Test 1 Flashcards
1
Q
What are these side effects of
- Hypotension
- Orthostatic hypotension
- drowisness
- N/V
- Dry cough
- HA
- Sexual dysfunction
A
antihyperlipidemic drugs
2
Q
What does nitroglycerin treat?
A
Angina (chest pain), perfuses cardiac tissue by dilating coronary arteries
3
Q
Side effect of transdermal
glycerin?
A
dizziness, headache, flushing
4
Q
how do you use sublingual nitroglycerin?
A
put it under the tongue every 5 minutes until angina disappears. (up to three tablets)
5
Q
What does does ST segmentation signify
A
Myocardial injury
6
Q
What cardiac enzyme is indicative of myocardial injury
A
Creatine Kinase-MB Fraction (CK-MB)
7
Q
Symptoms of Myocardial infarction
A
Dyspnea, pallor, Diaphoresis, Weakness, fatigue, nausea, vomitting, fever
8
Q
What are some nursing diagnosis related Myocardial Infarction
A
Pain related to imbalance between myocardial oxygen supply and demand (give Morphine Sulfate IV)
ineffective tissue perfusion (cardiac) related to blood flow interruption
Anxiety related to pain and fear
Activity intolerance related to imbalance between oxygen supply and demand
9
Q
What is amiodarone (cordarone) IV for
A
indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to other therapy
10
Q
What is lidocain IV used for
What are the side effects
A
management of ventricular arrhythmias
side effects: hypotension, drowsiness, seizures, bradycardia, and confusion
11
Q
What should be done after a Percutaneous transluminal Coronary Angioplasty done via femoral artery?
A
Immobolize the leg
12
Q
Chest pain with angina is a consequence of ?
A
severe ischemia secondary to increasing obstruction from plaque rupture and evolving thrombus (clot) formation in an atherosclerotic coronary vessel.
13
Q
block the effect of catecholamines and allow the heart to slow down. This decreases myocardial oxygen demand and provides for a longer diastolic phase.
What side effects does this medication have?
A
metoprolol or (atenolol), both beta-blocker
-bradycardia and decreased contractility; cardiac output would be further reduced.
14
Q
In continuing to prepare him for cardiac catheterization and possible percutaneous coronary intervention (PCI) you:
A
locate and mark his peripheral pulses
15
Q
what is effective against allergic reactions
A
Benadryl (diphenhydramine)
16
Q
What form should aspirin be when administering to MI patient?
A
non enteric coated aspirin
17
Q
decrease the oxygen needs of heart
A
Tenormin (atenolol)
18
Q
What should you watch out for when administering Tenormin atenolol
A
His heart rate may decrease
His blood pressure may decrease
19
Q
BMI less than 18.5
A
Under weight
20
Q
a BMI of 18.5-24.9.
A
normal weight
21
Q
a BMI of 25-29.9
A
overweight
22
Q
If a patient is experiencing a Myocardial infarction, will nitroglycerin alleviate the pain?
A
NO
23
Q
ST-segment depression is indicative of .
A
myocardial ischemia
24
Q
ST-segment elevation is indicative of
A
Myocardial tissue injury or infarction is
25
After obtaining a 12-lead ECG, the nurse notes tall peaked T waves and a wide QRS. The nurse is concerned with:
Electrolyte abnormalities
26
What is the primary pacemaker
| What is the rate range of this pacemaker
the Sinoatrial Node (SA node)
| rate range: 60-100
27
What is the secondary pacemaker
The atrioventricular Node (AV node)
| rate range: 40-60
28
What makes up the ventricular conduction system?
Bundle of His, Purkinje Fibers, Tertiary pacer (20-40)
29
how many seconds is 1 mm?
.04 seconds
30
what does the P wave represent
Depolarization of the atria, followed by atrial systole
31
what does the QRS wave represent?
Ventricular depolarization, followed by ventricular systole
32
What does the T wave represent?
ventricular repolarization followed and diastole
33
What are the two way to determine Heart rate by looking at ECG reading?
1) count the number of QRS's in 6 seconds, multiply by 10
2) count the number of small boxes for a R-R (time between beats or QRS's) and divide it into 1500 (number of small boxes in 60 seconds)
34
How do you measure a PR interval?
number of squares between the beginning of a "P" wave to the beginning of the QRS and multiply by .04
35
what is a normal PR interval?
0. 12- 0.20
| note: if longer than 0.20 seconds, it indicates atrioventricular heart block.
36
how do you measure a QRS interval?
number of squares from the end of a PR interval to the end of the S wave
37
what is the normal QRS interval?
| What does it mean if interval is longer than normal?
0. 06-0.10 seconds
| note: if longer than 0.10 seconds indicate bundle branch block
38
What do changes in T wave amplitude mean?
Electrolyte imbalance, myocardial infarction
39
What do peaked T waves indicate?
