Care Of The Cardiac Paitent

Question 1

CAD; modifiable risk factors

Answer 1

-Smoking
-Inactivity
-Obesity
-High blood pressure
-High cholesterol/triglycerides

Question 2

CAD; non modifiable risk factors

Answer 2

-Diabetes
-Age
-Gender
-Family history
-Race

Question 3

CAD; other risk factors

Answer 3

-Increased hematocrit (hct)
-Environment (Urban>rural)
-High resting HR
-High uric acid
-Oral contraceptive use
-Increased homocysteine level

Question 4

CAD; Stage 1 development

Answer 4

-Injury starts with damage to intimal wall
-Arterial wall becomes permeable to lipoproteins

Question 5

CAD; stage 2 development

Answer 5

-lipoproteins invade intima
-Fatty streaks form

Question 6

CAD; stage 3 development

Answer 6

-Acute disruptive phase
-Calcification or rupture of cardiac plaque
-Thrombosis can occur and result in nearly total occlusion of the arterial lumen

Question 7

CAD; stage 4 development

Answer 7

-Fibrous plaque develops and obstructs blood flow

Question 8

Types of Angina

Answer 8

-Stable
-Unstable
-Prinzmental’s

Question 9

NM of CP; ER

Answer 9

Primary goals are to relive chest pain and decrease anxiety.
-History
-IV
-Monitor
-MONA/Thrombolysis/LMWH
-Psychosocial care
-Diagnostics (12 lead, cardiac makers)

Question 10

NM of CP; ICU/CCU

Answer 10

Primary goal is to monitor for complications of MI and recurrence of CP.
-Assessing CP
-Vasoactive drips
-Serial 12 leads, Cardiac markers
-Provide serene environment
-Psychological care pt and family
-Decrease anxiety

Question 11

NM of CP; medicine/telemetry floor

Answer 11

Primary goal is to monitor for complications, recurrent chest pain, and patient teaching.
-if telemetry monitor for arrhythmias (most common complication)
-Monitor for chest pain
-Prepare for diagnostic tests such as heart catheterization, nuclear med tests, echocardiogram.
-Prepare pt for interventional treatment.

Question 12

Adult CPR Technique

Answer 12

-Ratio of compressions to breaths is 30:2
-100-120 Compressions per minute
-5-6cm deep
-5 Cycles takes 2 minutes
-Allow complete recoil between compressions
-Change compressor every two minutes
-Minimize interruptions in chest compressions
->60% of total CPR should be chest compressions

Question 13

5 H’s

Answer 13

-Hypovolemia
-Hypoxia
-Hypothermia
-Hypo/hyperkalemia
-H+ (acidosis)

Question 14

5 T’s

Answer 14

-Tablets (toxins)
-Tension pneumothorax
-Tamponade
-Thrombosis - MI
-Thrombosis - PE

Question 15

What is an ‘unstable’ paitnet

Answer 15

Impaired vital organ functions
-Altered mental status
-Ischemic chest pain
-Acute heart failure
-Hypotension
-Other signs of shock
Immediate treatment is required

Question 16

What are 3 things we can do for PEA/Asystole?

Answer 16

-Effective CPR
-Epinephrine (give immediately once PEA or Asystole is identified)
-Find and treat reversible causes

Question 17

What constitutes bradycardia?

Answer 17

-HR <60bpm
-Usually asymptomatic unless HR <50bpm
-May be physiologic
-Commonly associated with hypoexima

Question 18

How do you define tachycardia?

Answer 18

-HR >100bpm
-Usually not symptomatic unless HR >150
-May be physiologic response
-Hypoxemia a common cause

Question 19

Cardiac pharmacy; common side effects to watch for

Answer 19

-Bleeding
-Deceased HR (symptomatic)
-Decreased B/P
-Rhythm disturbances

Question 20

Anticoagulants

Answer 20

-Heparin
-LMWH (ex Enoxaparin)

Question 21

ACE inhibitors

Answer 21

(Ex altace, captopril, vasotec)
-primary function is to block the vasoconstriction and sodium and water retention associated with the activation of the renin-angiotensin-aldosterone system (blocks the conversion of angiotensin 1 to angiotensin 2)
-Watch out for…decreased BP, light headedness

Question 22

Calcium channel blockers

Answer 22

(Ex adalat, cardizem, verapamil)
-Causes coronary artery and peripheral vasodilation, decreased contractility, can depress AV and SA node.
-They decrease cardiac workload by decreasing afterload and preload
-Works well in prinzmental’s angina
-can control tachydysrythmias