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Complex Care > Week 6 THURS > Flashcards

Week 6 THURS Flashcards

Adult Cardiac

1
Q

What equipment should you call to get for someone who is slumped on the floor?

A

AED

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2
Q

What medication is the drug of choice for sinus bradycardia?

A

Atropine

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3
Q

Pt reports fatigue, shoulder blade discomfort, and SOB. What can the nurse suspect off of theses symptoms?

A

Myocardial infarction

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4
Q

Pt has angina pectoris, what does the nurse include for managing this condition?

A
  • balance rest w/ activity
  • stop smoking
  • carry nitro at all times
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5
Q

A pt is receiving nitroglycerin, what statement indicates therapeutic effect?

A

“My chest pain is decreasing”

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6
Q

The nurse knows a pt is having an MI after what lab result?

A

elevated troponin level

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7
Q

What assessment findings indicate possible bleeding or recurrent dissection?

A

Low BP and high HR
- BP: 82/40 and HR: 125bpm

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8
Q

Cardiac marker diagnostic labs

A
  • CK
  • troponin
  • CRP> inflammation marker
  • BNP> heart failure marker
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9
Q

Noninvasive cardiac diagnostic procedures

A
  • ECG
  • chest x-ray
  • echocardiogram
  • stress testing
  • CT
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10
Q

Invasive diagnostic procedures

A

Transesphageal echocardiogram(TEE)
- ultrasound down throat
Cardiac Cath
- balloon and stent

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11
Q

What does an echo show? and what is projected ejection fraction supposed to be?

A
  • blood flow in the heart
  • above 60% E.F.
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12
Q

Narrowing of an opening

A

Stenosis

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13
Q

What does stenosis cause?

A
  • creates partail obstruction which increases pressure and decreases forward blood flow and back up occurs
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14
Q

the narrowing of the mitral valve orifice that obstructs blood flow from the left atrium into the left ventricle

A

Mitral valve stenosis

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15
Q

What is mitral valve stenosis predominantly caused by?

A
  • rheumatic fever> complication of untreated strep or scarlet fever
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16
Q

The more severe mitral valve stenosis get what decreases?

A
  • cardiac output decreases
  • causing hypertrophy of the valve
  • causes dyspnea on exercition
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17
Q

What is an urgent concern of mitral stenosis

A
  • sudden increase in heart rate
  • decreased cardiac output
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18
Q

Atrial enlargement increases the risk for……

A

Atrial fibulation

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19
Q

A condition in which aortic valve is narrowed and blood flow obstructed from LV into aorta during systole

A

Aortic valve stenosis

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20
Q

Clinical manifestations of aortic stenosis

A
  • syncope
  • angina
  • dyspnea
  • orthopnea
  • paroxysmal noctural dyspnea
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21
Q

insufficient or incompetent valves that do not close completely and allows blood through he valve and backs up into where the blood just left

A

regurgitant

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22
Q

blood regurgitates back into the atrium vs being ejected through the aortic valve, decreasing forward cardiac output

A

mitral regurgitation

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23
Q

Blood flows back into the LV from the aorta during diastole leading to diminished cardiac output and LV pressure and volume increases
- Leads to left ventricular hypertrophy

A

Aortic valve regurgitation

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24
Q

Mitral cusps bulge up into the left atrium during ventricular systole
- floppy valve

A

valvular prolapse

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25
Q

Microbial infection, begins to damage endothelium of a valve

A

Infective endocarditis

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26
Q

groups at risk for infective endocarditis

A
  • preexisting heart disease
  • iv drug users
  • children> rheumatic fever or CHD
  • elderly
  • HIV
  • cardiac surgical pts
  • hemodialysis
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27
Q

How do you treat Infective endocarditis

A
  • timely and agressive administration of antibiotics
  • possible valve replacement\
  • prophylaxis antibiotics
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28
Q

How to manage valvular disorders

A
  • sodium restriction
  • lifestyle changes
  • monitor with yearly echocardiograms
  • prophylactic antibiotics
29
Q

T or F with a mechanical valve replacement pts need to be on a long term anti- coagulation

A

True!
- makes platelets less sticky and doesn’t stick to valve

30
Q

An abnormal localized dilation of an artery that results from a weakened arterial wall

A

Aortic Aneurysm

31
Q

nursing priorities for pts with valvular diseases include

A
  • assess/ maintain cardiac output
  • manage side effects
  • prevent complications
  • provide pt education
  • administer pharmocogic therapies
32
Q

Where can aneurysms be located?

A

Can be located all along the aorta, from the ascending thoracic aorta through the trunk of the abdominal aorta

33
Q

What is the most common location for an aneurysm?

