Cardiac Flashcards

Question

Chronic Stable Angina: Patho and treatment

Answer 1

Intermittent decreased blood flow to heart that leads to ischemia. This ischemia can lead to temporary pain/pressure in the chest because of the low perfusion due to exertion. Relieved by Rest and nitro Treatment: Nitro Beta blockers ( for prevention of Angina) - Decreases contractility, decreases CO thus decreasing workload of the heart. Calcium Channel Blockers ( prevention of angina) - decreases the afterload through vasodilation and increases oxygen to the heart muscle ASA: Antiplatelet.

Answer 2

``` Rest frequently Avoid Overeating Avoid excess caffeine of any drugs that increase HR Wait 2 hours after eating to excercise Dress warmly in cold weather ( any temperature extreme can precipitate an attack) Take Nitro prophylactically Smoking Cessation Lose Weight Avoid isometric exercise Reduce Stress ``` DO EVERYTHING YOU CAN TO DECREASE THE WORKLOAD OF THE HEART

Answer 3

Pre procedure: Ask if allergic to Iodine/contrast or Shellfish CHECK THAT KIDNEY FUNCTION because dye is excreted through the kidneys Acetylcytsteine is given pre- procedure if client has kidney problems. It protects the kidneys . HOT SHOT Palpitations are normal Post Procedure Monitor Vital Signs Watch the puncture site for bleeding and Hematoma formation Assess Pulselessness, Pallor, Pain, Paresthesia and Paralysis, extremely distal from puncture site, as well as circulation and vascular check Bed rest, Flat, Extremely straight for 4 -6 horus Major complication is hemorrhage report Pain ASAP If the client is on metformin, you must hold this med for 48 hours post procedure. We are worried about blood sugar impacting the kidneys.

Answer 4

Decreased Blood flow to the myocardium leads to both iscehmia and necrosis SIgns and Symptoms : Pain that is crushing, with pressure radiating to left arm and left jaw, N/V or pain between the shoulder blades Cold/clammy/ drop in BP and pulse Cardiac Output drops ECG changes Vomiting ( stimulates the vagus nerve which lowers the heart rate) PVC's because of hypoxia in the heart In women, they usually present with GI signs and symptoms, epigastric discomfort or pain between shoulders, an aching jaw or choking sensation. In the elderly and Diabetic, there will be behavioural changes, less or no pain, fainting and SHORTNESS OF BREATH

Answer 5

Cardiac specific isoenzyme Increased with damage to cardiac cells Elevates within 3 - 6 hours and peaks in 12 to 24 hours

Answer 6

Cardiac Biomarker with high specificity to myocardial damage Elevates within 3 to 4 hours and remains high for up to 3 weeks

Answer 7

Increased within 1 hour and peaks in 12 hours. Negative results are a good thing

Answer 8

Pulseless V. Tach, V.Fib and Asystole put the client at risk for sudden death Priority treatment V. Fib is DEFIB If the first shock doesn't work and the client remains in V-Fib, what is the first vasopressor we give? Epinephrine Amiordarone is an anti-arrhythmic and is used when V.Fib and pulseless VT are resistant to treatment and also for fast arrhythmias ( not a vasopressor)

Answer 9

Epinephrine

Answer 10

Amiodarone or Lidocaine. Hypotension is an important side effect of amiodarone so watch BP as it can lead to further arrthymias because of decreased perfusion.

Answer 11

any CNS changes

Answer 12

Oxygen, Aspirin, Nitro and Morphine Head up position ( decreases workload on the heart and increases effectiveness/CO) Thrombolytics Dissolves the clot that is blocking blood flow to the heart muscle --> decreases the size of the infarction Medications: alteplase, tenecteplasem reteplase and streptokinase Should be administered within 6 to 8 hours TIME IS BRAIN ( within three hours for a stroke client) Major complication: bleeding Obtain a good health/bleeding histroy ABSOLUTE CONTRAINDICATIONS: Intracranial neoplasm, intracranial bleed, suspected aortic dissection or internal bleeding, reent surgery, stroke, pregnant and ulcers During and after admin, we take bleeding precautions Follow-up therapy: Anti platelets are another important factor of thrombolytic therapy

Answer 13

For anticoagulants, antithrombotics and Tylenol overdose / liver disease or damage Watch for bleeding gums, hematuria and black stools. use electric razor, soft toothbrush, no IM's. Draw blood when starting IV's, decrease the number of puncture sites. NO ABG's

Answer 14

