test bank Flashcards
S3 heart sounds are normal in who? (3 children)
normal in children and adults up to 30 or 40
CAD - with exercise has an increase in HR - means what?
Myocardial ischemia
The nurse is caring for an 82-year-old patient. The nurse knows that changes in cardiac structure and function occur in older adults. What is a normal change expected in the aging heart of an older adult? Just one thing (old, wide aorta)
widening of the aorta
connective tissue with age (this is collagen)
increases with age
increased CVP is (think water)
hypervolemia
The critical care nurse is caring for a patient who has had an MI. The nurse should expect to assist with establishing what hemodynamic monitoring procedure to assess the patients left ventricular function? (left gets pampers)
Pulmonary artery pressure monitoring (PAPM)
Central venous pressure (CVP) monitoring is left or right ventricle? (RIGHT in the center)
right
The nurse is caring for an acutely ill patient who has central venous pressure monitoring in place. What intervention should be included in the care plan of a patient with CVP in place?
Change the site dressing whenever it becomes visibly soiled. NOT ROM.
A patient is brought into the ED by family members who tell the nurse the patient grabbed his chest and complained of substernal chest pain. The care team recognizes the need to monitor the patients cardiac function closely while interventions are performed. What form of monitoring should the nurse anticipate?
Hardwire continuous ECG monitoring
The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?
NOT DIET. Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately
The nurse is relating the deficits in a patients synchronization of the atrial and ventricular events to his diagnosis. What are the physiologic characteristics of the nodal and Purkinje cells that provide this synchronization? Select all that apply.
automacticity, conductivity, and excitability
A lipid profile has been ordered for a patient who has been experiencing cardiac symptoms. When should a lipid profile be drawn in order to maximize the accuracy of results? (fat after 12)
After a 12-hour fast
When hemodynamic monitoring is ordered for a patient, a catheter is inserted into the appropriate blood vessel or heart chamber. When assessing a patient who has such a device in place, the nurse should check which of the following components? Select all that apply.
tranducer, a flush system, a pressure bag.
Pulmonary artery pressure monitoring (PAPM) is to assess which ventricle?
the left
all types of angina on ECG
transient T-wave inversion
STEMI - what is the pain like?
unrelenting pain
troponin - how soon is it detected after an MI?
MI, detected 3-4 hrs after onset of chest pain. normal 0 - .1
Door to Balloon time
< 90 minutes
Fibrinolytic: door to drug time (fiber after 30)
less than 30 min for STEMI patients
PCI (balloon angioplasty) pre-op care - how long to fast? And what about allergies?
Fasting/NPO for 6-12 hrs
-Baseline assessment: VS, O2 sat, Heart and lung sounds, neurovascular assessment of extremities.
Assess all distal pulse, mark them for indicator for post op care
Stop meds like Aspirin/blood thinners
Assess labs
Allergies; contrast dye
Pt education: flush feeling when dye injected; fluttering of heart
PCI post op care - check for signs of..
-Baseline assessment: compare to preprocedural; note hypotension or HTN; Signs of PE
What is a Holter monitor? (holt continously watches me)
Continuous cardiac monitoring portable device.
transthoracic echocardiogram - invasive or not?
non-invasive
A critical care nurse is caring for a patient with a hemodynamic monitoring system in place. For what complications should the nurse assess? Select all that apply.
pneumothorax, air embolism, and infection
weight gain - what is too much?
over 3 lbs in 1 day, or 5 lbs in 7 days
HF - is there chest pain?
usually NOT.
left-sided HF - #1 treatment (the body is drIED)
IDE ending drugs, furosemide, bume
HOPE (for HF)
head of bed, oxygen, push furosemide and morphine, ending all sodium and fluids
how to know if HF treatment is working?
clearer lungs and decreased HR
always question any dr order that
wants to give fluids, even IV maintanence fluids
what part of heart is damaged with left-sided HF?
the myocardium, usually an MI
sleep apnea causes right or left sided HF?
right
aldosterone (AL)
Adds sodium and water to the body
Lets potassium out of the body
Pril drugs (P for potassium)
spare potassium
Ejection fraction - what % is HF?
less than 40% is BAD
what machine to monitor HF?
hemodynamic monitor (swan) also called PAC (pulmonary artery catheter), measures central venous pressure. anything over 8 is not great
PAC measures what?
PAC (pulmonary artery catheter), measures central venous pressure. anything over 8 is not great
can you take OTCs if you have HF?
no, even ibprofen
if pt is in immediate HF, pink froth, do what?
IV drugs - butanmide or furosimide
drugs for HF - ABC DDD
ace inhibitors and arbs, beta blockers, calcium channel blockers, digoxin, dilators, diuretics
digoxin doesn’t do what?
decrease BP, only HR. SO it doesn’t cause orthostatic hypotension
ACE and ARBS only lower BP, so
we can give if HR is lower than 60
which drug does not cause orthostatic hypotension?
digoxin BC it doesn’t drop BP
3 conditions that result from acute coronary syndrome (ACS)
unstable angina, NSTEMI, STEMI
if heart attack, how fast will you see troponin in blood test?
within 6 hours
unstable angina ECG (depressing angina)
normal or transient ST depression
NSTEMI - which part of the heart? (nystemi in my ventricle)
inner layer of ventricular wall
NSTEMI - is there ST elevation?
