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NRS 105 Exam #2 > Cardiac 1 > Flashcards

Cardiac 1 Flashcards

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1
Q

The nurse is caring for a patient after cardiac surgery. Which nursing intervention is most appropriate to help prevent complications arising from venous stasis?

a. Encourage crossing of legs.
b. Use pillows in the popliteal space to elevate the knees in bed.
c. Discourage exercising
d. Apply sequential pneumatic compression devices as prescribed.

A

d. Apply sequential pneumatic compression devices as prescribed.

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2
Q

What is the main electrolyte involved in cardiomyopathy?

a. Calcium
b. Phosphorus
c. Potassium
d. Sodium

A

d. Sodium

Rationale:
Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to heart failure, which develops, in part, from fluid overload. Fluid overload is often associated with elevated sodium levels

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3
Q

A patient with restrictive cardiomyopathy taking digoxin presents with symptoms of anorexia, nausea, vomiting, headache, and malaise. What should the nurse expect to be included in the plan of care for this patient?

a. The patient’s digoxin will be changed to nifedipine.
b. The patient’s digoxin dose will be decreased.
c. Nothing; these are signs of restrictive cardiomyopathy that are expected.
d. The patient will be admitted to an ICU.

A

b. The patient’s digoxin will be decreased

Rationale:
Patients with restrictive cardiomyopathy are sensitive to digitalis. Nurses must closely monitor these patients for digitalis toxicity, which is evidenced by dysrhythmia, anorexia, nausea, vomiting, headache, and malaise.
These patients should avoid nifedipine (CCB) as they may cause fluid retention or decrease cardiac function.

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4
Q

The nurse obtains a blood pressure reading of 50/30. The patient is awake, alert, and is talking calmly with visiting family members. Which action should the nurse take?

a. Ask the family to leave the room
b. Recheck the blood pressure
c. Place the patient in Trendelenburg position.
d. Prepare for resuscitation procedures.

A

b. Recheck the blood pressure

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5
Q

A patient has a new diagnosis of stable angina. The nurse determines the patient needs further education when they make the following remark.

a. Angina is ischemia that can be reversed by resting
b. Angina occurs when arteries are blocked 80% or more
c. When experiencing angina, cardiac tissue is viable for 60 minutes.
d. Drugs can be prescribed to control my angina.

A

c. When experiencing angina, cardiac tissue is viable for 60 minutes.

Rationale:
Cardiac tissue is only viable for 20 minutes.

Angina is a symptom of ischemia

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6
Q

A nurse enters a male client’s room to find them short of breath, rubbing his left arm, and complaining of nausea. Which assessment would take priority?

a. Listen to the apical pulse for one minute.
b. Assess for dysrhythmias
c. Auscultate for breath sounds
d. Evaluate the level and quality of the arm pain.

A

b. Assess for dysrhythmias.

Use a 12 lead ECG

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7
Q

A patient with angina is instructed to rest when having an episode of chest pain. What is the best explanation of how rest relieves the pain associated with angina.

a. Coronary blood vessels dilate and increase myocardial cell perfusion.
b. Increased venous return to the heart decreased myocardial oxygen needs
c. A balance between myocardial cellular need and demand is achieved.
d. Coronary arteries constrict and shunt blood to vital areas of the myocardium

A

c. A balance between myocardial cellular need and demand is achieved.

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8
Q

Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis? The patient states that the pain:

a. Wakes me up at night.
b. Does not fully resolve when I take my nitroglycerin
c. Has increased in frequency over the previous week.
d. Goes away with one nitroglycerin tablet

A

d. Goes away with one nitroglycerin tablet

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9
Q

While caring for a patient recovering from a myocardial infarction and stent placement, the monitor alarms and the nurse notes ventricular fibrillation. What is the priority intervention?

a. Notify the health provider
b. Increase the oxygen delivered
c. Assess the patient’s level of consciousness
d. Prepare to defibrillate the patient

A

c. Assess the patient’s level of consciousness

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10
Q

What are some causes of arrhythmias?