Includes all interventions such as angioplasty and stents Major complication of an angioplasty is an MI. The patient may bleed from the cath site or they could reocclude; If there is chest pain after the procedure, They must go to the cath lab to fix this as they are reoccluding. Antiplatelets are on BOARD : ASA, Clopidogrel, Abciximab and Eptifibatide ( last two given to clients who have been stented to keep artery open and those waiting to go to the cath lab)

Answer 15

Can be scheduled or emergency procedure Used with multiple vessel disease or left main coronary artery occlusion The LEFT main coronary artery supplies the entire left ventricle. Occlusion = death.

Answer 16

Smoking cessation Stepped care plan Diet changes : less fat, sugar and cholesterol No isometric exercises- increases the workload of the heart No Valsalva Maneouver No straining, suppositorys or docusate ( Use Stool softener) Sex can be resumed when client is able to walk up a flight of stairs - 1 week to 10 days. Safest time is the morning, when the client is well rested The best excercise is walking. S/s of heart failure (Weight gain, Ankle Edema, SOB and Confusion) - pt is at increased risk after MI

Answer 17

HF is a complication that can result from problems such as cardiomyopathy, valvular heart disease, endo-carditis, acute MI and HTN ``` Types: Left Sided: blood going back in towards the lungs Pulmonary congestion Dyspnea Cough Blood tinged frothy sputum Restlessness Tachycardia S-3 Orthopnea Nocturnal dyspnea ``` Right Sided Failure: Blood going backward into body systems. Can be caused by pulmonary embolism - hypoxia and pulmonary HTN increase the workload on the right side of the heart leading the R HF. COPD in the end stages is always hypoxic because the right side if failing from pulmonary edema/HTN ``` Distended Neck veins Edema Enlarged Organs Weight gain Ascites FVE ```

Answer 18

B-type natriuretic peptide Secreted by ventricular tissues in the heart when ventricular volume and pressures in the heart are increased Sensitive indicator Can be positive for heart failure when the CXR does not indicate a problem If pt is on nesiritide, turn it off 2 hours prior to drawing a BNP CXR Enlarged heart, pulmonary infiltrates (fluid) at lung bases Echocardiogram: Looks at the pumping action or ejection fraction of the heart. An ECG can also give you info on backflow and valve disease

Answer 19

ACE inhibitors DOC for HF results in arterial dilation and increased stroke volume Monitor for hyperkalemia because it blocks aldosterone, which usually excretes potassium ARBS Decrease arterial resistance and cause decreased BP Monitor for hyperkalemia because it blocks aldosterone, which usually excretes potassium Both these drugs decreases the workload on the heart by prevent vasoconstriction (decreasing the afterload) This will increase the cardiac output and keep blood moving forward out of the heart. Digoxin Monitor for toxicity, especially in the elderly. Used when client is in sinus rhythm or a.fib and has accompanying chronic HF Often given in combination with ACE inhibitor, ARBS, Beta blockers or diuretics Contractions are stronger, HR decreases Increasing Cardiac Output and Kidney perfusion Nursing considerations Normal dig level = 0.5 - 2 ng/ml You know dig is working because CO goes up Before giving, take apical pulse for one minute monitor electrolytes - Hypokalemia + digoxin = toxicity

Answer 20

Early signs: Anorexia, nausea, vomiting Late: weird arrhythmias and vision changes Any electrolyte imbalance can promote toxicity

Answer 21

Diuresis is a GOOD thing for this client because they can't handle the fluid. Diuretics will decrease the preload Give in the morning, because client will be peeing all day. At night, this will increase their risk for falls.

Answer 22

Low sodium diet Decreases fluid retention and helps decrease the preload Watch salt substitutes as they can contain excessive potassium Elevate head of the bed Weigh Daily and report gain of 4.4 lb ( 1-2 kg) Fluid retention - think heart problems 1st Report signs and symptoms of recurring failure

Answer 23

Your natural pacemaker is the SA node - it sends out impulses that make the heart beat If your heart rate drops to 60 or below, cardiac output can decrease, thus decreasing perfusion to organs such as brain and showing decreased CO symptoms Pace makers are used for symptomatic bradycardia They can be temporary ( invasive or non-invasive) or permanent. Most are on demand but you can also see fixed. Always worry if it drops below set rate Any pace maker will maintain a certain minimal heart tate depending on the set rate A demand pacemaker kicks in only when the client needs it OK for rate to increase, but never decrease

Answer 24

