Flashcards in Cardio Deck (68):
Mnemonic for endocarditis S/S
fever, Roth spots, osler's nodes (open sores), murmur, Janeway lesion (red spots on hand feet), anemia, nail hemorrhage, emboli
S/S of a myocardial infarction:
Hypoxia that causes= ST segment elevation, T wave inversion, pathological Q wave, crushing angina
Note: pericardial friction rub heard 1 wk post MI
A pt w/MI will describe his pain as:
Crushing angina, MI pain last longer than 30 min, radiates to L arm and shoulder and requires morphine for relief
Three: dysrhythmia, cardiogenic shock, HF
NSG priority intervention for a MI
3) cardiac monitor
4) 2-4 L O2 via NC
5) IV access
PVC EKG S/S
Wide, bizarre QRS with absent P wave
Mnemonic for Pericarditis S/S
Pleuritic Angina (sharp, stabbing pain), pericardial friction rub, pulsus paradoxus, dyspnea, dysrhythmia (ST elevation)
Pleuritic angina, fever, leukocytosis
How do you assess for bleeding in a pot who underwent an iliac angioplasty?
Measure abdominal girth d/t bleeding into the retroperitonal space
Raynaud's dz S/S
Vasopastic D/o of the hands and feet causing:
Diminished peripheral pulsus, pale cyanotic extremities, brittle fingernails, thin skin
After cardiac catheterization, what position should the Pt be placed in
Supine, must keep the affected extremity flat d/t risk of hemorrhage or arterial occlusion
What are complications for an IABP:
Bc IABP affects aortic volume, it is contraindicated in pts with: significant aortic regurgitation and aortic dissection
Risk factors for primary HTN
High fat/NA intake, obesity, stress, EtOH, inactivity, caffeine, V D deficiency
What ate the risk factors for secondary HTN
DM, renal dz, Cushing's syndrome, hyperthyroidism, hyperaldosteronism, pheochromocytoma, birth control
How do you relieve Pericarditis pain?
Instruct pt to lean forward will sitting (keeps inflamed heart off of lungs) and administer meds (NSAIDS, corticosteroids, ABX)
Pt is getting a pericardiocentesis for a cardio tamponade. How should he be positioned?
For a pericardiocentesis, the Pt should be positioned supine with HOB 30-60 degrees for easier needle insertion
How is pain described in a pt with angina pectoris?
Angina pectoris pain occurs with activity, spreads to arms and back, and is relieved with rest
What is claudication?
Claudication is an arterial insufficiency to the lower extremities that causes pain to the leg muscles with a small amount of activity (walking up stairs) and is relieved by rest.
Where do abdominal aortic aneurysms occur and how are the assessed?
AAA occur below the renal arteries (90%) and are auscultated for bruits slightly distal to the renal arteries
What electrolyte imbalances are the common cause of VTac?
Hypomagnesemia, Hypokalemia, and Hyperkalemia
What are the 6 L (lows) of Hypokalemia
Hypokalemia 6 lows:
Low, shallow RR
Less stool (constipation)
What valvular dz causes syncope and DOE
Aortic stenosis (hallmark S/S is syncope)
When preparing to DFib a VFib pt, the synchronizer should be turned:
Off: synchronizer should be off before DFib-ing a VFib pt
The synchronizer is only turned on to cardiovert arrhythmias with QRS complexes (AFib). VFib does not have a QRS complex.
What is the most common PC with an AAA repair?
The PC of an AAA repair is AKF d/t possible renal arteries occlusion via wrong insertion of the stent.
What can trigger Prinzmetal's (aka variant) angina?
Because Prinzmetal's/variant angina is vasopastic, it can be triggered by cold, tobacco, stress, activity, and meds
A cardiac pt is deteriorating into carcinogenic shock. What are the S/S?
Because carcinogenic shock is inadequate flow of circulating blood, the S/S are:
Tachycardia, hypotension, weak and thready pulse, cold and clammy skin, and low UO
What triggers should you instruct a pt with Raynaud's Dz to avoid?
Raynaud's Dz is vasopastic to the extremities. Pts should avoid stress, cold, caffeine, and tobacco
Cardiac tamponade S/S
Muffled HS, tachycardia, hypotension, JVD
high pulmonary artery pressure wedge indicates:
High PAWP increase in pulmonary circulation = L HF
Major risk factors for CAD
HTN, obesity, tobacco, increase LDL (> 130)
Where can an aortic regurgitation and stenosis be auscultated?