A
  • Heart disease
  • Electrolyte imbalance
  • Structural abnormalities
  • infection
  • Medications
  • ETOH, recreational drugs
  • Caffeine
  • Exercise
  • Stress
  • Anxiety
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11
Q

Assessment of the patient with an Arrhythmia

A
  • EKG (12 lead)
  • 2-D and/or 3-D echo, Chest X-Ray
    * Physical assessment:
  • Skin (pale and color)
  • Signs of fluid retention (JVD, lung auscultation, edema)
  • Rate, rhythm of apical, peripheral pulses
  • Heart sounds
  • Blood pressure, pulse pressure
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12
Q

Complications of arrhythmias

A
  • Cardiac arrest
  • Heart failure
  • Thromboembolic event, especially with atrial fibrillation
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13
Q

Causes of Sinus Bradycardia

A

Rate less than 60bpm
* Vagal stimulation
* Beta blockers
* Calcium Channel Blockers
* Increased Intracranial pressure
* Coronary Artery Disease
* Heart failure
* Conditioning (athletes)

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14
Q

Effects of Sinus Bradycardia

A
  • Hypotension
  • Fatigue
  • Dizziness
  • Shortness of Breath
  • Syncope
  • Confusion
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15
Q

Treatment for Sinus Bradycardia

A
  • Change medications
  • Pacemaker
  • Atropine
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16
Q

Causes of Sinus Tachycardia

A

Rate 100-150
* Stress
* Exercise
* Medications
* Hypotension
* Hypertension
* DM
* thyroid issues

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17
Q

Effects of Sinus Tachycardia

A
  • Decreased Cardiac Output
  • Headache
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18
Q

Treatment for Sinus Tachycardia

A
  • Vagal maneuver
  • Medications: (e.g.: BB, CCB, adenosine)
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19
Q

Causes of Atrial Fibrillation

A

Rapid, disorganized, uncoordinated twitching of the atrium
* Hypertension
* Diabetes
* Heart Disease
* Myocardial Infarction
* Obesity
* age

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20
Q

Effects of Atrial Fibrillation

A
  • Loss of atrial kick
  • Hypotension
  • Clot formation
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21
Q

Treatment for Atrial Fibrillation

A
  • Beta Blockers
  • Warfarin
  • Amiodarone
  • Cardioversion
  • Ablation
  • Watchman
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22
Q

Adjunctive Modalities for Arrhythmias

A
  • Pacemakers
  • ICD or AICDs
  • Cardioversion
  • Defibrillation

Nurse is responsible for assessment of the patient’s understanding regarding medicinal therapy

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23
Q

How do cardioversion and defibrillation work?

A

They treat tachyarrhythmias by delivering electrical current that depolarizes critical mass of myocardial cells

When cells repolarize, the SA node is usually able to recapture its role as the heart’s pacemaker

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24
Q

When is cardioversion used?