Monitor the incision Most common complication is electrode displacement Monitor ECG for changes Immobilize arm - avoid extension Assisted passive range of motion to prevent frozen shoulder Keep client from raising the arm higher than shoulder height pt teaching : Check pulse daily - ID card or bracelet - avoid electromagnetic fields and MRI's Signs and symptoms of Malfunction Loss of Capture - no contraction following stimuli ( can affect CO) Failure to sense - pacemaker fires at inappropriate times LOOK FOR DECREASED CO S/S

Answer 25

Who is at risk? Any one receiving IV fluids very quickly, The very young and very old and any person who has a history of heart or kidney disease Fluid is backed up into the lungs, the heart is unable to move the volume forward. Usually occurs at night when the client goes to bed. ``` Signs/Symptoms Sudden Onset Breathless Restless/anxious Productive cough ( pink frothy sputum) ```

Answer 26

Priority nursing action is to administer high flow oxygen. Monitor SPO2 and titrate to keep above 90% Meds: Furosemide : causes diuresis and vasodilation which traps more blood out in the arms and legs and reduces preload 40mg IVP over 1-2 minutes to prevent otoxicity Bumetanide: can be given IV push or as a continuous IV infusion to provide rapid fluid removal 1-2mg IVP over 1-2 minutes Nitro: Vasodilation to decrease afterload = increased CO because the heart is pumping against less pressure and more blood can move forward Morphine: 2mg IV push for vasodilation to decrease preload and afterload Nesiritide: IV infusion - short term therapy, not for more than 48 hours, vasodilates veins and arteries and has a diuretic effect Upright Position; Legs down. Improves CO because gravity helps pumping. promotes pooling of blood in lower extremities

Answer 27

Blood, Fluids or exudates hae leaked intp the pericardial sac resulting in compression of the heart. This can occur in an MVA, Right ventricular biopsy, an MI, pericarditis or hemorrhage post CABG ``` Decreased CO Increased CVP because of the pressure BP dropping because CO bottoming out Heart sounds will be muffled or distant Neck veins will be distended Pressures in all four chambers are the same Narrowed pulse pressure Shock Paradoxical pulses Dypsnea Increased pulse ```

Answer 28

Pericadiocentesis to remove fluid from around the heart | Surgery

Answer 29

If you have atherosclerosis in one place, you have it everywhere It is a medical emergency if you have an acute arterial occlusion Client will report numbness and pain. Extremity will be cold. No palpable pulses, More symptomatic in lower extremities Intermittent claudication - hallmark sign for arterial problems coldness numbness, decreased peripheral pulses, atrophy, bruit, thick and brittle nails and ulcerations Pain at rest means SEVER obstruction Treatment: Since arterial blood is having problems getting to the tissue, if you elevate the extremity, the pain would increase. WE DANGLE ARTERIES. Usually treated with angioplasty or endarterectomy

Answer 30

S/s - Fever, malaise, murmur, weight loss, splinter hemorrhage and Oslar nodes Splinter hemorrhages are tiny clots that run vertically under the finger nails. Oslers Nodes are painful subQ lesions thaat occur in the palms, soles and pads. Risk factos include: Mechanical heart valve replacement, IV drug use, dental procedures, rheumatic fever and immunosuppression

Answer 31

Pulse stops when client takes a deep breath

Answer 32

Characterized by inflammation and thrombosis of the vessels of the hands and feet. It is strongly associated with smoking. Usually treated with vasodilators and sometimes bypass surgery. Ulceration is a common complication.

Answer 33

A pulse that is forceful and then suddenly collapses. It is usually found in patients with aortic regurgitation, a condition caused by a leaky aortic valve. The left ventricle of the heart ejects blood under high pressure into the aorta.

Answer 34

High salt and fat intake, obesity, stress, alcohol consumption, inactivity, caffeine and vitamin D deficiency Primary HTN does not have any identifiable causes

Answer 35

is a narrowing of the mitral valve opening that blocks (obstructs) blood flow from the left atrium to the left ventricle. Mitral stenosis usually results from rheumatic fever, but infants can be born with the condition. Mitral stenosis does not cause symptoms unless it is severe. Does not cause syncope

Answer 36

Narrowing of the aortic valve. This causes reduced cardiac output and increased left ventricle pressure. Syncope is the hallmark

Answer 37

