Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 4390 Adult Health Theory > Week Four Modules > Flashcards

Week Four Modules Flashcards

1
Q

why would you perform an EKG on a patient pre-operatively?

A

if there is a rhythm change in the patient or if the patient is having chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

a normal electrical impulse begins in the _____ which is located in the _____ near the entrance of the vena cava

A

sinoatrial (SA) node; upper right atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

the SA node is known as the ______ of the heart

A

pacemaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is happening during the “P-Wave”? of an ECG?

A

atrial depolarization (the two atria are contracting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

the ___ is the second pacemaker of the heart and can initiate a _____ if the SA node does not fire

A

atrioventricular (AV) node; heartbeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

the _____ transmit an electrical impulse to the ventricles causing them to ____ which is known as the ______

A

purkinje fibers; contract; QRS complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

p wave = _____

p-r interval = ______

qrs complex = ______

A

atrial depolarization;

represents the movement of the impulse through the atria, AV node, and bundle of His/Purkinje fibers

represents ventricular depolarization of both ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

st segment = _____

t wave = ______

qt interval = ______

A

represents time between ventricular depolarization and repolarization

represents time for ventricular repolarization

represents the time for the entire ventricular depolarization and repolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how long should the p-r interval last?

how long should the QRS complex last?

how long should the ST segment last?

A

.12-.20 seconds;

usually between .04-.06, but less than 0.12 seconds;

.12 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how long does the T wave usually last?

A

.12 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

if the QRS complex is wide what might this suggest?

it’s important to remember that the ST segment should always be _____ (on the baseline)

A

right or left bundle branch block;

isoelectric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

a prolonged QT interval could trigger a ________ also known as torsades de pointes

A

polymorphic ventricular tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the seven steps of rhythm analysis?

A

determine the rate; is the rhythm regular/irregular; analyze the p-waves; measure the PR interval; measure the QRS complex; measure the QT interval; then interpret the rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how can you determine if the rate is regular/irregular in a ECG strip?

A

you can do this by counting the number of small boxes between the start of one R wave to the next R wave

for it to be considered “regular” the distance from one R wave to the other needs to be the same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the requirements for a patient who has a basic sinus rhythm?

A

hr is within normal limits, p wave is present, pr interval is within normal limits; qrs complex is within normal limits; and qt wave is within normal limits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the requirements that need to be met in order for the patient to have sinus bradycardia?

A

hr is <60 bpm, regular rhythm, p waves present, pr interval within normal limits, and qrs within normal limits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are signs and symptoms of a patient who has bradycardia?

A

patient may have symptoms of inadequate perfusion like fatigue, dizziness, chest pain, hypotension, or syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

something to remember is that some patients may have asymptomatic bradycardia if they are ____, who often “brady down” during sleep

A

trained athletes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

bradycardia can also happen if the patient is taking a _____. if the patient is showing symptomatic signs of bradycardia due to the drug then their dosage may need to be ______

A

beta blocker; reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

if you’re on the telemetry floor and you notice that your patient is is showing signs of symptomatic bradycardia what would you do?

A

assess the patient; go into the patient’s room and say “hi there. i came to see how you’re doing since your heart rate is a little low. are you feeling lightheaded or dizzy?”; afterwards, you’ll take a set of VS and if the BP is low/patient is experiencing symptoms, you’ll want to call the provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

if you’re on the telemetry floor and one of your patients is stable and asymptomatic but they are experiencing bradycardia what would you do?

A

text/page the provider and let them know what’s going, especially if this is a change from their normal heart rate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are some treatment options for bradycardia?

A

sometimes atropine is used to increase the HR if the patient is symptomatic

transcutaneous pacing, where there is an electrode that is placed on the patient’s skin which can capture the patient’s HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

it’s important to remember that transcutaneous pacing is a ______ until the patient can have a permanent pacemaker placed

A

temporary fix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the requirements the patient needs to meet in order to be diagnosed with sinus tachycardia?

A

HR is somewhere between 101 - 180, regular rhythm, p wave is within normal limits, pr is within normal limits, qrs is within normal limits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are signs and symptoms of tachycardia?

