Cardiac

Question 1

What is released when the heart is stretched

Answer 1

BNP

Question 2

What is sterlings law

Answer 2

CO = HR X SV

Question 3

What drugs affect preload

Answer 3

diuretics and nitrates

vasodilate or diurese to reduce preload (amount of stretch)

Question 4

what drugs affect afterload

Answer 4

ACE inhibitors, ARBS, Hydralazine, Nitrates (vasodilate to reduce afterload)

Question 5

what drugs improve contractility

Answer 5

Inotropes

dopamine, dobutamine, milrinone

Question 6

What drugs are used for rate control

Answer 6

beta blockers, calcium channel blockers, digoxin

Question 7

what is used for rhythm control

Answer 7

antiarrhythmics

Question 8

What 3 arrhytmias are always a big deal

Answer 8

pulseless V tach, Vfib, asystole

CPR NOW NO CO

Question 9

What is chronic stable angina

Answer 9

when there is intermittent decreased blood flow to the heard causing ischemia.
usually on exertion

Question 10

when does stable angina cause pain

Answer 10

on exertion due to low O2 to heart

Question 11

what relieves pain in stable angina

Answer 11

rest or nitro SL

Question 12

what are the actions of nitoglycerin

Answer 12

venous and arterial dilation decreasing preload and afterload
dilates coronary arteries –> increase blood flow

Question 13

what is the timing of administering nitro

Answer 13

1 every 5 min x 3 doses

Question 14

how often should nitro SL be renewed? spray?

Answer 14

SL: 6 months
spray: 2 years

Question 15

common side effect of nitro

Answer 15

HA

Question 16

for pts taking nitro when should an ambulance be called

Answer 16

if still pain after 1 spray

Question 17

what should happen to BP after nitro

Answer 17

decrease

Question 18

what do BP do

Answer 18

block beta cells –> receptor sites for epi and NE

decrease BP, P and contractility –> decreases workload of heart

Question 19

what happens with CO when taking beta blockers

Answer 19

decreases

Question 20

what drugs are given for stable angina

Answer 20

nitro
beta blockers
calcium channel blockers
ASA

Question 21

give examples of calcium channel blockers

Answer 21

nifedipine
verapamil
amlodopine
diltiazem

Question 22

how do calcium channel blockers work

Answer 22

vasodilation of arterial system

dilate cornary arteries

Question 23

what are two benefits of caclcium channel blcokers

Answer 23

decrease afterload and increase oxygen to the herat muscle

Question 24

How does Aspirin work

Answer 24

prevents platelets from sticking together –> keeps blood flow

Question 25

What is an important question to ask pre procedure regarding cardiac catheterization

Answer 25

are they allergic to iodine or shellfish

Question 26

what is important to check prior to cardiac catheterization

Answer 26

renal function since you excrete the dye through your kidneys

Question 27

what might the patient experience during dye injection for cardiac catherterization

Answer 27

warm and flush | palpitations

Question 28

post cardiac catherization what it is important to do as a nurse

Answer 28

assess puncture site for bleeding assess extremeity distal to puncture site for 5ps bed rest, flat, extremeity striaghht ask pt. to report pain asap