``` also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. Does not cause syncope. Symptoms: chest pain or tightness that increases with exercise and subsides when you're at rest. fatigue. heart palpitations. shortness of breath. difficulty breathing when lying down. weakness. fainting. swollen ankles and feet. ```

Answer 38

``` DVT Pulmonary embolisms Thromboembolic complications Prevention of clot formation Dialysis Open heart surgery DIC Atrial fibrillation with embolization ``` Contraindicated if bleeding SUBQ/IV Interactions: Increase heparin action with oral anticoagulants, salicylates, NSAIDS, penicillin, SSRIs. Decrease heparin action with digoxin, tetracyclines, antihistamines, cardiac glycosides, nicotine, nitroglycerin. Increase bleeding risk with garlic, ginger, ginkgo, green tea. MoA: Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III. Disadvantages: Does not dissolve clots that are already present ``` Side Effects: Injection site reactions Fever Chills Headache Rash ``` ``` Adverse Effects: Hemorrhage Hypotension Thrombocytopenia Anaphylaxis ``` Interventions: Monitor aPTT (Activated Partial Thromboplastin Time) Heparin dosage is adjusted to keep the aPTT between 1.5 and 2.5 times the normal control level. Have antidote Protamine Sulfate readily available. Monitor for bleeding. Do not massage SubQ injection. ``` Client Eduction: Purpose of medication. Avoid OTC preparations. Bleeding precautions. Carry ID identifying product ``` A typical aPTT value is 30 to 40 seconds. If you get the test because you're taking heparin, you'd want your PTT results to be more like 120 to 140 seconds, and your aPTT to be 60 to 80 seconds.

Answer 39

``` Common Uses: Decrease platelet aggregation Arterial thrombi Thrombotic stroke TIA’s Post-MI thrombi Prevents re-occlusion post stent ``` PO/IV Interactions: Increased bleeding when taken with Dong quai, feverfew, garlic, and ginkgo biloba. Advantages: Long-term, low-dose ASA therapy has been found to be both an effective and inexpensive treatment for suppressing platelet aggregation. Side Effects: GI complaints Tinnitus Dizziness Adverse Effects: Serious Bleeding episodes Thrombocytopenia Agranulocytosis Interventions: Monitor for bleeding Safety precautions Bleeding precautions Education: Teach bleeding precautions. Notify health care provider if surgery is scheduled while on antiplatelet medication. It should be discontinued at least 7 days prior to surgery

