Flashcards in Cardio Exam 1 Study Guide Deck (30)
List diet considerations/examples for the pt with HTN
DASH (Dietary Approaches to Stopping HTN)
Low sodium, high potassium, high calcium diet proven to lower BP and cholesterol.
Limit alcohol intake.
apricots, bananas, tomatoes, potatoes, low fat dairy for calcium.
Define stable angina and unstable angina. What causes angina? How might the pt present? Goals of therapy/treatment? Pt education
Stable angina - exertional angina. occurs with exercise or emotional stress and is relived by rest of nitroglycerin (nitrostat)
Unstable angina - pre-infarction angina. occurs with exercise or emotional stress, but it increased in occurrence, severity, and duration over time.
Will present with anxiety, feeling of impending doom. Chest pain (substernal or precordial). Nausea and dizziness.
Nursing considerations for angio/cardiac catheterization (pre, infra, and post procedure)
Pre - client must understand the procedure prior to signing the informed consent. Ensure client remains NPO 8 hours prior to procedure. Determine the the client and family understand the procedure. Identify and report iodine/shellfish allergy (contrast media)
Infra – Remind patient that they will be awake and sedated during procedure. A local anesthetic is used. The client will feel warmth and flushed when the dye is inserted.
Post – Check vitals every 15 minutes’ x 4, every 30 x 2, every hour x 4, then every 4 hours. Monitor groin at the same intervals for bleeding hematoma formation, CMST. Maintain bed rest in supine positon with extremity strait for the prescribed time. Administer antiplatelet or thrombolytic agents to prevent clot formation and restenosis. Also anxiolytics (Ativan), and analgesics as needed for pain. Monitor urine output.
List causes of an MI
The main cause of an MI is when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle and heart muscle dies. The blood clot that causes the heart attack usually forms at the site of rupture of an atherosclerotic, cholesterol plaque on the inner wall of coronary artery.
S/S of an MI and reasons for symptoms
What are cardiac enzymes and why are they used?
These tests can measure blood levels of the enzyme creatine phosphokinase (CPK), also called creatine kinase (CK), and a more specific form of this enzyme called CK-MB.
Additionally, cardiac enzyme tests can be used to check blood levels of the proteins myoglobin and troponin.
What is creatine kinase? Why is it important?
An elevated level of creatine kinase is seen in heart attacks, when the heart muscle is damaged, or in conditions that produce damage to the skeletal muscles or brain.
S/S (early and late) of HF (differentiate between L and R sided). How do we monitor the pt with Heart Failure?
Left sided failure: dyspnea, orthopnea, SOB, fatigue, displaced apical pulse, S3 heart sound (gallop), pulmonary congestion, frothy sputum, altered mental status, organ failure.
Right sided failure: jugular vein distention, ascending dependent edema, abdominal distention, fatigue, nausea and anorexia, polyuria at rest, liver enlargement, weight gain.
Monitor daily weight and I&O, SOB, vitals.
Correct use of the defibrillator (when and how to use), proper pad placement.
An automated external defibrillator is used on a person who is having sudden cardiac arrest and may save the person’s life. Two pads are placed on the body. One on the right of the sternum below the clabicle (2nd and 3rd intercostal space. The other paddle left (4th or 5th intercostal space mid axillary line.
Describe each part of the PQRST of the ECG and be able to label each letter on a rhythm strip
The P wave, QRS complex and the T wave represent electrical activity in the heart on an electrocardiogram. The ECG Learning Center explains that the P wave represents the depolarization of the right and left atria. The QRS complex follows the P wave and depicts the activation of the right and left ventricles. Practical Clinical Skills reveals that the T wave indicates repolarization of the ventricles.
Describe how to apply and perform an ECG. Pt education while doing an EKG
atient must lie still while nurse places 12 leads on the body.
What is cardiac tamponade? What are the findings?
Compression of the heart caused by fluid collecting in the sac surrounding the heart. Findings include pain in the chest, low blood pressure, fainting, lightheadedness, fast heart rate, SOB, faint heart sounds, swelling in extremities, wheezing.
Who is at risk for HTN?
Those who have a BMI of more than 30, have diabetes, caffeine and alcohol drinkers, smokers, people who are severely stressed out, people who don’t work out at least 3 times a week.
