avoid strenuous activity and dehydration (important!)
rest and elevate legs to improve venous return
avoid vasodilators

55
Q

Describe restrictive cardiomyopathy

A

rock hard heart muscles, stiffen

heart can fill but can’t contract

56
Q

What are the clinical manifestations of restrictive cardiomyopathy?

A

Low oxygen
- restlessness
- dyspnea
- syncope
- fatigue

Exercise intolerance
Left sided HF (lung fluid)

57
Q

What is the treatment for restrictive cardiomyopathy?

A

transplant list

58
Q

What should a client be educated on if they have cardiomyopathy?

A

DRESS

Diet (low sodium/fat)
Rest
Exercise (avoid strenuous)
Stop smoking/alc
Stress reduction

Med Surg 2 (7 decks)

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