A

fever, pain, hypotension, hypovolemia, or hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

medications like _____ or ______ are also known to cause tachycardia

A

epinephrine; pseudoephedrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

tachycardia can also result from things like _____, _____, and ______

A

exercise; anxiety; fear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

if the patient on your telemetry floor is experiencing sinus tachycardia what would you do?

A

go to the room and assess the patient; ask them if they’re feeling dizzy or short of breath; take a set of VS and call the provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are some treatment options for sinus tachycardia?

A

first thing first, you want to treat the underlying cause

for example, if the patient has a fever, place a cool cloth on their forehead, use ice bags, and look for a PRN order of acetaminophen (325-650mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

sometimes, young _____ patients will have unexplained tachycardia and have a HR in the ___

why does this happen?

A

male trauma; 120s

because the patient is already in a hypermetabolic state as the body is trying to heal from its wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

once all other causes have been ruled out in sinus tachycardia, only then will the doctors prescribe a medication such as _____, a _____ to help reduce the metabolic demand of a high heart rate

A

propranolol; beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

premature atrial contractions are contractions that come from an ______ (a place other than the AV node) in the atrium _____ than ____

A

ectopic focus; sooner; expected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

when looking at an ECG you’ll be able to see premature atrial contractions where?

A

premature atrial contractions will display themselves on the R waves

often times, you’ll see that each R wave will come earlier than expected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what are some signs and symptoms of premature atrial contractions?

A

PACs can result from emotional or physical stress, caffeine/nicotine use, or alcohol use

patients will often report feelings of palpitations or a “skipped” heart beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are some treatment options for premature atrial contractions?

A

withdrawal of stimulants such as caffeine can help to reduce PACs

use of beta blockers can also help decrease PACs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

how are premature junctional contractions treated?

A

the same way as PACs are treated

withdrawing any stimulants or using medications such as beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what causes premature junctional contractions?

A

they happen due to the SA node not firing so the AV node has to become the pacemaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what causes an atrial flutter?

A

atrial flutter is an atrial tachydysrhythmia that results from a single ectopic foci in the atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are some signs and symptoms of atrial flutter?

A

this will typically occur in patients who have coronary artery disease, COPD, or cor pulmonale

can also happen if the patient is taking digoxin or quinidine

patient may complain of things like lightheadedness or low blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

patients who have a-flutter are also at a high risk of developing _____ that form in the atria

A

blood clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

often times, patients with a-flutter will be prescribed _____ to prevent clot formation

A

warfarin/coumadin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is the primary treatment goal for patients who have a-flutter?

A

slow down the ventricular rate by increasing the AV block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what kinds of medications are known to increase the AV block?

A

calcium channel blockers and beta blockers are known to increase the AV block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

_____ tends to be the treatment of choice for a-flutter patients which involves inserting a ___ into the right atrium

a _____ of electricity is then used to “ablate” or destroy the ectopic foci

A

ablation; catheter

low voltage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what causes atrial fibrillation to occur?

A

results from total disorganization of atrial electricity activity from MULTIPLE ectopic foci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

a-fib is one of the most _____ dysrhythmias

A

common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

a-fib is an ____ rhythm

A

irregular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what are some underlying causes that can also cause atrial fibrillation to occur?

A

a-fib can also result due to things like heart disease, heart failure, electrolyte imbalances, and stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what is considered “controlled” a-fibrillation?

what is considered “uncontrolled” a-fibrillation?

A

when the patient has a HR between 60 and 100

when the patient has a HR that is greater than 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

a-fib is similar to a-flutter as it results in loss of an atrial kick which can cause decreased cardiac output and can manifest itself as ______, _____, _____, and ____

A

hypotension, weakness, palpitations, and fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

patients who are prescribed coumadin/warfarin will need to have PT/INR drawn in order to titrate Coumadin

what is considered a “therapeutic level” of INR?

A

INR is considered to be therapeutic when it is between 2-3 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

can coumadin be prescribed to help treat patients with A-fib?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is one of the first treatment goals when it comes to treating a-fib?