Hyperkalemia
40
where should the ST segment be?
On the isoelectric line
41
What does depression of ST segment mean?
Ischemia
42
What does elevation of ST segment mean?
myocardial injury
43
What is the normal QT interval?
| What does prolonged QT interval indicate?
.36-.44
| it indicates electrolyte imbalances or cardiac medication
44
What does prolonged QT intervals predispose patients too?
Torsades de pointes (ventricular tachycardia)
45
What are the two criteria for Tachycardia?
Heart rate is greater than 150/min and symptomatic
46
What are the nursing interventions for tachycardia?
- identify and treat underlying cause
| - keep patent airway, apply oxygen, monitor ox, apply cardiac monitor, monitor BP, IV access, obtain 12 lead ECG
47
Patient has tachycardia.
Is there hypotension, altered mental status, shock, chest pain, and syncope (passing out)?
Yes? what do you do
No? what do you do
Yes: Synchronized Cardioversion (or adenosine for regular, narrow complex tacharrhythmias
No: 12 lead ECG, IV access, consider adenosine, vagal maneuvers, beta blockers (heart will beat more slowly and with less force), calcium channel blockers, antiarrhythmics (amiodarone)
48
What is considered ACLS bradycardia?
HR less then 50 and sympotomatic
49
What are the nursing interventions for ACLS bradycardia?
identify and treat underlying causes
| maintain patent airway, apply oxygen, monitor pulse ox, apply cardiac monitor, monitor BP, IV access, obtain 12 lead ECG
50
Patient has ACLS bradycardia.
Is there hypotension, altered mental state, shock, chest pain, syncope?
Yes? what do you do
No? what do you do
Yes: give atropine. If ineffective start transcutaneous pacing and or dopamine, epinephrine infusion.
No: monitor and observe
51
U wave represents?
late ventricular repolarization. It is not normally seen in all leads. (Ignatavicius 714)
52
QT interval represents?
the total time required for ventricular depolarization and repolarization (Ignatavicius 714)
53
Is cardiac arrest with pulseless electrical activity (PEA)/asystole shockable or not shockable
It is not shockable.
54
What is the intervention for PEA/ asystole?
CPR cycles, IV/IO access, Epi every 3- 5 minutes, treat reversible causes, reassess for shockable rhythm, consider advanced airway/ medical futility
55
Is cardiac arrest with VT (pulseless)/VF shockable?
Yes
56
What is the intervention for VT/VF
| what medications would you consider using?
CPR cycles, IV/IO access, Epi every 3-5 min., shock when there is a shockable rhythm between CPR cycles
medications: Epinephrine, vasopressin, amiodarone
57
How long is a CPR cycle?
2 minutes
58
How many cycles of CPR should be done?
5 cycles
59
What does defibrillation do?
| Does it stop re-entry of circuits and allow SA node to take over?
Delivers electrical current to depolarize large area of myocardium
- Yes
note: remember defibrillation fixes problems having to do with problems of ventricles
60
What does cardioversion do?
Does it stop re-entry of circuits and allow SA node to take over?
What is it indicated for?
What mode must you set the machine to?
- synchronized shock delivered electively or emergently
- Yes
- atrial fibrillation, atrial flutter, tachydysrythmias
- synchronized mode
61
What needs more energy? Biphasic or monophasic waveform?
Monophasic...refquires 360 joules
| Biphasic requires 120- 200 joules
62
How do pacemakers work?
Do they maintain a reasonable heart rate to depolarize?
What kind of heart rate does a pacemaker usually correct?
Can a pacemaker pace the atrium, ventricle or both?
sends out electrical signal to cause the heart to depolarize
- Yes
- A slow heart rate
- Yes, both
63
are electronic pacemakers implanted or attached to a patient?
either implanted or attached
64
What are indications for a permanent pacemaker
atrial fibrillation
cardiac related syncope
sick sinus syndrome (malfunction of SA node)
Sinus bradycardia
Complete heart block (3rd degree AV block)
65
What does ICD stand for?
implantable cardiac defibrillator
66
Does an ICD reduce sudden cardiac death?
Yes
67
When will a ICD defibrillate?
During ventricular tachycardia
68
Includes stable angina, acute coronary
syndromes
Ischemia—insufficient oxygen supply to
meet requirements of myocardium
Infarction—necrosis or cell death that
occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissu
Coronary Artery Disease (CAD)
69
is reproducible and occurs during physical
exertion or emotional stress and can be relieved by resting or with nitroglycerin
Temporary imbalance between coronary
artery’s ability to supply oxygen and cardiac muscle’s demand for oxygen
Ischemia limited in duration and does not
cause permanent damage to myocardial tissue
Stable Angina
70
Is stable angina considered an Acute Corornary Syndrome?