Question 29

what are the 5 ps you must assess post cardiac catheterization

Answer 29

``` pulselessness pallor pain paresthesia paralysis ```

Question 30

where do you assess the 5 ps and when

Answer 30

post cardiac catheterization and extreity distal to puncture site

Question 31

what is the major complication we are worried about post cardiac catheterization

Answer 31

hemorrhage

Question 32

what medication is held prior to cardiac catheterization and when is it given again. why?

Answer 32

metformin, 48 hours after; worried about kidneys

Question 33

what is the number 1 sign of an MI in the elderly

Answer 33

SOB

Question 34

what 3 components in lab work are we looking at regarding the heart

Answer 34

CPK-MB Troponin Mytoglobin

Question 35

what is CPK-MB

Answer 35

cardiac specific increased with damage to cardiac cells elevates w/in 3-12 hours and eaks in 24 horus

Question 36

What is troponin

Answer 36

cardiac biomarker with high specificity to myocardial damage | elevates within 3-4 hours and reminas elevated for up to 3 weeks

Question 37

2 things about myoglobin

Answer 37

increases within 1 hour and peaks within 12 wnat a negative result

Question 38

what cardiac biomarker is the most sensitive indicator for an MI

Answer 38

troponin

Question 39

which enzymes or biomarkers are most helpful when the client delays seeking care?

Answer 39

troponin

Question 40

If shocking a client doesnt' work and the client remains in V-fib what is the first vasopressor we give

Answer 40

epinephrine

Question 41

what common antiarrhythmic do we give for rapid heartrates and pulseless VT

Answer 41

amiodarone

Question 42

what anti-arrhythmic drugs are given to preven a second episode of V fib

Answer 42

amiodarone and lidocaine

Question 43

what sign is indicative of lidocaine toxicity

Answer 43

neuro changes

Question 44

what is an important side effect of amiodarone

Answer 44

hypotension

Question 45

what 4 things are given for P in emerg

Answer 45

oxygen aspirin 160-325 nitro morphine

Question 46

what position do we keep an MI patient in and why

Answer 46

head up - decreases workload on the heart and increases CO

Question 47

what is ideal door to drug time for thrombolytics

Answer 47

30 mins

Question 48

how soon after the onset of myocardial pain should these drugs be administerd?

Answer 48

w/in 6-8 hours

Question 49

what is the major complication associated with thrombolytics?

Answer 49

bleeding

Question 50

what are 4 medications that require bleeding precautions

Answer 50

anti coags anti platelets anti thrombotics acetaminophen

Question 51

should you do ABGs on someone on bleeding precaution meds

Answer 51

hellz no; arteries bleed more

Question 52

what is PCI what are some examples

Answer 52

percutaneous coronary intervention | include all angioplasty and stents --> can be any artery including renal

Question 53

what is a major complicatoin of angioplasty

Answer 53

MI

Question 54

what happens if there is any problem with PCI

Answer 54

pt. goes straight to sx

Question 55

What is CABG? when is it used?

Answer 55

coronary artery bypass graft | used for multiple vessel disease or left main coronary artery

Question 56

what coronary artery if occluded resuts in immediate death

Answer 56

LCA or widowmaker

Question 57

what types of exercises should cardiac patients avoid?

Answer 57

isometric (weights)

Question 58

when can sex be resumed for cardiac patients

Answer 58

when they can walk around the block or up a flight of stairs w/o discomfort

Question 59

what is the safest time in the day for sex

Answer 59

morning time

Question 60

what is the best exercise for an MI patient

Answer 60

walking

Question 61

how is heart failure diagnosed

Answer 61

BNP (sensiive indicator; secreted b ventricle V and P is increased) CXR (enlarged heart) echo (look at pumping action and ejection fraction; also gives inromation on backflow and valve diseaes)

Question 62

What do ACE inhibitors do

Answer 62

suppress RAS prevent conversion of angio I --> II dilation and increased stroke volume

Question 63

what do ARBS do

Answer 63

block angiotension II receptors and cause a decrease in arterial resistance and BP

Question 64

What do ACE and ARBs block? what does this do?

Answer 64

block aldosterone --> lose water and sodium and retain potassium

Question 65

what needs to be monitored when taking digoxin

Answer 65

toxicity

Question 66

what does digoxin do

Answer 66

slows HR and increases strength of contractions, thus improving CO and kidney perfusion

Question 67

what is normal digoxin level

Answer 67

0.5-2

Question 68

what are the early signs and symptoms of digoxin toxicty

Answer 68

anorexia | N/V

Question 69

what are the late signs and symptoms of digoxin toxicitiy

Answer 69

arrhytmias and vision changes

Question 70

where is the apical HR found

Answer 70

5yh intercostal space mid clavicular

Question 71

what electrolyte imbalance are we worried about with digoxin? why

Answer 71

hypokalemia + digoxin = toxicity | ANY ELECTROLYTE IMBALANCE CAN CAUSE DIG TOXICITY

Question 72

what do diuretics do

Answer 72

decrease preload

Question 73

why should salt substitutes not be used in cardiac patients

Answer 73

contain excessive potassium

Question 74

what amount of weight gain needs to be reported

Answer 74

1-2 kg

Question 75

what should you think with fluid retention problems

Answer 75

HEART PROBLEMS

Question 76

when are pacemakers used

Answer 76

with symptomatic bradycardia

Question 77

what are the 3 types of pacemakers

Answer 77

temporary (invasive or non-invasive) | permanent

Question 78

whats the difference between demand and permanent pacemakers

Answer 78

fixed - constant rate | demand - kicks in when HR goes below set rate

Question 79

what is the most ommno complication post-op

Answer 79

electrode displacement

Question 80

what exercises should be done with permanent pacemaker clients? WHy?

Answer 80

assisted passive range of motion exercises --> prevent frozen shoulder

Question 81

why do you want to prevent pacemaker clients from raising their arms

Answer 81

could cause wires to fall out

Question 82

what is it called if no contraction will follow the stimulus

Answer 82

loss of capture

Question 83

wht is it called if the pacemaker fires at inappropriate times

Answer 83

failure to sense

Question 84

what can cause loss of capture, failure to sense or other malfunctions

Answer 84

not programmed properly electrodes dislodge battery may be depleted

Question 85

what client teaching needs to be done regarding pacemakers

Answer 85

check pulse daily ID card and bracelet avoid electromagnetic fileds (use cellphone on other side) AVoid MRIS

Question 86

who is at risk for pulmonary edema

Answer 86

reeiving IV fluids really fast the very young and very old any person who has a histroy of heart or kidney disease

Question 87

when does pulmonary edema ussually occr

Answer 87

at night --> increased venous return lying down

Question 88

what cough is associated with pulmonary edema

Answer 88

pink frothy sputum

Question 89

how is pulmonary edema treated

Answer 89

``` oxygen furosemide (push slow to prevent hypotension and ototoxicity) nitroglycerin morphine --> vasodilation nesiritide --> vasodilation sit upwright ```

Question 90

what drug infusion needs to be turned off 2 hours prio to drawing a BNP lvl

Answer 90

nesiritide

Question 91

what is cardiac tamponade

Answer 91

blood, fluid or exudate leaks into the pericardial sac resluting in compression of the heart

Question 92

what are the two hallmark signs of tamponade

Answer 92

``` increaseing CVP (heart is being squeezed) decreasing BP ```

Question 93

what should you think with narrowed pulse pressure

Answer 93

cardiac tamponade

Question 94

what should you think with widened pulse pressure

Answer 94

increased ICP

Question 95

what is the pulse pressure

Answer 95

difference between systolic and the diastolic

Question 96

we ______ veins and we ______arteries

Answer 96

elevate veins | dangle arteries