Aortic stenosis=2nd ICS R sternal border
Percutaneous transluminal coronary angioplasty (PTCA) IS a balloon tipped cath inserted via femoral artery and advanced into coronary arteries to compress plaque
What conditions can exacerbate HF
chronic CHF can be exacerbated by infections, dysrhthmias, HTN, hyperthyroidism, anemia, and NSAIDs (NSAIDs can cause fluid/Na retention)
A stable AAA pt will indicate what S/S if it worsens?
Worsening pain in the back and abdomen d/t aneurysm possibly pressing on the lumbar nerve
Nursing interventions for endocarditis
ABX (long term IV ABX Tx), antipyretics, teach to take prophylactic ABX before dental work and other invasive procedures, teach pt to report fever, tachycardia, dyspnea, SOB
what is rheumatic heart dz?
Rheumatic heart can occur by heart damage 2/2 rheumatic fever (affects joints, skin, brain) caused by strep or by endocarditis
Pt with rheumatic endocarditis will have what S/S
Hx of strep pharyngitis (sudden sore throat, swollen lymph nodes, HA with 104 F), polyarthritis, chorea (emotional instability, muscle weakness, jerky movements), ring-like rash, murmurs/pericardial rub
What is the main cause of mitral stenosis in women
Mnemonic for mitral stenosis management
Mitral stenosis: DO-ABLE
D = diuretics for pulmonary overload
O = oxygen for hypoxia
A = ace inhibitors to reduce preload/afterload
B = BB to prevent dysrhthmias and heart load
L = low Na diet
E = exercise as tolerated
Surgery for mitral valve repair
What's the main cause of pulmonary stenosis
Congenital, tetralogy of Fallot
What is tetralogy of Fallot
4 abnormalities resulting in insufficiency of circulating oxygen:
1) narrowing of pulmonary valve
2) thickening of R ventricle
3) displaced aorta over ventricular septal defect
4) ventricular septal defect opening
Pulmonary edema Tx Mnemonic
M = morphine
D = diuretics (furosemide)
O = oxygen
G = gases (blood gases)
What are the the classic signs of aortic stenosis
Dyspnea, syncope, angina (SAD)
what is the common cause of cardiomyopathy?
Myocarditis: after initial infection subsides, immune system will continue to damage the heart muscle, weakening the heart
What is MI
Myocardial infarction is necrosis of myocardial tissue (may be sudden/gradual from 3-6 hrs); caused by CAD (atherosclerotic plaques), thrombi, stenosis of coronary arteries
What are the risk factors for MI
Hx of smoking/obesity/diabetes/sedentary lifestyle, hyperlipidemia, stress, depression
pain that radiates to L arm/jaw/neck/shoulder blades, impending doom, pain not resolved w/rest, mild indigestion-to no pain, SOB, N/V, (large ST elevation s/s of shock = emergency revascularization)
What would you expect the MD to order for a pt w/a suspected MI?
ECG (12 lead for ST & arrhythmias), elevated CK-MB, & troponin
MI management mnemonic:
O = Oxygen
H = Heparin
B = BB (decrease myocardio O2 demands/arrhythmias)
A = ASA
T = Thrombolytics
M = morphine
A = ACE (reduces cardiac remodeling)
N = nitroglycerin (decrease pain/pre/after -load)
MI surgical TXs:
1: coronary angiogram (cardiac cath for a percutaneous transluminal coronary angioplasty or stent; tPa to dissolve any thrombus)
2: pulmonary artery/Swan-Ganz to monitor pulmonary artery & f(x) of L vent
3: intra-aortic balloon counterpulsation if cariogenic shock occurs
A pt with post MI wants to know when to resume sexual activity?
Pt can gradually resume sexual activity if he can walk up 2 flights of stairs w/no S/S; Don't take Viagra w/NTG d/t severe hypotension
What is cardiac tamponade?
cardiac tamponade occurs when fluid quickly fills the pericardial sac minimizing CO = need ER care before cardiac arrest occurs
Cardiac Tamponade Triad S/S:
hypotension, muffled HS, marked JVD
in addition: pulsus paradoxus, narrowed pulse pressure (poor CO indicator), tachypnea/tachy, decreased LOC
Cardiac Tamponade Tx:
pericardiocentesis, bed rest w/HOB 35-45 degrees, monitor for PCs: pneumothorax, arrhythmias, hypotension
Blood pressure Guidelines:
Normal = < 120/80 mm Hg
PreHTN = 120-139/80-89
HTN1 = 140-159/90-99
HTN 2 = > 160/100 mm Hg
DASH = fruits, veggies, fat-free or low fat dairy, whole grains, fish, poultry, beans, nuts
What are the 6 Ps of acute arterial occlusion?
