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NCLEX > Cardiac Part 2 > Flashcards

Cardiac Part 2 Flashcards

(53 cards)

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1
Q

Leading cause of HF

A

HTN

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2
Q

Left HF S/S

A 
Lung problems
Blood tinged frothy sputum
S3
Restless
Orthopnea (SOB laying down)
Nocturnal SOB
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3
Q

2 common causes of RHF

A

PE - lung clot causes pooling of blood before it gets there, causing increased pressure and pulmonary HTN (RV has to push HARD to get blood to the lungs)

COPD - always have low O2 causing pulmonary HTN (hypoxia is #1 cause of pul HTN)

Pulmonary HTN b/c of increased workload on the R side of the heart

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4
Q

3 ways to diagnose HF

A
  1. BNP
  2. CXR
  3. Echo
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5
Q

What is BNP?
What do results mean?
What may alter this test?

A

B-Type Natriuretic Peptide

A substance that the ventricle tissue secretes when there is increased volume and pressure within the heart

Increased amounts are a sensitive indicator of HR and can be positive for HF when the CXR doesn’t show any problems

If a patient is taking nesiritide, turn it off 2 hours before drawing a BNP because this drug is man-made BNP and will give a false high

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6
Q

What will a HF CXR look like?

A

Enlarged heart

Pulmonary infiltrates / edema

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7
Q

What will an echo do?

A

Look at the pumping action of the heart muscle

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8
Q

What does a Swan Ganz cath do?

A

Cath floated to R side of heart and pulmonary artery to rapidly get hemodynamics, CO, and mixed venous blood sample

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9
Q

What is an easy access to get ABG samples?

A

Art line

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10
Q

NY heart association functional Classification of HF

A

Classes 1-4, 4 being the most

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11
Q

What are the 4 main drugs used in the management of HF?

A

ACE
ARB
Dioxin
Diuretics

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12
Q

Drug of choice for HF?

A

ACE Inhibitors

SE: hypotension, cough, hyperkalemia

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13
Q

How do ACE Inhibitors work?
How do ARBs work?

What do they both do?
So what do we watch for?

A

Suppress RAAS resulting in arterial dilation and increased stroke volume - prevent angio 1 to 2 conversion

Decrease arterial resistance and decreased BP - block angio 2 receptors

Block aldosterone, resulting in losing Na and water, and retaining K
Watch for S/S hyperkalemia

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14
Q

Standard core measure that a HF patient will be sent home with what? Why?

A

ACE Inhibitor and/or BB

They decrease the workload of the heart by preventing VC and promoting forward blood flow out of the heart

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15
Q

How does digoxin work?

Usually used for what?

A

Increased contractility and decreases HR to increase CO and kidney perfusion

A slow HR gives the ventricles more time to fill

Usually used with sinus rhythm or A fib in combo with HF

Often given with the 4 HF drugs

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16
Q

How is the dosing of Digoxin?

Normal level on the body?

A

Digitalizing dose - large 1st dose

Normal level: 0.5-2

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17
Q

What kind of blood transfusions do HF patients get?

A

NOT WHOLE BLOOD! If they need a specific component, they will receive that
Ex: Platelet transfusion, RBC transfusion

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18
Q

Early and Late signs of Dig toxicity

What should we monitor while they are on it?

What 2 things will especially put the patient at risk for toxicity?

NCLEX strategy here

A

Early: Anorexia, N/V
LateL Arrhythmias, Vision changes

Monitor Electrolytes

LOW potassium and dig

NCLEX: ANY E IMBALANCE CAN PROMOTE DIG TOXICITY

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19
Q

Signs that Dig is working?

What to check before we give it?

A

Increased CO

Apical pulse (5th IC space, left midclavicular line)

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20
Q

What do diuretics do?

When do we give them?

A

Decrease Preload

In the morning - pee a lot

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21
Q

How does a low sodium diet do for HF?
What should we watch for?
Examples of high sodium foods?

A

Decreases fluid retention and decreases preload

Na substitutes - contain excessive K

Canned/processed foods and OTC meds

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22
Q

How do pacemakers work in regards to HF?

Study These Flashcards
A

Increase HR with SYMPTOMATIC bradycardia (HR

23
Q

Always worry if what happens with the pacemaker?

Study These Flashcards
A

It drops below the set rate (minimal HR)