List the classifications for HTN (pre, stage 1, stage 2)! Must know values.
Pre – systolic BP 120 to 139. Diastolic 80 to 89.
Stage 1 – Systolic 140 to 159. Diastolic 90 to 99.
Stage 2 – Systolic greater than or equal to 160. Diastolic greater than or equal to 100
Describe a low cholesterol diet, give examples.
Eliminate fatty parts of meat, dairy, processed meat, deep fried foods, and egg yolks can drop cholesterol.
Which electrolyte imbalances can affect cardiac status? Know those normal values/ therapeutic ranges.
Sodium (136-145), potassium (3.5 – 5.0), magnesium (1.3 – 2.1), and calcium (9.0 – 10.0) are involved in heart contraction and relaxation
List risk factors for CAD:
Atherosclerosis, hyperlipidemia, diabetes, smoking, HTN, sedentary lifestyle, stress, dissecting aneurysm, infection vasculitis, syphilis, congenital abnormalities.
What labs needs to be monitored for heparin and Coumadin? What are the expected and therapeutic ranges?
PT, PTT, INR
What is the purpose for taking anticoagulants/blood thinners in different disorders? (DVT, MI, A-Fib, etc.)
1. These drugs prevent blood clots and is important in a way to prevent disorders from happening.
What is cardioversion? What type of dysrhythmias require cardioversion
Cardioversion is a synchronized countershock that may be performed in emergencies for stable tachydysrhythmias that are resistant to medical therapies. Treatment of choice for symptomatic clients. Needed for those with atrial fibrillation.
S/S of hyper/hypokalemia. Normal K lab values.
Normal value is 3.5 – 5.0. Hypo <3.5. Hyper >5.0.
Hyper S/S: fatigue or weakness, feeling of numbness or tingling, nausea/vomiting, SOB, chest pain, palpitation.
Hypo S/S: constipation, palpitation, fatigue, muscle damage, muscle weakness or spasms.
What is a pacemaker? How do we assess for it? What are important nursing considerations? How will it affect an ECG? What are possible complication symptoms?
A small device placed in the chest to help control abnormal heart rhythms. Uses low energy electrical pulses to promt the heart to at a normal rate.
What is a stress electrocardiogram (stress test)?
The cardiac muscle is exercised by the client walking on a treadmill. Provides information regarding the workload of the heart. Patietns should bring exercise clothes/shoes/water. Should fast 2-4 hours before the procedure. Consent form.
What is an echocardiogram and patient education.
An ultrasound of the heart which is used to diagnose valve disorders and cardiomyopathy. Explain the reason for the test. Noninvasive and takes up to one hour. Patient will lay on left side and remain still. Provider review results and a plan for follow up care with client.
What is atherosclerosis? Differentiate between modifiable and non-modifiable risk factors? How can diet help?
Atherosclerosis is the type of arteriosclerosis that involves the formation of plaque within the arterial wall and is the leading risk factor for CAD. Modifiable factor: smoking, HTN, diabetes, sedentary lifestyle, stress, oral contraceptives. Non-modifiable: family hx, age, sex, culture, ethnicity.
What factors affect BP (think BP=C0 x SVR)
Smoking, being overweight, lack of physical activity, too much salt in diet, too much alcohol consumption, stress, older age, genetics
What labs may indicate HTN? List S/S of HTN.
No labs exist to diagnose HTN. Can check BUN and creatinine to check elevation is indicative of kidney disease. Elevated serum corticoids to detect crushing’s disease. Blood glucose and cholesterol studies can identify contributing actors related to blood vessel change. S/S include: headaches, dizziness, fainting, retinal changes, visual disturbances, nocturia.
Describe what a CABG is and nursing considerations for the procedure and the donor site. Where might the donor site be located, which vein?
Coronary artery bypass grafting is a type of surgery that improves blood flow to the heart. Left main coronary artery
What is a percutaneous transluminal coronary angioplasty? What are post procedure
Minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. Post op care: monitor vitals, monitor groin, monitor and identify thrombosis, maintain bedrest with supine position and leg straight for prescribed time. Document pedal pulses. capillary refill, color, temperature. Provide continuous cardiac monitoring.