A

control the HR, meaning the rate needs to decrease and be around 100 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

if a-fib is treated in the hospital, the patient may receive _____ for a total of 3 doses that are five minutes apart

A

5 mg IVP metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

in order to receive metoprolol in the hospital, the patient must be on a ______

A

telemetry (heart) monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

if a-fib is resistant to the med pushes of metoprolol and the heart rate remains high, the patient will then be placed on _____ or ______ drip, that will run continuously

A

amiodarone; diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is the maximum dose of diltiazem that can be given?

A

20 mg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

remember: diltiazem _____ works; whereas, amiodarone _____ works

A

sometimes; almost always

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

if the patient is suffering from a-fib, vital signs should be done at least once every ____ hours

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

if the patient has decreased tolerance for medications, what would be the next best solution?

A

placing the patient on cardioversion or ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

if none of these treatment plans work, the last resort would be to place the patient on an _____ such as _____

A

anticoagulant; warfarin

62
Q

in a 1st degree AV block everything remains normal except there is a prolonged ______

A

PR interval

63
Q

with the 1st degree AV block, the impulses that are conducted through the ventricles are _____ than usual

A

much slower

64
Q

with a 1st degree AV block, the PR interval lasts about _____

A

0.4 seconds

65
Q

what are some signs and symptoms of 1st degree AV block?

A

patients with 1st degree AV block tend to be asymptomatic

66
Q

what kinds of comorbid conditions tend to put the patient at a high risk for developing 1st degree AV block?

A

old age, myocardial infarctions, coronary artery disease, hyperthyroidism, hypokalemia, and taking medications such as digoxin, beta blockers, and calcium channel blockers

67
Q

is there a treatment plan for those who are diagnosed with 1st degree AV block?

A

no, there is no treatment for 1st degree AVB, but treatment for the comorbid/associated conditions may help

68
Q

what are PVCs?

what are some signs/symptoms of PVCs?

A

premature ventricular contractions

there tends to be very little signs and symptoms but patients have reported feelings of fluttering in the chest, skipped heartbeats, or awareness of their heartbeat

69
Q

PVCs are ____ and ___ with age

A

common; increase

70
Q

what are some common causes of PVCs?

A

stress, nicotine or caffeine use, and surgery

71
Q

what are some treatment options for PVCs?

A

resolve the underlying cause such as hypokalemia/hypomagnesemia

PVCs are not typically treated

72
Q

if the patient complains of frequent PVCs after the underlying issue has been resolved then ______ will be prescribed to the patient

A

beta blockers

73
Q

what are some signs and symptoms of ventricular tachycardia?

A

HR of 150-250 bpm and no p-wave present

74
Q

what are treatment options for ventricular tachycardia?

A

treat the precipitating cause!!

if the patient is stable and the pulse is present, you’ll want to monitor the patient’s O2 and place them on an EKG

75
Q

if the patient is suffering from ventricular tachycardia and their condition is unstable with no pulse what are some treatment options?

A

defibrillate, do CPR, or give antidysrhythmic medications such as amiodarone or magnesium sulfate

76
Q

if your patient is suffering from ventricular fibrillation what are some signs and symptoms you’d expect to see?

A

the patient has no pulse, call a code blue

77
Q

what are some treatment options for ventricular fibrillation?

A

get an AED/defibrillator, defibrillate the patient, do CPR, or use pharmacologic therapy such as epinephrine, amiodarone, vasopressin, or magnesium sulfate

78
Q

cardioversion is to be used on a _____ basis

cardioversion is used to treat what kind of conditions?

what is the energy level of shock for cardioversion?

A

non emergency;

used to convert a-fib or treat ventricular/supraventricular dysrhythmias

50 joules

79
Q

defibrillation is to be used in _____ situations of unstable ____ and _____

what is the energy level of shock for defibrillation?

A

emergency; v-tach; v-fib

anywhere from 150 - 360 joules

80
Q

is defibrillation synched with an ECG?

is cardioversion synched with an ECG?

A

no, it is not synchronized

yes, it is synchronized with the R wave of the QRS complex

81
Q

what causes heart failure?

