Quiz #3 Cardiac Flashcards
What to do for epistaxis
Can occur during hypertensive crisis
Priority is to administer IV to lower decrease BP by 20%
Blood pressure and ECG monitoring
Neurological assessment
What is heart healthy diet
Low sodium <2.3 g/day, low fat, low cholesterol, high fiber
DASH - high in fruit, high in vegetables, low fat dairy foods
Consume foods rich in calcium
Increase potassium consumption - apricots, bananas, tomatoes, potatoes
Teachings on hydrochlorothiazide
Diuretic
- take med first thing in the morning
- be sure med is taken by 1400 to prevent nocturia
- consume food high in K+
- take med with food if GI upset
- report significant weight loss, lightheadedness, dizziness, GI upset
Primary prevention for hypertension
Eat a heart healthy diet
Exercise
No smoking
Limit alcohol
Get enough sleep
Secondary prevention for hypertension
Obtain blood cholesterol levels
- this is aimed to screen at risk community members
- focus on further illness or injury
Tertiary prevention for hypertension
Anti hypertensive therapies
Ex: medication adherence programs
Walking program for those with hypertension
Adverse effects of digoxin toxicity
Hypokalemia —> can increase toxicity
Anorexia [usually the first sign]
N/V, diarrhea
Blurred vision and halo lights
Digoxin toxicity reversal agent
Digoxin immune fab (digibind) or DIGIFAB
Left side heart failure manifestations
Occurs due to inadequate tissue perfusion
- dyspnea
- pulmonary congestion (cough, crackles)
- frothy sputum
- S3 heart sound
- decreased o2
- altered LOC
- nocturia
Right sided heart failure manifestations
Systemic congestion due to fluid outside lungs
- dependent edema
- ascites
- anorexia, vomiting
- jugular vein distention
- weakness
- weight gain
- Fatigue
- hepatomegaly
Patient teaching for heart failure
Consume a diet low in sodium
Continue to take meds even if feeling better
Measure weight daily at the same time
- more than 2 lbs in a day or 5 lbs in a week
Report swelling of feet
Metabolic syndrome risk factors
Inactive
Obesity
Not having a proper diet
Triglycerides > 150 mg/dL
Low HDL
High fasting glucose level
Nitroglycerin
A vasodilator
Can be used to open up coronary artery in the heart
Helps deliver oxygen to heart muscle
- used for angina, which is chest pain occurs with decreased perfusion or atherosclerosis
Chronic stable angina
Precipitated by exertion or stress
Relieved by rest or nitroglycerin
Manifestations last less than 15 min
Not associated by nausea or, anxiety, diaphoresis
Chronic unstable angina
Occurs with exercise or at rest but increases in occurrence, severity, and duration over time
Risk factors for coronary artery disease
No modifiable
- age, gender, ethnicity
- family history
Modifiable
- increase serum lipids
- cholesterol > 200 mg/dL
- triglycerides > 150 mg/dL
- increase LDL decrease HDL
- hypertension
Others
-obesity, diabetes, metabolic syndrome, substance abuse tobacco use
Example of low cholesterol diet
Oats
Barely
Whole grain
Beans
Skim milk
Veggies
Pears and apples
Nitroglycerin tablet
Can be sublingual tab or spray
S for STABLE
S for STRESS induced
- will stop when activity stops
Nitroglycerin patch
U for UNSTABLE
U for UNPREDICTABLE
Take nitro before stressful activity
Can be used for first indication of chest pain
Client teaching for sublingual nitroglycerin (stable angina)
Take first tablet (let dissolve under tongue)
Call 911 if pain not relieved by first tablet, then take 2nd tablet
Make take up to 3 doses and must be 5 min apart
Store NTG away from light and heat source
Replace every six months
Take acetaminophen for headache
Adverse effects of simvastatin
Hepatotoxicity
- anorexia, N/V, jaundice
Myopathy
- muscle aches, pain, tenderness
Drinking grapefruit juice can lead to rhabdomyolysis which can further damage heart and kidneys
Propranolol adverse effects that need immediate action
Bradycardia (hold medication if HR is less than 60)
Orthostatic hypotension
Bronchoconstriction
Heart failure
Sexual dysfunction
Captopril
Drug of choice for hypertensive clients with heart failure
Vasodilator to help lower BP
Captopril adverse effects
C- Cough
A- Angioedema
P- pregnancy problems
T- taste changes
O- orthostatic hypotension (monitor BP for several hours after treatment)
P- proteinuria
R- rash
I- increased potassium
L- low neutrophil count
Captopril client teaching
TAKE ON AN EMPTY STOMACH (at least 1 hour before meals)
Stop taking diuretic 2-3 days before
NOTIFY HCP IF COUGH DEVELOPS
Monitor blood pressure and heart rate
Do not double up on doses
Do not stop medication abruptly (can get rebound hypertensive crisis—> stroke)
Change positions slowly
What to do if BP meds aren’t working
Maybe ask provider for different medication.
Stress test
Patient walks on treadmill, exercising the cardiac muscle
Provides info regarding workload of the heart
Test discontinued once heart reaches a certain rate
Nurse is monitoring a client who is undergoing exercise stress test. Which of the following assessment findings require most rapid action by the nurse?
Electrocardiographic changes indicating coronary ischemia (can be shown as newly inverted Twaves)
Cardiac catheterization
Also known as angiography
Used to evaluate presence and degree of coronary artery blockage
The groin is the most common site used inserted through femoral artery
Injection of contrast media
Cardiac catheterization post procedure
After procedure pressure will be held on access site
Extremity must be keep straight for a prescribed amount to prevent bleeding
Assess vital signs every 15 min x 4
ASSESS FOR BLEEDING AND HEMATOMA FORMATION AT THE INSERTION SITE
*THROMBOSIS (document pedal pulse, color, and temp)
Cardiac catheterization and what do we need to be concerned about
Bleeding and hematoma formation at insertion site
Assess for thrombosis (document pedal pulse, color, and temp)
Cardiac tamponade
- fluid in the pericardium (which is sac surrounding heart)
Artery dissection
- puncture on arterial wall
A nurse is reinforcing teaching with a client who has a prescription for simvastatin. Which of the following instructions should the nurse provide?
Take medication in evening hours
Normal cholesterol
Total cholesterol <200 mg/dL
LDL <100 mg/dL
HDL >60
For someone who had coronary artery bypass
**Low cholesterol
Low sodium, low fat
High fiber
Cholesterol and warfarin
Using garlic to help lower cholesterol can potentiate effects of warfarin
Warfarin adverse effects
Hemorrhage
-bruising, Petechiae, hematoma, and black tarry stools
Hepatitis
Toxicity