A
  • abdomen!
34
Q

T or F aneurysms are usually a complication of long-standing atherosclerosis

A

True!!
- build-up of plaque leads to obstruction and backup of blood causing an aneurysm

35
Q

risk factors for aneurysms

A
  • HTN
  • smoking
  • age
  • male gender
  • hyperlipidemia
  • hx of PAD
36
Q

Clinical manifestations of aneurysms

A
  • often asymptomatic or cause only minimal symptoms
  • back/ flank pain, epigastric discomfort, altered bowel elimation
37
Q

primary diagnostic for aneurysms

A

Diagnostic imaging is the primary tool for diagnosing aortic aneurysms

38
Q

interventions for aneurysms

A
  • open surgical repair> high risk
  • endovascular Aortic Repair> less invasive, more patients qualify
39
Q

T or F with an aortic rupture there is a slow onset of severe symptoms

A

FALSE
- there is rapid onset
- shock goes through he body very fast!

40
Q

Heart tissue is not getting enough perfusion (heart itself)

A

Acute coronary syncdrome

41
Q

What does Acute coronary syndrome encompass

A
  • unstable angina
  • NSTEMI
  • STEMI
42
Q

What lab test is the big indicator of an MI

A

troponin

43
Q

Post op considerations for pts after a valve replacement

A
  • check pulses
  • I and O
  • s/s infection
  • assess physical health
  • monitor vs
44
Q

inital collaborative management for Acute coronary syndrome

A
  • relieve chest pain
  • reduce myocardial oxygen demand
  • ECG obtained
  • aspirin administered
  • nitro given
  • morphine give
  • education to pt and family
45
Q

MONA

A
  • morphine
  • oxygen
  • nitroglycerin
  • aspirin
46
Q

sustained ischemia, causing irreversible myocardial cell death

A

Myocardial Infarction

47
Q

clinical manifestations of MI

A
  • chest pain lasting longer than 20 min
  • crushing/ gripping pain
  • chest heaviness and doom feeling
  • jaw pain, shoulder, epigastric pain, fatigue, nausea, worsening sob
48
Q

Complications of MI

A
  • dysrhythmias
  • premature contractions
  • life threatening> death
  • HF
  • cardiogenic shock
  • ventricular aneurysm
  • pericarditis
49
Q

Nursing considerations when giving morphine and nitro

A
  • decreased oxygen sats
  • low blood pressure
  • low pulse
  • severe headaches
  • too many vasodilators can cause issues too!
  • ask about viagra/ other vasodilators
50
Q

Anticoag medications to help with Acute coronary syndrome> MI/ angina

A
  • heparin
  • aspirin
  • plavix
51
Q

Do all pts qualify for thrombolytic therapy?

A

NO
- only used in pts experiencing acute STEMI
- contradicted in pts w/ active bleeds and potential aneurysm

52
Q

1 goal intervention to restore perfusion

A
  • reperfuse the heart asap
53
Q

nursing care for pre-procedure (PCI)

A
  • perform baseline assessment
  • medication administration
  • patient and family education
  • pre op care
  • assess allergies> iodine!! Seafood!!
54
Q

post op nursing care for PCI

A
  • moniotr VS frequently
  • ECG
  • assess access site for pain, swelling, bleeding
  • bruising may be present> mark circumference
  • bloodwork
  • pt should remain flat and no ambulation for 4-6hrs
55
Q

what is the #1 nursing care post-procedure for PCI

A
  • monitor and stop bleeding!
56
Q

CABG is what?

A

coronary artery bypass graph
- takes vein from leg and put in in heart and bypasses a block

57
Q

early pharmaceutical treatment for post MI, PCI, CABG

A
  • beta blockers
  • Antiplates> aspirin, plavix
  • ACE inhibitors> prils
  • ARBs> artan’s
  • Calcium channel blockers
  • digoxin
58
Q

client education for beta blockers

A
  • check pulses daily
  • teach pts how to check pulse
  • < 60 hold med
  • know when to call provider; light-headedness, increasing fatigue, impotence, low pulse, low bp
59
Q

Stop taking antiplatelets if pt is experiencing…

A
  • frequent nosebleeds that won’t stop
  • rash
  • gi upset
  • bleeding
  • abdominal pain
  • blood in stool
60
Q

ACE inhibitors are used especially in pts who ….

A
  • recovering from STEMI
  • Heart Failure
  • EF < 40%
  • HTN
61
Q

What is a major side effect of ACE inhibitors?

A
  • angioedema
  • maculopapular rash
62
Q

ARBs do what

A

block the binding of angiotensin II to muscles on blood vessels

63
Q

Avoid antiarrhythmics (calcium channel blockers) in pts w/

A
  • Heart failure
  • hypotension
  • sinus node dysfunction
64
Q

What medication is Positive inotropes strengthen the hearts contractions, so it can pump more blood w/ fewer heartbeats

A

Digoxin
- strengthen the force of the heartbeat, so every heartbeat counts

65
Q

Digoxin toxicity s/s

A
  • usually get when first taking this medication
  • confusion
  • irregular pulse
  • less appetite
  • n/v/diarrhea
  • fast heartbeat
  • vision changes
66
Q

right side of heart holds what blood??

A

deoxygenated

67
Q

left side of heart holds what blood??

A

oxygenated

68
Q

Left side of heart pumps oxygenated blood where?

A

throughout the body!

Complex Care (26 decks)

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