A

heart failure occurs when the heart cannot provide enough blood to meet the oxygen needs of the organs and tissues

82
Q

heart failure can cause the supply to be ____ than the demand resulting in ______ cardiac output

A

less; decreased

83
Q

decreased cardiac output can lead to what types of problems?

A

decreased tissue perfusion, decreased function, impaired gas exchange, and fluid volume imbalance

84
Q

heart failure is associated with things such as _____, ______, and ______

A

HTN, coronary artery disease, and myocardial infarction

85
Q

long term treatment of _____ can reduce the incidence of heart failure by ____%

A

HTN; 50%

86
Q

what are the four things that impact cardiac output?

A

preload; afterload; contractility; and HR

87
Q

______: the amount of blood pumped out into the circulation per heart beat

A

stroke volume

88
Q

what is preload?

A

the volume of blood in ventricles AT THE END of diastole

89
Q

what is afterload?

A

FORCE that the ventricle has to overcome in order to push blood out into circulation

90
Q

what causes an increase in afterload?

A

hypertension and vasoconstriction

91
Q

what causes an increase in preload?

A

hypervolemia, heart failure, and regurgitation of cardiac valves

92
Q

heart failure results in response to ______ and results in ______ cardiac function

A

myocardial injury; decreased

93
Q

what is the most common form of heart failure?

what causes left-sided heart failure?

A

left-sided heart failure

l-sided heart failure results from inability of the ventricle to empty blood during contraction or from not filling up with enough blood BEFORE the contraction

94
Q

left sided heart failure can have problems with either systole (which is during _____), or diastole (which is ____).

A

contraction; filling

95
Q

what is systolic heart failure?

A

the inability to pump blood

96
Q

what is diastolic heart failure?

A

inability to relax and fill during diastole

97
Q

what is the ejection fraction?

A

the EF compares the amount of blood in the heart to the amount of blood that is being pumped out

98
Q

what range (percentage wise) is considered “normal” ejection fraction?

A

50-70% of blood is pumped out during each contraction

99
Q

what range (percentage wise) is considered “borderline” ejection fraction?

A

41-49% of blood is pumped out during each contraction

100
Q

what range (percentage wise) is considered “reduced” ejection fraction?

A

40% or less of blood is pumped out during each contraction

101
Q

with borderline ejection fraction are symptoms noticeable on the patient?

with reduced ejection fraction are symptoms noticeable on the patient?

A

symptoms might become noticeable but only during activity

symptoms may become noticeable even during periods of rest

102
Q

how do you measure/find an individual’s ejection fraction?

A

you can find this through the use of an electrocardiogram

103
Q

what is an electrocardiogram?

if your patient is receiving an electrocardiogram what is one helpful tip you can mention to them?

A

electrocardiogram is an ultrasound of the heart

you can remind the patient that this is painless procedure which can help reduce any anxiety

104
Q

what is considered an “early sign” of heart failure?

A

fatigue following activities of daily living

105
Q

what are the two “special” side effects of left-sided heart failure?

A

orthopnea and paroxysmal nocturnal dyspnea

106
Q

what is orthopnea?

what is paroxysmal nocturnal dyspnea?

A

orthopnea is dyspnea that occurs when the patient is lying in recumbent position which causes the redistribution of fluid from the BLE to the lungs

paroxysmal nocturnal dyspnea is a sudden awakening at night due to shortness of breath, again which is caused by fluid accumulation in the lungs while patient is in supine position

107
Q

how can you relieve orthopnea?

A

this can be relieved by having the patient sit upright

108
Q

if a patient comes to you and says they wake up in the middle of the night and feel like they’re suffocating what is this a sign of?

A

paroxysmal nocturnal dyspnea

109
Q

what are some other side effects related to left-sided heart failure?

A

oliguria during the DAY, fatigue, pallor, weak peripheral pulses, cool extremities, crackles in the lungs, angina & nocturia, and S3 Kentucky

110
Q

what is the most common dysrhythmia that occurs with chronic heart failure?

A

atrial fibrillation

111
Q

what are some side effects of right-sided heart failure?

