Cardiac

Question 1

What can atrial dysrhythmia cause?

Answer 1

Decrease CO, no atrial kick (lost), hypotension, and thrombi (can cause stroke).

Question 2

What happens to the atria and ventricles during diastole?

Answer 2

atria contract/ventricles relax and fill

Question 3

What happens to the atria and ventricles during systole

Answer 3

atrial relaxation/filling and ventricular contraction

Question 4

S1 sound caused by the closure of what valves?

Answer 4

atrioventricular valve closure; “Lub” sound

Question 5

S2 sound caused by closure of what valves?

Answer 5

aortic/pulmonic valves close; “Dub” sound

Question 6

When can S3 be considered normal?

Answer 6

In children

Question 7

When is S3 produced?

Answer 7

when heart is overfilled or poorly compliant (Ex: CHF/fluid overload)

Question 8

When is S4 heard?

Answer 8

Just before the S1 is heard

Question 9

What causes murmurs?

Answer 9

turbulent blood flow- through heart valves or septal defect

Question 10

What are the Cardiac Enzymes?

Answer 10

CKMB, Troponin, Myoglobin

Question 11

What can hyperkalemia cause

Answer 11

Asystole and ventricular dysrhythmias

Question 12

Can you list 3 exams used to monitor heart function?

Answer 12

Cardiac stress test, echocardiogram, transesophageal echo, myocardial perfusion scan, electrophysiological testing (invasive), holter, Muga scan, ct scan, PET scan, MRA

Question 13

What is CVP?

Answer 13

Central venous pressure; pressure within the superior vena cava/right atrium and reflects end diastolic pressure; “filling pressure” of right ventricle

Question 14

What are some nursing actions we would expect to do after a cardiac cath insertion?

Answer 14

Evaluate distal peripheral pulses, color, warmth & sensation
Evaluate insertion site for hematoma and bleeding
Bedrest 6-8 hours post procedure, and keep affected limb straight 6-8 hours and do not elevate head more than 20 degrees if femoral artery used.
Encourage PO fluids to promote renal excretion of dye
Monitor urine output (should be at least 30 ml per hour)
Repeat H&H, BUN, Creatinine (dye can cause renal failure)
Possible sand bag to insertion site

Question 15

What type of diet should someone with CAD follow?

Answer 15

Low cholesterol, low salt, high fiber

Question 16

What is the area of dead muscle known as and how would this reflect on the ECG?

Answer 16

“Zone of Infarction” and seen by new Q waves reflecting lack of depolarization in the dead cells

Question 17

When does a STEMI occur?

Answer 17

STEMI usually occurs because of plaque rupture leading to complete occlusion of the artery

Question 18

How should we first assess an MI is occurring?

Answer 18

Thorough history and clinical presentation

Question 19

What are some signs and symptoms of an MI occurring?

Answer 19

Crushing substernal chest pain, may or may not radiate to left arm and/or jaw that is unrelieved with rest and nitrates
Diaphoresis and cool, clammy, pale skin, cyanosis
Dyspnea with and without crackles
Nausea and vomiting
Syncope and hypotension
Palpitations
Dysrhythmias such as PVCs, tachycardia, or bradycardia
Weakness
S3 sound indicating left ventricle involvement
Anxiety and fear, restlessness, feelings of impending doom

Question 20

How is Morphine usually given for an acute MI?

Answer 20

if pain not relieved with nitro: usually morphine sulfate 2 to 4 mg may be given every 5 to 15 minutes via I.V. push (NO IM’s)

Question 21

What is a normal Left Ventricular EF?

Answer 21

ranges from 50-70%

Question 22

What does EF 35 - 40% mean?

Answer 22

May confirm diagnosis of systolic heart failure

Question 23

What does an EF < 35% mean?

Answer 23

risk of life-threatening irregular heartbeats that can cause sudden cardiac arrest and death. An implantable cardioverter defibrillator (ICD) may be recommended for these patients

Question 24

List some ways nurses can help those with Heart failure?

Answer 24

High fowlers position (sometimes called orthopneic position)with legs in dependent position if severely short of breath
High concentration of oxygen (may need intubation if severe respiratory distress or Bi-pap)
Suction if needed (Lt. side failure frothy sputum)
Monitor vital signs
Cardiac monitoring for dysrhythmia
Assess for edema (peripheral, JVD, hepatomegaly, ascites, sacral)
I&O (insert foley, accurate I&O to determine effectiveness of treatment), avoid unnecessary IV fluids
Low sodium diet, low cholesterol diet; may be on fluid restriction
Daily weight and abdominal girth
Monitor peripheral pulses and capillary refill
Monitor ABGs and serum potassium levels (Lasix and Digitalis cause excretion of K+)

Question 25

What are some later signs of Endocarditis?