  • It’s okay for the rate to increase but NEVER decrease
24
Q

Fixed vs demand pacemaker

Study These Flashcards
A

Fixed:Fire at a fixed rate constantly

Demand: Only kicks in if the patient needs it

25
Post op pacemaker care Most common complication? What not to move Why do we do assistive passive ROM? How high can we raise the arm?
Monitor the incision Electrode displacement (wires pulled out - wires need time to imbed into the heart muscle) Immobilize arm - prevent displacement Frozen shoulder Not above shoulder height!! Unless wires might come out
26
Failure to capture What is happening? What causes this? What do we watch for?
Stimulus fired but heart doesn't react Not programmed right Dislodged electrodes Low battery Watch for decreased CO or decreased HR
27
Pacemaker edu Need a ID bracelet/card? What to avoid? Will they set off alarms?
Check HR daily YES Avoid electromagnetic fields (use opposite cell ear, large motors) Avoid MRI Avoid contact sports Will set off airport alarms
28
What is an ICD? Post op care?
Implantable Cardioverter Defibrillator / Cardiac device Be be used to pace the heart or defibrillate the patient in V Fib Same pot op care as pacemaker
29
Risks for getting pulmonary edema?
IVF really fast Young and old Hx of heart or kidney disease
30
What is happening in pulmonary edema? When does it usually occur?
Fluid in the lungs, heart can't more the volume forward Night time- promotes pooling
31
S/S Pulmonary edema
``` Sudden onset Breathless Restless/anxiety SEVERE HYPOXIA Productive cough and pink frothy sputum ```
32
How to treat pulmonary edema
``` High flow oxygen - keep above 90% Furosemide Bumetanide NTG Morphine Nesiritide ```
33
How do we give Furosemide?
40 mg IVP slowly over 1-2 min to prevent ototoxicity and hypotension
34
How do we give Bumetanide?
IVP or continuous infusion 1-2 mg IVP over 1-2 min
35
Why do we give NTG for pulmonary edema?
Decreases preload and after load to increase CO and promote forward blood flow
36
Why do we give morphine?
Causes vasodilation to decrease preload and after load Decrease agitation
37
Why do we give Nesiritide? Precaution? What to remember about this drug?
For short term therapy Don't give for more than 48 hours! Vasodilator veins and arteries and had diuretic effect DC 2 hours before BNP draw
38
How to position pulmonary edema patient
Upright with legs dependent (down) This improves CO and promotes pooling in LE
39
What happens in cardiac tamponade? What can cause this?
Blood, fluid, or exudate have leaked into the pericardial sac resulting in compression of the heart and improper filling capabilities MVA, RV biopsy, MI, pericarditis, hemorrhage after CABG
40
Hallmark signs of cardiac tamponade? Other S/S?
Increased CVP and Decreased BP ``` Muffled/distant heart sounds Distended neck veins with clear lungs Same pressure in all chambers (fluid all around the heart) SHOCK d/t decreased CO Narrowed pulse pressure ```
41
Narrow Pulse pressure think: | Widened pulse pressure think:
Narrow: Cardiac tamponade Widened: Increased ICP ** Need to know the baseline!!!
42
How to treat cardiac tamponade?
Pericardiocentesis to remove the fluid around the heart | Surgery
43
If you have atherosclerosis in 1 place, you have it ______
everywhere
44
What does it mean if you have an arterial occlusion? (numb, pain, cold, pulseless)
MEDICAL EMERGENCY
45
Hallmark sign of intermittent claudication
PAIN
46
What does pain at rest mean?
A severe obstruction
47
When arterial/oxygenated blood can't get to the tissues, what would we see?
``` Cold, numb DECREASED PERIPHERAL P Atrophy (decreased muscle tone d/t lack of O2) Bruit (turbulent blood flow) Skin/nail changes Ulcerations ```
48
If arterial/oxygenated blood is having trouble getting to the tissue, what's going to happen if you elevate the extremity?
Increased PAIN!!!! You are making it even hard for the blood to get there!
49
How are arterial disorders usually treated?
Angioplasty (balloon & stent) Endarterectomy (remove inner artery lining) Both increase perfusion
50
Rule of thumb for extremity placement for arterial / venous insufficiencies
ELEVATE veins | DANGLE arteries
51
If you don't know the artery in the question, try to think of where the artery feeds
Ex: Radial feeds hand, carotid feeds head, femoral feeds leg Ex: Carotid endarterectomy Think- Replenishing blood flow to the head so think ^LOC Ex: AAA patient post op has a leg cramp -- BAD! perfusion disrupted - DVT - Never delay treatment!! Get a wheelchair and then call MD! Don't just assume an answer that has increased perfusion anywhere or that flow will come booming in
52
Chronic ARTERIAL Insufficiency ``` Pain: Pulses: Color: Temp: Edema: Skin changes: Ulceration: Gangrene: Compression: ```
ARTERIAL Insufficiency Pain: Intermittent claudication Pulses: Decreased or absent Color: Pallor w/ elevation, red with lowering Temp: Cold, numb Edema: Absent or mild Skin changes: Thin, shiny, loss of hair over feet/toes, nail thickening Ulceration: If present, will involve toes Gangrene: May develop Compression: Not used
53
Chronic VENOUS Insufficiency ``` Pain: Pulses: Color: Temp: Edema: Skin changes: Ulceration: Gangrene: Compression: ```
VENOUS Insufficiency ``` Pain: None to aching Pulses: Normal (may be hard to palpate d/t edema) Color: Normal or petechiae or brown Temp: Normal Edema: Present Skin changes: Brown, leathery, scarring Ulceration: If present, will be on sides of ankles Gangrene: None Compression: Used ```

NCLEX (23 decks)

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