A

systemic congestion, enlarged liver & spleen, jugular vein distention, dependent edema, swollen abdomen & hands, and polyuria at NIGHT

112
Q

if one of your patients has a nursing diagnosis of impaired gas exchange, what is the treatment plan?

A

your initial goal is to increase oxygen supply, you can do this by: changing positioning, using oxygen, CPAP/BIPAP, or the use of medications

113
Q

if one of your patients needs to decrease oxygen demands what would their treatment plan look like?

A

alternating rest periods and decreasing activity periods; plan for activities that reduce competition for oxygen, decrease preload through the use of medications or changes in the diet

114
Q

if one of your patients has a nursing diagnosis of decreased cardiac output, what would be your treatment plan?

A

your initial goal would be to improve cardiac function by prescribing medications such as: diuretic inhibitors (lasix), vasodilator drugs (nitroglycerin), inotropes (digoxin), and ACEs (lisinopril)

115
Q

if one of your patients has a nursing diagnosis of fluid volume excess, what would their treatment plan look like?

A

your initial goal would be to decrease the intravascular volume which can be done through the use of medications, changes in positioning, and placing the patient on a LOW SODIUM diet

116
Q

According to the Core Measures, what are some guidelines/rules that must be met when providing care for a patient with heart failure?

A

before discharge, you’ll want to evaluate their left ventricular function (EF), have a ACEI/ARB prescribed at discharge, and provide specific discharge instructions that relate to diet, activity, weight monitoring, and s&s the patient must be on the look out for

117
Q

when monitoring for complications, what are some signs of worsening heart failure?

A

rapid weight gain (3-5 lbs in one week or 1-2 pounds overnight), decrease in exercise tolerance, cough lasting more than 3-5 days, or excessive awakening at night to urinate

118
Q

what are some signs and symptoms of digoxin toxicity?

A

confusion, irregular pulse, loss of appetite, N/V/D, vision changes

119
Q

how does coronary artery disease occur?

what does angina do to blood flow?

A

it occurs when plaque builds up in the artery

it makes it harder for blood to get through to the artery

120
Q

what causes a heart attack?

A

a heart attack happens when plaque build up cracks and forms a blood clot blocking the artery from receiving blood

121
Q

what are some modifiable risk factors for coronary artery disease?

A

elevated serum lipids, hypertension, smoking, physical INactivity, obesity, and comorbid conditions

122
Q

what is a major consequence of coronary artery disease?

A

angina imbalance of supply and demand

123
Q

what things consist of the “supply”?

what things consist of the “demand”

A

heart rate, BP, O2 concentration, and coronary vessel diameter

basal requirements, HR, preload/afterload, and contractility

124
Q

STABLE ANGINA

  • is typically provoked by ______
  • is usually ______
  • only lasts about ___ to ____ minutes
  • can be relieved by ___ and _____
A

exercise; reversible; 5-15; rest; NTG SL

125
Q

STABLE ANGINA is usually associated with a _______

A

stable atherosclerotic plaque

126
Q

in STABLE ANGINA, there is ___ change in frequency, ____ in duration, or any _____ in the preceding 60 days

A

no; no change; precipitation factors

127
Q

UNSTABLE ANGINA

  • typically occurs at ____ or _______
  • has a duration greater than or equal to ___ minutes
  • the frequency and intensity of the pain tend to _____
  • usually have an _____ pattern
A

rest; awakens the patient from their sleep; 15 minutes; increase; unpredictable

128
Q

how does chest pain present itself in MEN?

A

upper chest pain, substernal pain radiating to the neck and jaw, substernal pain radiating down LEFT ARM, epigastric pain, epigastric pain that radiates to the neck, jaw, and arms and interscapular pain

129
Q

when it comes to chest pain presentation in WOMEN something to keep in mind is WOMEN tend to have symptoms more often when _____ or ______

A

resting; sleeping

130
Q

what are some angina symptoms that occur in women?

A

most commonly reported symptom is chest pressure/”chest tightness”, unusual fatigue, SOB, N/V, diaphoresis, indigestion, and pain in one or both arms

131
Q

what is a special symptom we should remember when it comes to angina symptoms in WOMEN?