No
71
Patients who present with:
◦ unstable angina or ◦acute myocardial infarction (STEMI or NSTEMI
Believed that atherosclerotic plaque in
coronary artery ruptures, resulting in platelet aggregation, thrombus formation or vasoconstriction
Acute Coronary Syndrome
72
occurs with minimal exertion or at rest and
increased doses of nitroglycerin are needed to relieve the pain.
ACS symptoms with or without ST-segment
elevation on the 12- lead
cardiac enzymes will NOT be elevated it is suggestive that plaque has ruptured in
the coronary artery, but did not occlude the artery to cause widespread cardiac ischemia.
Unstable Angina
73
Chest pain symptoms with elevated troponin
levels.
12 Lead EKG: ST-segment depression and T-
wave inversion.
The heart is experiencing more ischemia
as
evidenced by abnormal troponin levels
Non ST elevation MI
74
Chest Pain symptoms & elevated troponins 12 lead ECG with ST segment elevation Indicates occlusion of blood flow and
myocardial tissue injury
of all three layers of
the heart muscle
Requires immediate reperfusion: Fibrinolytics,
PCI, or surgical (CABG)
Time is Muscle!
ST elevation MI
75
What kind of assessment is the following:
12-lead electrocardiograms
Troponins: myocardial muscle protein
Creatine kinase-MB (CK-MB): Peaks late
Myoglobin: nonspecific
ACS Assessment
76
Is transcutaneous pacing considered invasive or non invasive
non invasive
77
```
Reduces sudden cardiac death
Ventricular tachycardia
Prophylactic for advanced stages of heart failure
Significantly decreases mortality rates
Delivers
```
ICD (Implantable Cardiac Defibrillator)
78
What is Toprol (metoprolol)used for?
| What are the side effects?
hypertension,Toprol is a beta-blocker and can lead to a decreased heart rate. Nurse should assess for syncopal episodes related to bradycardia
-Symptoms related to bradycardia may also include dizziness and weakness, confusion, hypotension, diaphoresis, shortness of breath, and chest pain.
79
Used to treat atrial fibrillation
Side effects include: rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; blurred or double vision and yellow vision; confusion; fast, slow, or irregular heartbeat; hallucinations; mood or mental changes; severe or persistent nausea, vomiting, or stomach pain; unusual bruising or bleeding; and unusual tiredness or weakness.
Digoxin, (Lanoxin)
80
What medication is used to treat SVT (sinus ventricular tachycardia)?
- Can it be repeated in 1-2 minutes?
- What are the side effects?
Adenosine (Adenocard):
- Yes
- short period of asystole is common after administration. Bradycardia and hypotension may also occur.
81
What is the preferred treatment for recurrent SVT?
Radiofrequency catheter ablation
radiofrequency energy (low-voltage, high-frequency electricity) is targeted toward the area(s) causing the abnormal heart rhythm, permanently damaging small areas of tissue with heat. The damaged tissue is no longer capable of generating or conducting electrical impulses. If the procedure is successful, this prevents the dysrhythmia from being generated, thereby curing the patient.
82
Patients with which type of dysrhythmia make up the largest group of those hospitalized with dysrhythmias?
Atrial fibrillation
83
What is used to increase cardiac output?
Digoxin, epinephrine, dopamine
84
Elevation in serum troponin levels is associated with?
acute myocardial injury and indicates a need for immediate interventions such as angioplasty, anticoagulant administration, or administration of fibrinolytic medications.
85
Normal troponin should be less than?
0.03 ng/mL.
86
What lab values will test for acute coronary syndrome (ACS)?
- Normal troponin should be less than 0.03 ng/mL.
| - Normal myoglobin should be less than 90 mcg/L.
87
What lab values will test for Coronary Artery Disease (CAD)?
- C-reactive protein should be less than 1 mg/dL; however, this tests for risk for coronary artery disease (CAD), not ACS.
- triglycerides should be less than 150 mg/dL; however, this tests for risk for CAD, not ACS.
- lipoprotein-a (Lp[a]) is 18 mg/dL; however, this tests for risk for CAD, not ACS.
88
What can infusing normal saline do in regard to cardiac out put?
It will restore normal fluid volume providing more volume, potentially increasing cardiac output and pressure within the atria and ventricles if they are too low.
89
the differences in symptoms of MI in men versus those in women are?
Women may have atypical symptoms, including absence of chest pain and extreme dizziness and fatigue.
90
Myocardial infarction can be further divided by what two groups?
STEMI
non-STEMI
note: myocardial infarction is a atherosclerosis in the coronary arteries
91
beta-blockers (lower BP) end with
ol
92
Ace inhibitors (lower BP) end with
il
93
calcium channel blockers (lower BP) end with
ine
94
Fibrinolytics: dissolve thrombi in coronary arteries
| what do the medications end with
anything that ends with -ase (tissue plasminogen activators)
you can also use (coumadin (warfarin), heparin)