Answer 25

Loud regurgitant heart murmur or change in character of an existing murmur in the presence of fever is a classic sign Petechiae of the skin (upper ant. trunk), buccal, pharyngeal, and conjunctiva. Splinter hemorrhages of nail beds. Occasionally Osler’s nodes(tender raised lesions on fingers or toes), Roths spots (hemorrhagic areas with white centers on retina of eye), and Janeway lesions (purple macules on palms and soles) Emboli from vegetative lesions causing splenic, renal, cerebral, or pulmonary infarction or peripheral occlusion. Splenic infarction: pain in upper lt. quadrant radiating to the left shoulder and abdominal rigidity. Renal infarction: hematuria, pyuria, flank pain , and decreased output. Pulmonary infarction is most common in right sided endocarditis and often occurs among IV drug users and after cardiac surgery. Cough, pleuritic pain, pleural friction rub, dyspnea, and hemoptysis

Question 26

Difference between false and true aortic aneurysms?

Answer 26

False versus true (false aneurysm is usually caused by trauma; the vessel wall of the vessel is ruptured and blood escapes into the surrounding areas causing a clot to form) Treatment based on size; with those >5 CM usually requiring surgical repair

Question 27

After sustaining an MI, the patient is most at risk for developing what in the first 24 hours?

Answer 27

V Fib

Question 28

How will calcium channel blockers (CCB) influence contractility?

Answer 28

They will decrease contractility and must be used with caution in those with heart failure) Decrease in contractility (inotropic effect) decreases cardiac workload and O2 demands

Question 29

What are some manifestations of Cardiac tamponade?

Answer 29

``` Paradoxical pulse Narrowed pulse pressure, hypotension Tachycardia Weak peripheral pulses Distant, muffled heart sounds Jugular venous distention High central venous pressure Decreased level of consciousness Low urine output Cool, mottled skin ```

Question 30

What are some symptoms of right sided heart failure?

Answer 30

Peripheral edema, jugular vein distension, and hepatojugular reflex

Question 31

What assessment finding can given us more information about left sided heart function?

Answer 31

Status of breath sounds

Question 32

What is a risk assessment for CAD?

Answer 32

A risk assessment for coronary artery disease (CAD) is determined by comparing the total cholesterol to high density lipoprotein (HDL) and a ratio can be calculated by dividing the total cholesterol level by the HDL level. The ratio provides more information than either value alone and an increased ratio indicates an increased risk

Question 33

What are the goals of management of an AMI?

Answer 33

To dissolve the lesion that is occluding the coronary artery and to increase blood flow to the myocardium. Options: emergent percutaneous intervention, such as angioplasty, emergent coronary artery bypass surgery, or thrombolytic therapy if the patient has been symptomatic for less than 6 hours.

Question 34

Let's discuss the differences between pain in Angina vs in an MI

Answer 34

Angina: substernal chest discomfort maybe only radiating to Left arm, precipitated by exertion or stress, relieved by NTG or rest, lasts less than 15 min. MI: substernal radiating to Left arm, pain/discomfort in jaw, back, shoulder, or abdomen; occurs without cause; relieved only y opioids; lasts 30 mins or more; frequent associated symptoms like nausea/vomiting

Question 35

When would we usually see an asymptomatic MI occur?

Answer 35

In elderly patients, in women, and in diabetic patients

Question 36

When would a CABG be needed?

Answer 36

For significant (greater than 50%) occlusion is seen the left main coronary

Question 37

Why would we need to know that a patient is taking Sildenafil citrate prior to giving Nitroglycerin?

Answer 37

Meds for erectile dysfunction potentiate the hypotensive effects of nitrates

Question 38

What are some contraindications to thrombolytic therapy? (absolute)

Answer 38

If patient has had any prior intracranial hemorrhage Any known structural cerebral vascular lesions Any known malignant intracranial neoplasm An ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours A suspected aortic dissection Active bleeding Significant closed-head or facial trauma within 3 months

Question 39

What kind of activity should we recommend for those with Coronary artery disease?

Answer 39

Begin walking the same distance at home as in the hospital (usually 400 feet) 3 times each day Carry nitroglycerin with you Check your pulse before, during, and after the exercise Stop the activity for a pulse increase of more than 20 beats/min, shortness of breath, angina, or dizziness Make gradual increases in walking distance After an exercise tolerance test and your HCP approval, walk at least 3 times each week, increasing the distance every other week, until the total distance is 1 mile Avoid straining

Question 40

What is a major manifestation of MI in people older than 80yrs?

Answer 40

Disorientation or acute confusion due to poor cardiac output and inadequate coronary perfusion