Pallor (mottling), pain, paresthesia, pallor (cool/cold skin), pulselessness (distal to blockage), paralysis
What and why is this med, pentoxifylline (trental) given?
Pentoxifylline is given to pts w/chronic arterial occlusive Dz. It promotes blood flow by making blood more slippery
Disseminated Intravascular Coagulation S/S:
Bleeding, blood clots, bruising, drops is BP
Dyspnea, fatigue & weakness, edema in legs, ankles, and feet
Sickle Cell Dz S/S:
Episodes of pain, anemia, frequent infections
Common AFib S/S:
Fluttering or Thumping sensation in the chest
Excessive bruising, bleeding, swollen & painful joints, lengthy bleeding
Orthostatic hypotension S/S and Tx:
decrease in SBP 15 mm Hg accompanied w/increase in HR 15-20 BPM above baseline w/a change in position from supine to upright, dizzy
Tx: Instruct pt to increase fluid intake for several hrs if MD okayed and reassessed for hypotension resolution
You notice that a pt w/a chest tube connected to -20 cm suction has constant bubbling in the eater seal chamber. What is the nsg priority?
Continuous bubbling in the water seal chamber indicates an air leak. Priority is to assess the chest tube dressing, tubing, drainage system for leaks. If there's no leak in the equipment, then the leak is coming from the pt
A pregnant client, at 34-weeks gestation, is diagnosed with a pulmonary embolism (PE). Which of these medications does the nurse anticipate the health care provider will initially order?
A: SQ heparin 5000 units twice a day
B: Low dose ASA tx
C: Heparin infusion to maintain the aPTT at 1.5-2 times the control value
D: Warfarin (coumadin) tx every other day to maintain a PT at 1.5-2 times the control value
C: Heparin infusion
Clients diagnosed with PE, whether pregnant or not, are initially treated with intravenous unfractionated heparin (UFH). The client's activated partial thromboplastic time (aPTT) should be monitored and kept in the therapeutic range of between 1.5 to 2 times the baseline value. Alternatively, low molecular weight heparins, such as enoxaparin (Lovenox), can be used to treat PE in women who are pregnant. Warfarin should never be given during pregnancy due to its teratogenic effects. Although aspirin has anticoagulant properties, low dose aspirin therapy (81 mg), with or without heparin, is more often used prophylactically to prevent the development of deep vein thrombosis.
An 88 year-old client is admitted to the telemetry unit following a minor surgical procedure. The client’s history includes insulin dependent diabetes and a previous myocardial infarction. The nurse responds to the client’s ECG alarm and finds the client's rhythm shows asystole and the client obtunded but responsive. Prioritize the actions of the nurse (with 1 being the top priority).
A: Look at a different ECG lead to confirm rhythm
B: Check BG level
C: Initiate emergency response system if indicated
D: Assess RR and pulse
D, C, A, B
After checking responsiveness, establishing a patent airway and then assessing breathing and circulation are the next priorities (ABCs). This assessment would provide information to decide whether the emergency response team is needed. Because the client is responsive, the monitor rhythm is not correct, as a client with asystole would be unresponsive. Asystole on a rhythm strip may simply be a loose lead; a quick way to check this is to select another lead. The client's obtunded state indicates that ion is needed, so assessment of a central pulse and blood pressure is indicated to determine whether cardiovascular compromise is responsible for this condition. If no evidence of an immediate cardiac event is present, the blood glucose should be checked. Stress and changes in food or fluid consumption secondary to surgery increase the risk of glucose imbalance in the person with diabetes.
A nurse admits a client transferred from the emergency department (ED). The client, diagnosed with a myocardial infarction, reports substernal chest pain, diaphoresis and nausea. What should be the first action taken by the nurse?
A: Order the PRN 12-Lead ECG
B: Obtain VS
C: Give PRN NTG
D: Administer IV morphine Sulfate as ordered
D: IV Morphine (MONA)
Decreasing the client's pain is the priority at this time. As long as pain is present, a danger exists for the extension of the infarcted area. Morphine administered intravenously or sublingually will quickly decrease the oxygen demands of the heart, dilate the coronary arteries and cause the client to relax, further decreasing myocardial oxygen demand. Because the client is diagnosed with an MI, the narcotic analgesic should be given instead of the nitroglycerin, which is used to dilate the coronary arteries in ischemic episodes such as acute coronary syndrome. The other actions are also appropriate, but are a lower priority than the immediate relief of ischemic pain.