NO. T wave inversion or ST depression or both.
STEMI
complete occulusion of blood flow
STEMI - ECG?
ST elevation
if you have ACS (angina, STEMI, NSTEMI), what meds?
same ones used for angina
what procedure is best for STEMI? (stemi gets a balloon)
PCI - percutaneous coronary intervention - the balloon
if PCI treatment is not available for STEMI, then what?
fibrinolytics
treatment for unstable angina or NSTEMI (no stemi gets angie in 24 hrs)
angiography within 24 to 48 hrs. (uncomplicated)
immediate angiography for complicated
what about fibrinolytics for angina and NSTEMI?
NO, NOT GOOD FOR THEM
acute decompensated HF - right or left side? (the left can’t even compensate)
left
PCI post op - how often to observe for bleeding? (very serious)
Complication
Observe for q 15min- 1 hr bleeding:
PCI post op - watch for
hypotension, tachycardia, hematoma.
Myocardial ischemia
Arterial occlusion- check distal pulse again.
AKI
PCI post op - bedrest for how long?
Bed Rest for 6 hr
Monitor ECG, chest pain, Intake/output
angina after PCI?
*There should be no angina s/p PCI, stent should provide 100% flow to coronary artery
cath lab with acute MI within
60 min
2nd degree (Mobitz type 1) heart block
longer, longer, longer drop, that is a winkebach
1st degree heart block
just a PR interval that is longer than .20 (or 5 small boxes)
type II - mobitz type 2
PR interval is constant, and then you drop a beat. It doesn’t keep getting longer.
3rd degree AV block
low low HR, brady
treatment for blocks
stop meds that are slowing it down- ie beta blockers.
if that doesn’t work, atropine, dopamine, epinephrine.
if that doesn’t work, pacemaker
An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?
Fewer QRS complexes than P waves
The nurse is caring for a patient who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurses assessment?
Vigilant monitoring of the patients ECG
who gets cardiac conduction treatment?
Atrial and ventricular tachycardias not responsive to other treatments
The nurse and the other members of the team are caring for a patient who converted to ventricular fibrillation (VF). The patient was defibrillated unsuccessfully and the patient remains in VF. According to national standards, the nurse should anticipate the administration of what medication?
Epinephrine 1 mg IV push
signs of heart block - COLLAPSED
chest pain, oxygen, low bp, lethargy, anxiety, palpitations, SOB, elevated HR, dizziness
ST depression - causes
hypokalemia, cardiac ischemia, and medications such as digitalis
STEMI - thrombolylic therapy - how fast? (throw bombs within 12 hours)
Thrombolytic therapy is within 12 hours from onset of pain/sx
PCI - pre op care - how long to fast?
Fasting/NPO for 6-12 hrs
-Baseline assessment: VS, O2 sat, Heart and lung sounds, neurovascular assessment of extremities.
Assess all distal pulse, mark them for indicator for post op care
Stop meds like Aspirin/blood thinners
Assess labs
Allergies; contrast dye
Pt education: flush feeling when dye injected; fluttering of heart
PCI - post op care
-Baseline assessment: compare to preprocedural; note hypotension or HTN; Sings of PE
Complication
Observe for q 15min- 1 hr bleeding: hypotension, tachycardia, hematoma.
Myocardial ischemia
Arterial occlusion- check distal pulse again.
AKI
Bed Rest for 6 hr
Monitor ECG, chest pain, Intake/output
*There should be no angina s/p PCI, stent should provide 100% flow to coronary artery
Variant or Prinzmetals:
***Variant angina (prinzmetal’s angina or atypical): Occurs at rest, caused by coronary artery vasospasm with or w/o CAD. Reversible ST segment elevation · Unrelieved by NGT or rest
· We treat with calcium channel blockers
· Associated with migraines
on ECG,
1-4 is left, the others are right coronary artery
5 lead - what intercostals?
2nd, 4th, and 8th intercostal spaces
phases of polarization
P4 (baseline)
Depolarization:
P0
Platea:
P2
Repolarization:
P3
what percent is blocked for claudation? (Claud only got 50%)
about 50% of the arterial lumen or 75% the cross-sectional area
what test can diaganose pericarditis? (Peri echos)
Echocardiography
Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? (mitral regurg is an SOB)
SOB
cardiac output = colorado sveet heart
CO = SV x HR
baroreceptors as we age?
decrease in sensitivity
CK-MB
this is a subtype of CK. It is more sensitive for finding heart damage from a heart attack. CK-MB rises 4 to 6 hours after a heart attack. goes back to normal in a day or 2, so not helpful if time has passed.
BNP detects what type of HF?
ventricular
homocysteine (homo will work around lipids)
detects CAD even when lipids are normal
wide QRS
hyperkalemia, vfib
12 lead (12 monkeys for 12 heart attacks)
differentiates between myocardial ischemia and infarction
magnetic or tomography is
radionucleotide
what test measures ejection fraction? (the ejact echos)
echocardiography
catheter - how often to assess?
assessed every 15 minutes for an hour, every 30 minutes for an hour, and then every hour for 4 hours until pulses are stable
AV carries to which bundle branch?
RBB