A

With Atrial fibrillation

Delivery is synchronized with patient’s EKG

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25
When is defibrilation used?
**V-fib, V-tach, Supraventricular Tachycardia (SVT)** Unsynchronized
26
Which rhythms are unshockable?
* Pulseless Electrical Activity (PEA) * Asystole (Flatline)
27
What is Coronary Atherosclerosis?
* Most prevalent cardiovascular disease in adults * The abnormal **accumulation of lipid deposits and fibrous tissue** within the arterial walls and lumen * Blockages and narrowing of the coronary vessels **reduce blood flow** to the myocardium
28
Causes of Coronary Atherosclerosis
* Plaque forms narrowing the vessel lumen * Damage to the vascular system: HTN, HLD, Smoking, etc. results in the inflammatory response * Inflammatory response damages the endothelium, furthering the atherosclerotic process
29
What is stable Coronary Atherosclerosis?
Still able to resist blood flow and movement
30
What is unstable Coronary Atherosclerosis?
* Thin Fibrous caps, susceptible to rupture
31
Modifiable Risk Factors for Coronary Atherosclerosis
* Tobacco use * HTN * DM * Obesity * Physical Activity * Chronic Kidney Disease
32
Nonmodifiable Risk Factors for Coronary Atherosclerosis
* Family history * Age * Gender * Race * Premature menopause * Preeclampsia * Primary HLD
33
What is stable angina?
* Predictable and consistent pain occuring **with exertion** * Relieved by rest and/or nitroglycerin
34
What is unstable angina?
* Symptoms increase in frequency and severity * Not relieved by rest or nitroglycerin * May occur during rest times **REQUIRES MEDICAL ATTENTION**
35
What is variant angina?
* AKA: Prinzmetal angina * Pain due to coronary artery vasospasm * Rare * Usually happens at night, at rest * Typically in younger (healthier) adults
36
What is silent angina?
ECG changes with no symptoms
37
Clinical Manifestations of **Coronary Atherosclerosis**
**Caused by myocardial ischemia** *Related to location, degree of obstruction, and time* * Angina pectoris (Chest Pain) * Epigastric distress * Weakness/numbness * Pain that radiates to the jaw or left arm * SOB
38
Atypical clincal manifestations of **Coronary Atherosclerosis in Women**
* Indigestion * Nausea * Palpitations * Numbness * Sweating * Fatigue
39
Complications of **Coronary Atherosclerosis**
* Myocardial Infarction *(circulation problem)* * Heart Failure * Sudden Cardiac Death *(conduction problem)*
40
Prevention of **Coronary Artery Disease**
* Manage cholesterol *(Diet, medications)* * Diet: DASH, vegetarian, Mediterranean, limit red meat * Physical activity: Intense (75 min./week) or Moderate (150 min/week) ***(stop if CP)*** * Statins * Cessation of tobacco use * Manage HTN * Control Diabetes
41
Medications to treat Cholesterol
* HMG-CoA Reductase Inhibitors **(Statins)**: Inhibit enzyme involved in cholesterol synthesis *(lowers Total cholesterol, LDL, TGs, raises HDL)* * Fibric acids/*fibrates* **(fenobriate, gemfibrozil)**: *(lowers TGs, raises HDL)* * Bile Acid Sequestrants **(Cholestyramine, Colestipol, Colesevelam)**: *(lowers LDL, slightly raises HDL, decreases fat absorption)* * Cholesterol Absorption Inhibitors **(Ezetimibe)**: Inhibits absorption of cholesterol in small intestine *(lowers LDL)*
42
**Angina Pectoris** Definition
* Syndrome/symptom characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by ***insufficient coronary blood flow*** * Myocardial oxygen demand increased by physical exertion or emotional distress: coronary vessels are unable to supply sufficient blood flow to meet the oxygen demand
43
Clinical Manifestations of **Angina**
* Central chest pain *(mild to debilitating)* * Chest tightness, choking, heavy sensation * Anxiety * Dyspnea/Shortness of Breath * Dizziness * Diaphoresis * N/V * Feeling of impending doom
44
Gerontologic considerations for **Angina**
* Diminished pain sensation * Silent CAD *(EKG changes, no symptoms)* * Weakness, numbness, nausea * Pharmacologic stress testing/cardiac catheterization * Medications should be used cautiously
45
Treatment of **Angina**
**Goals: Decrease oxygen demand, increase oxygen supply** * Reduce and control risk factors * Oxygen * Medications * Reperfusion therapy *(PCI, stents, CABG)*
46
Medications to treat **Angina**
* **Nitroglycerin** * **Beta-adrengergic Blockers** *(-olols)* * **Calcium Channel Blocking Agents** *(amlodipine, diltiazem)* * **Antiplatelet** *(aspirin, clopidogrel, ticagrelor, ticlopidine)* * **Anticoagulants** *(heparin, LMW heparins - enoxaparin)* *Monitor Heparin with aPTT (2-2.5)*
47
How do Beta Blockers help angina?
* Block sympathetic stimulation to the heart * Reduces HR, BP, contractility, ischemia Risks: bradycardia, hypotension, AV block, acute heart failure
48
How do Calcium Channel Blockers help angina?
* Decrease SA and AV node action, lowering HR and contractility * Dilate coronary arterioles to decrease oxygen demand Risks: hypotension, AV block, bradycardia, constipation
49
Goals for patient with **Angina**
* Immediate and appropriate treatment of angina * Prevention of angina * Reduction of anxiety * Awareness of disease process * Understanding of treatment * Absence of complications
50
Nursing Interventions for **Angina**
* Priority: Stop ALL activities, sit or rest in bed *(Semi-Fowler's position)* * Assess the patient: EKG, VS, respiratory distress, pain * Administer medications as ordered *(NTG, ASA)* * Monitor HR, BP, ST segment * Administer oxygen 2L/min by nasal cannula - minimum * Reduce pt anxiety * Prevention of pain
51
Patient Teaching for **Angina**
* Balance activity w/rest * Build up activity gradually * Avoid exercising in extreme temps * Resources for emotional support * Avoid OTC that increase HR or BP * Stop using tobacco products * DASH diet, low in fat, high in fiber * Follow up with provider * Report any increase in S/S to provider * Maintain normal BP and glucose levels *(Home BP monitoring)* * Carry NTG at all times
52
Patient Teaching for **Nitroglycerin**
* Routes: Sublingual tablet or spray, oral capsule, topical agent, IV * Sublingual --> under the tongue or in the buccal pouch *(Should relieve pain in 3 minutes)* * Don't swallow until tablet dissolves, crush tablet between teeth if pain is severe * Store in original packaging - dark, glass bottle *(not in plastic pillboxes)* * Inactivated by heat, moisture, air, light, and time * Take NGT prophylactically before any stressful activity *(e.g.: exercise, intercourse, stair climbing)* * If pain continues after 3 tablets in 5 minute intervals, call 911 * Side effects: flushing, throbbing headache, hypotension, tachycardia * Sit down after administration to avoid hypotension and syncope * Do not take with other vasodilators - "-fil" drugs (Viagra)
53
Complications of **Angina**
* ACS, MI, or both * Arrhythmias and cardiac arrest * Heart Failure * Cardiogenic Shock
54
Definition of **Acute Coronary Syndrome (ACD)**
* **Emergent Situation** * Range of conditions associated with sudden, reduced blood flow to the heart * Applied to patients in whom there is a *suspicion or confirmation* of acute ischemia or infarction * Three traditional types: NSTEMI (Non-ST-Elevation Myocardial Infarction), STEMI (ST-Elevation Myocardial Infarction), and Unstable Angina * Any acute Myocardial Ischemia that will result in Myocardial Death *(Myocardial Infarction)* if interventions to not occur promptly
55
Pathophysiology of **Myocardial Infarction**
* Plaque ruptures and thrombus forms blocking a coronary artery OR vasospasm of coronary artery * Result is ischemia and necrosis of the myocardium supplied by that artery * Time is muscle - urgent treatment needed to improve outcomes * 12 lead EKG determines likely location of injury
56
Clinical Manifestions of **Myocardial Infarction**
* Sudden and continuous chest pain despite rest and medication * SOB * Tachycardia * Dyspnea * N/V * Indigestion * Anxiety * Restlessness * Feeling of impending doom * Denial * Cool, pale skin * Increased HR, BP, RR
57
Risk factors for **Myocardial Infarction**
* Lifestyle - poor nutrition/lack of physical activity * Smoking * HTN * HLD * Obesity * Male * Lack of patient and family knowledge of s/s * Lack of adherence to a plan of care
58
Diagnostic Tests for **Myocardial Infarction**
* Priority: 12 lead EKG * Cardiac Biomarkers * 2D/3D Echocardiogram * Past Medical History
59
Important things to know about **EKG/ECG for MI**
* Used to rule out or diagnose MI * Should be done **within 10 minutes** of patient arrival * **T wave inversion**: if injury becomes ischemic, repolarization is altered and results in inverted T waves * **ST segment elevation:** rapid repolarization causes ST segment to rise * **Abnormal Q wave**: no depolarization of necrotic tissue
60
Important info to know for **Troponin**
* Protein found in myocardial cells, isomers I and T are specific for cardiac muscle and are reliable for myocardial injury * Detected within a few hours of an MI * Remains elevated for 8-10 days (sometimes up to 2 weeks) * May also rise due to sepsis, heart failure, and respiratory failure
61
Important info to know for **CK-MB**