Answer 40

``` Anemia associated with: Chronic renal failure, HIV, and Chemotherapy Reduce need for blood transfusions in surgical clients. ``` Contrainducations: Uncontrolled hypertension Hypersensitivity to human albumin ``` SubQ/IV Interactions: Anticoagulants: need for an increase in heparin during hemodialysis Mechanism ``` MoA: Erythropoietin is one factor controlling the rate of red blood cell production. Side Effects: Hypertension Flushing Headache Seizures Fever Bone pain ``` Adverse Effects: Seizures Hypertensive encephalopathy CHF DVT ``` Interventions: Monitor hemoglobin. Target hemoglobin should never exceed 12g/dL Monitor Blood Pressure. Only use one dose per vial Do not shake solution, it can cause the glycoprotein to denature. 2g/dl. Monitor for seizures Client Education: Teach patient or family how to take blood pressure. Teach patient to avoid hazardous activity during treatment. Teach patients with renal disease to include high iron and low potassium foods in their diet: meat, dark green leafy vegetables, eggs and enriched breads.

Answer 41

Megaloblastic anemia Pregnancy Contraindications: Hypersensitivity Other types of Anemias ``` PO/SubQ Interactions: Estrogens, glucocorticoids, Hydantoin increase the need for folic acid. ``` MoA: Folic acid is needed for erythropoiesis to increase RBCs, WBCs and platelet formation needed in megablastic anemia and is necessary for DNA and RNA synthesis ``` Side Effects: Allergic bronchospasm Pruritus Rash General malaise Erythema ``` ``` Adverse Effects: Confusion Depression Excitability, irritability Anaphylaxis ``` Interventions: Monitor Hgb, Hct and reticulocyte count; and folate levels: 6 – 15mcg/mL baseline, throughout treatment Identify products taking that cause increase folic acid use: alcohol, oral contraceptives, estrogens, glucocorticoids. ``` Education: Teach foods high in folic acid: bran, yeast, dried beans, nuts, fruit, fresh vegetables, asparagus. Take as prescribed, do not double up Advise that urine may become dark ```

Answer 42

``` Vitamin B12 Deficiency, pernicious Anemia, Vitamin B12 malabsorption ``` ``` Contraindications: Optic nerve atrophy (Leber’s disease) Pregnancy and breastfeeding Cobalt Allergy ``` IM/SubQ/Nasal/Sublingual/PO ``` Interactions: Cimetidine, colchicine, chloramphenicol, aminoglycosides, anticonvulsants and potassium products cause a decreased absorption ``` ``` Side Effects: Fever Diarrhea Pruritus Flushing/itching Pain at injection site ``` ``` Adverse Effects: Cardiac failure Thrombosis Optic nerve atrophy Pulmonary edema Hypokalemia ``` Interventions Monitor potassium levels. Monitor CBC for increase in RBC, Hemoglobin. Monitor for CHF or pulmonary edema in cardiac patients Education: Life-long treatment is required for pernicious anemia. Teach foods high in B12 such as: egg yolks, fish, organ meats, dairy products, clams, and oysters.