A

takotsubo cardiomyopathy which occurs under extreme stress and emotional conditions

132
Q

how can we assess chest pain?

A

determine the onset, location, duration, character (“what does it feel like?”), are there any aggravating/alleviating factors, and the timing and severity of pain

133
Q

what are some nursing interventions you can perform when your patient is experiencing chest pain?

A

it’s important that you ASSESS THE PAIN FIRST; call a rapid response/call the provider for orders, grab a set of VS (especially the BP), perform an EKG, and give the patient meds such as sublingual nitroglycerin, morphine, or troponin I

134
Q

when giving NTG SL, what is the dosing and how long do you wait between each dose?

A

you give the patient 0.04 mg under the tongue, 3 times, 5 minutes apart with VS and EKG in between each dosage

135
Q

remember, with chest pain, you’ll only give your patient morphine if there has been _____ from the nitroglycerin

A

NO RELIEF

136
Q

with UNSTABLE ANGINA what are some EKG changes you will notice?

A

ST depression and t-wave inversion which are both ISCHEMIC changes

137
Q

with a STEMI, there is ____ segment ____

A

ST; elevation

138
Q

what are some drugs that can be used to treat myocardial infarction?

A

morphine, nitrates, aspirin, heparin, beta blockers, ACE inhibitors, and lipid lowering drugs like statin medications

139
Q

what happens in cath lab?

why is the cath lab considered an “emergency” situation?

A

pt is placed on emergency defibrillation while cardiologists try to open the coronary artery that is blocked

b/c cardiac cells are only viable for about 20 minutes during ischemic conditions

140
Q

MORPHINE:

  • helps with ____
  • ____ O2 demand
  • _____ preload
  • ______ anxiety
A

pain relief; decreases; decreases; decreases

141
Q

NITRATES:

  • _____ smooth muscle
  • _______ the coronary arteries
  • ______ preload & afterload
A

relaxes; dilates; decreases

142
Q

ACE INHIBITORS:

  • what is an example of an ACE inhibitor?
  • ____ afterload by ____ blood vessels
  • _____ progression of heart failure and ventricular remodeling
A

lisinopril; decrease; dilating; slows

143
Q

what is a CABG procedure?

who are some eligible patients for CABG procedure?

A

coronary artery bypass graft

pts. who have failed management, pts. who have left main coronary artery disease, pts. who have 3 vessel disease or more

144
Q

what happens in a CABG procedure?

what arteries/veins tend to be used in a CABG procedure?

A

a CABG procedure uses placement of arterial or venous grafts to provide blood flow from the aorta

internal mammary artery, saphenous vein, or radial arteries tend to be used

145
Q

what are some nursing interventions for CABG patients?

A

teach sternal precautions, monitor chest tubes, have continuous telemetry monitoring, encourage early ambulation and the use of TEDs to prevent DVTs, and provide wound care for the surgical incision

146
Q

what are sternal precautions?

how long must the patient follow sternal precautions?

A

not lifting more than 5-8 lbs, no pushing or pulling with the arms, don’t reach arms overhead, and brace the sternum with a pillow while getting up

precautions must be followed for 6-8 weeks to allow proper healing

147
Q

RULES OF DIGOXIN:

if the patient’s pulse is less than _____ you’ll want to hold the digoxin and call the provider

digoxin toxicity can cause ______ b/c it is known to bind to the ATP pump which can keep ______ in the periphery

A

less than 60 bpm

hyperkalemia; potassium

148
Q

what are some signs and symptoms of HYPERKALEMIA?

what treatment is used to treat hyperkalemia?

A

spiked t waves on an EKG, severe palpitations, muscle weakness, and numbness

calcium gluconate

149
Q

if you have a heart failure patient and they’re prescribed lasix what supplement should they be receiving to go with it?

A

the patient should be receiving a potassium supplement

150
Q

what is the most common trigger of digoxin toxicity?

A

HYPOKALEMIA

151
Q

what are some signs and symptoms of hypokalemia?

A

st wave depression on EKG, fatigue, and muscle cramping

NURS 4390 Adult Health Theory (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions