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Mnemonic for endocarditis S/S

FROM JANE

fever, Roth spots, osler's nodes (open sores), murmur, Janeway lesion (red spots on hand feet), anemia, nail hemorrhage, emboli

1

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

2

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

3

MI PCs

Three: dysrhythmia, cardiogenic shock, HF

4

NSG priority intervention for a MI

1) nitroglycerin
2) morphine
3) cardiac monitor
4) 2-4 L O2 via NC
5) IV access

5

PVC EKG S/S

Wide, bizarre QRS with absent P wave

6

Mnemonic for Pericarditis S/S

APPDD:
Pleuritic Angina (sharp, stabbing pain), pericardial friction rub, pulsus paradoxus, dyspnea, dysrhythmia (ST elevation)

Pleuritic angina, fever, leukocytosis

7

How do you assess for bleeding in a pot who underwent an iliac angioplasty?

Measure abdominal girth d/t bleeding into the retroperitonal space

8

Raynaud's dz S/S

Vasopastic D/o of the hands and feet causing:

Diminished peripheral pulsus, pale cyanotic extremities, brittle fingernails, thin skin

9

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

10

What are complications for an IABP:

Bc IABP affects aortic volume, it is contraindicated in pts with: significant aortic regurgitation and aortic dissection

11

Risk factors for primary HTN

High fat/NA intake, obesity, stress, EtOH, inactivity, caffeine, V D deficiency

12

What ate the risk factors for secondary HTN

DM, renal dz, Cushing's syndrome, hyperthyroidism, hyperaldosteronism, pheochromocytoma, birth control

13

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)

14

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

15

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

16

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.

17

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

18

What electrolyte imbalances are the common cause of VTac?

Hypomagnesemia, Hypokalemia, and Hyperkalemia

19

What are the 6 L (lows) of Hypokalemia

Hypokalemia 6 lows:

Lethargy
Lethal dysrhthmias
Leg cramps
Limp muscles
Low, shallow RR
Less stool (constipation)

20

What valvular dz causes syncope and DOE

Aortic stenosis (hallmark S/S is syncope)

21

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.

22

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.

23

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

24

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

25

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

26

Cardiac tamponade S/S

Muffled HS, tachycardia, hypotension, JVD

27

high pulmonary artery pressure wedge indicates:

High PAWP increase in pulmonary circulation = L HF

28

Major risk factors for CAD

HTN, obesity, tobacco, increase LDL (> 130)

29

Where can an aortic regurgitation and stenosis be auscultated?

Aortic regurgitation=apex
Aortic stenosis=2nd ICS R sternal border

30

PTCA procedure

Percutaneous transluminal coronary angioplasty (PTCA) IS a balloon tipped cath inserted via femoral artery and advanced into coronary arteries to compress plaque

31

What conditions can exacerbate HF

chronic CHF can be exacerbated by infections, dysrhthmias, HTN, hyperthyroidism, anemia, and NSAIDs (NSAIDs can cause fluid/Na retention)

32

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

33

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

34

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

35

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

36

What is the main cause of mitral stenosis in women

Rheumatic fever

37

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

38

What's the main cause of pulmonary stenosis

Congenital, tetralogy of Fallot

39

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

40

Pulmonary edema Tx Mnemonic

M-DOG

M = morphine
D = diuretics (furosemide)
O = oxygen
G = gases (blood gases)

41

What are the the classic signs of aortic stenosis

Dyspnea, syncope, angina (SAD)

42

what is the common cause of cardiomyopathy?

Myocarditis: after initial infection subsides, immune system will continue to damage the heart muscle, weakening the heart

43

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

44

What are the risk factors for MI

Hx of smoking/obesity/diabetes/sedentary lifestyle, hyperlipidemia, stress, depression

45

MI S/S:

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)

46

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

47

MI management mnemonic:

OH BATMAN:

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)

48

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

49

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

50

What is cardiac tamponade?

cardiac tamponade occurs when fluid quickly fills the pericardial sac minimizing CO = need ER care before cardiac arrest occurs

51

Cardiac Tamponade Triad S/S:

hypotension, muffled HS, marked JVD

in addition: pulsus paradoxus, narrowed pulse pressure (poor CO indicator), tachypnea/tachy, decreased LOC

52

Cardiac Tamponade Tx:

pericardiocentesis, bed rest w/HOB 35-45 degrees, monitor for PCs: pneumothorax, arrhythmias, hypotension

53

Blood pressure Guidelines:

Normal = < 120/80 mm Hg
PreHTN = 120-139/80-89
HTN1 = 140-159/90-99
HTN 2 = > 160/100 mm Hg

54

HTN Diet?

DASH = fruits, veggies, fat-free or low fat dairy, whole grains, fish, poultry, beans, nuts

55

What are the 6 Ps of acute arterial occlusion?

Pallor (mottling), pain, paresthesia, pallor (cool/cold skin), pulselessness (distal to blockage), paralysis

56

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

57

Disseminated Intravascular Coagulation S/S:

Bleeding, blood clots, bruising, drops is BP

58

HF S/S:

Dyspnea, fatigue & weakness, edema in legs, ankles, and feet

59

Sickle Cell Dz S/S:

Episodes of pain, anemia, frequent infections

60

Common AFib S/S:

Fluttering or Thumping sensation in the chest

62

Hemophilia s/s:

Excessive bruising, bleeding, swollen & painful joints, lengthy bleeding

63

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

64

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

65

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.

66

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.

67

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.

68

In order to enhance a client's response to medication for chest pain from acute angina, the nurse should emphasize which approach?

A: Eat smaller meals
B: Learning relaxation techniques
C: Avoiding passive smoke
D: Limiting alcohol use

B: Learning relaxation techniques

The only factor that can enhance the client's response to pain medication for angina is reduction of anxiety through relaxation methods. Anxiety may increase intensity to a point where pain medication outcomes are totally ineffective.