Answer 43

``` Leukemia Melanoma Non-Hodgkin’s lymphoma AIDS related Kaposi sarcoma ``` SubQ/IM MoA: Has antiviral, antiproliferative, and immune-modulatory effects, which means that these drugs inhibit intracellular replication of DNA, interferes with tumor cell growth, and enhances natural killer cell activity. Advantages: Can improve resistance to invading microorganisms and reduce cell proliferation. ``` Side Effects: Flulike syndrome Nausea/Vomiting Diarrhea Anorexia Xerostomia Taste alterations Poor concentration ``` ``` Adverse Effects: Seizures Transient aphasia Psychoses Suicidal ideation Cyanosis Orthostatic hypotension Thrombocytopenia ``` Interventions: Keep prefilled syringes in the refrigerator. Do not freeze or shake. Protect from light. Obtain baseline CBC and liver function tests. Education: Keep prefilled syringes in the refrigerator. Do not freeze or shake. Protect from light. Notify prescriber of adverse effects.

Answer 44

Excessive bleeding from hyperfibrinolysis Contraindications: Disseminated intravascular coagulation (DIC) ``` IV/PO/1 hour Interactions: Factor IX complex: increased risk of thrombosis ``` MoA: Promotes clot formation by inhibiting plasminogen activators. Advantages: Antidote for thrombolytic therapy with excessive bleeding ``` Side Effects: Edema Headache Malaise Nausea/Vomiting Diarrhea Abdominal pain ``` ``` Adverse Effects: Uncommon and generally mild. Rare: Thrombophlebitis Orthostatic hypotension. ``` Interventions: Monitor bleeding episode. Continuous cardiac monitoring – Looking for signs of re-occlusion Monitor for signs of M

Answer 45

Acute MI Thrombolic stroke Pulmonary embolism DVT ``` Contraindications: Intracranial neoplasm Intracranial bleed Suspected aortic dissection Internal bleeding ``` ``` IV/5-10 mins Interactions: Increased bleeding when taken with oral anticoagulants, NSAIDs, ginkgo, garlic, ginger, green tea. Decreased effects when taken with nitroglycerin. ``` MoA: Promotes the fibrinolytic mechanism (converting plasminogen to plasmin, which destroys the fibrin in the blood clot). The thrombus disintegrates when a thrombolytic drug is administered within 4 hours after an acute MI. Necrosis is prevented or minimized. Advantages: Dissolves clot within 4 hours after an acute MI. Disadvantages; Risk for Hemorrhage ``` Side Effects: Bleeding Nausea Vomiting Fever ``` ``` Adverse Effects: Hemorrhage Anemia Bronchospasms Anaphylaxis Reperfusion anemias MI Stoke ``` Interventions: Check baseline vital signs and baseline CBC, PT, INR. Obtain medical and drug history. Bleeding history. Have Amicar readily available – Antidote. Continuous cardiac monitoring. Continuously monitor for hemorrhage for 24 hours. Initiate bleeding precautions Avoid venipuncture/arterial sticks Education: Explain thrombolytic treatment. Advise to report lightheadedness, dizziness, palpitations, nausea, pruritus, or urticaria. Avoid use of aspirin or NSAIDS for pain or discomfort.

Answer 46

11 - 12 seconds Should be 1.5 to 2.5 the normal when on Coumadin. (15.5 - 35 seconds)

Answer 47

0.9 - 1.2 Should be 2 .0 - 3.0 when on Coumadin for Afib and 2.5 -3.5 for a valve

Answer 48

30 to 40 seconds When on Heparin, should be 45 to 100 seconds

Answer 49

Increase HOB Dangle legs Low Salt diet

Answer 50

Aortic: 2nd intercostal space to right of sternal border Pulmonic: 2nd ICS to left of sternal border Erbs: 3rd ICS to the left of sternal border Tricuspid : 5th ICS to the lower left sternal border Mitral : Apex, PMI and 5th ICS at MCL

Answer 51

A sickle cell crisis is pain that can begin suddenly and last several hours to several days. It happens when sickled red blood cells block small blood vessels that carry blood to your bones. You might have pain in your back, knees, legs, arms, chest or stomach. The pain can be throbbing, sharp, dull or stabbing ``` Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain Acute chest syndrome Pulmonary hypertension Organ damage Blindness Leg ulcers Gallstones Priapism ```

Answer 52

This client is experiencing third-degree atrioventricular (AV) block, or complete heart block, which involves complete inhibition of impulse conduction from the atria to the ventricles, usually at the AV node or bundle of His. The atrial and ventricular rhythms are regular but unrelated to each other. A complete heart block results in bradycardia, decreased cardiac output, syncope, and possibly heart failure/shock. The client is typically symptomatic and requires immediate treatment with transcutaneous pacing until a permanent pacemaker can be inserted. Atropine, dopamine, and epinephrine can be used to increase heart rate and blood pressure until temporary pacing is available.

Answer 53

Milrinone (Primacor) is a phosphodiesterase-3 inhibitor given via IV infusion to increase contractility and promote vasodilation. Milrinone, an inotropic agent, is often prescribed to clients with heart failure unresponsive to other pharmacologic therapies. The medication is usually infused over 48-72 hours in a hospital setting; however, home infusion through a central line is becoming more common as a palliative measure for end-stage heart failure. Milrinone infusion requires central venous access (eg, peripherally inserted central catheter) as the medication is a vesicant and can cause extravasation if infused through a peripheral IV line. The home health nurse should perform the following: Ensure that an infusion pump is used to control the rate, and instruct the family on basic troubleshooting (Option 4). Evaluate medication effectiveness and possible side effects. Monitor the central line insertion site for infection. Change the central line dressing as prescribed (Option 3). Monitor daily weight (Option 1). Monitor blood pressure for possible hypotension (Option 2). Implement safety precautions as hypotension increases the client's risk of falling. A client may receive a milrinone infusion in the home for palliative treatment of end-stage heart failure. The infusion is set up via an infusion pump and infused through a central line. The client and family should be instructed on basic pump troubleshooting as well as the importance of measuring daily weight and blood pressure.

Answer 54

<100 pg/ml

Answer 55

20-215 U/L

Cardiac Flashcards

(81 cards)