* Creatine Kinase found in the heart muscle * Increases when there has been damage to these cells - acute MI * Increases within a few hours and peaks 24 hours after an infarct
62
Important info to know for **Myoglobin**
* Heme protein that helps transport oxygen * Found in cardiac and skeletal muscle * Starts to increase 1-3 hours after onset of symptoms, peaks within 12 hours * Negative results can rule out an MI * Positive results may not be specific to an MI
63
Complications of **Myocardial Infarction**
* Acute pulmonary edema * Heart failure * Cardiogenic Shock * Arrhythmias and cardiac arrest * Pericardial effusion and cardiac tamponade
64
Initial Medical Treatment of **Myocardial Infarction**
* Nitroglycerin * Aspirin * Supplemental Oxygen * Beta Blockers * Heparin
65
Definition of **Percutaneous Coronary Intervention (PCI)**
* **Preferred treatment** * Endovascular procedure to open occluded vessels and promote reperfusion * Performed in cath lab * Door to balloon time should be less than 60 minutes * Small incision into radial or femoral artery, uses needle puncture, guidewire, and sheath to provide access * Balloon angioplasty: widening of blocked off or narrowed vessel by balloon catheter. * Stent placement: bare metal or drug-eluting
66
When to use/not use **Thrombolytics** for MI
**IV: alteplase, reteplase** **Indications:** * When PCI is not readily available *(buys time to get to cath lab)* * Chest pain lasting more than 20 minutes, unrelieved by nitroglycerin * ST elevation in at least 2 leads in same area * Door to needle time should be less than 30 minutes for best results **Contraindications:** * Pts with bleeding disorders * Active bleeding * History of hemorrhagic stroke * History of intracranial vessel malformation/Intracranial Cancer * Recent major surgery/trauma * Uncontrolled HTN (SB >180) * Suspected Aortic dissection *Do not affect the underlying atherosclerotic lesion... may still need cardac catheterization afterwards*
67
Inpatient ongoing treatment for **Myocardial Infarction**
* Continuous cardiac monitoring *(telemetry)* * Aspirin, clopidogrel * Beta Blockers * ACE Inhibitors/ARBs * Stool softeners to prevent straining * Cardiac Rehabilitation
68
Nursing Management for **Myocardial Infarction**
* Oxygen and medication therapies * Frequent VS assessments * Physical rest in bed, semi-fowler's position * Pain management * Monitor I&O * Monitor tissue perfusion * Frequent position changes * Report changes in pt condition * Reduce pt anxiety * Educate pt and family
69
Complications of **Cardiac Surgery**
* Decrease in CO: bradycardia, tachycardia, arrhythmias, loss of fluid volume, vasodilation * Fluid and electrolyte imbalances * Impaired gas exchange: due to anesthesia, post op atelectasis * Impaired cerebral perfusion: thrombi, emboli
70
Discharge Education for pts with **Myocardial Infarction**
* Lifestyle changes *(smoking cessation, weight management, stress management)* * Medications: Compliance, mech. of action * Diet: Sodium Limits, reading labels, fluids, DASH diet * When to call for help (CP, pain that radiates, etc.) * Activity limits/Rest
71
Medications used during **Cardiac Catheterization**
* Midazolam *(for sedation)* * Fentanyl *(for pain control)*
72
Benefits of PCI vs Coronary Artery Bypass Graft (CABG)
* Faster time to begin procedure * Minimally invasive * Lower risk of complications * Quicker recovery
73
Post Care for **Percutaneous Catheterization Intervenetion**
* Monitor for signs of bleeding * Angio-Seal/Vaso-Seal may be used at end of procedure to close artery and maintain homeostasis. * Homeostasis may also be achieved by direct manual pressure, a mechanical compression device, or a pneumatic compression device. * Pts with femoral approach that came to unit with sheath will need to **lie flat** while sheath is in place and several hours afterwards. * If sheath removal causes vasovagal response, IV atropine is used.
74
Complications of **PCI**
* MI * Bleeding and hematoma formation * Retroperitoneal bleeding * Arteriovenous fistual formation * Acute Kidney Injury
75
Nursing Management **Post Cardiac Surgery**
* Pain management * Assess cardiac, neuro, respiratory, renal, F&E **Goals:** * Maintain Cardiac Output * Maintain fluid and electrolyte balances * Promote adequate gas exchange * Monitor for Impaired Cerebral Circulation * Maintain adequate tissue perfusion * Maintain body temperature * Promote health and community based care * Prevent postoperative delirium: *early screening & interventions, frequent reorientation, F&E balance*

NRS 105 Exam #2 (6 decks)

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