Exam 2

Question 1

Preprocedural for Cardiac Catheterizations

Answer 1

Explain procedure to patient
Assess size and patency of coronary arteries and presence of collateral circulation
Identify pressure gradients for aortic an mitral valves
Assess pumping action of the left side of heart by measuring ejection fraction of left ventricle

Question 2

nursing implications for cardiac catheterizations

Answer 2

requires signed consent
patient must be NPO for 6-8hrs before
assess for allergy to iodine, shellfish, or contrast dye
have patient void before giving preoperative med
record baseline vital signs and mark location of pedal pulses
patient must lie still during test
procedural sedation used
ECG leads, BP cuff, O2 saturation monitor, CO2 monitor will be in place during the test

Question 3

What is PTCA

Answer 3

minimally invasive
open up an narrow or blocked coronary arteries

Question 4

what complications can arise from PTCA

Answer 4

Arrhythmias
Hematomas
Reocclusion
Contrast induced neuropathy

Question 5

what is CAD

Answer 5

damage in coronary arteries due to atherosclerosis

Question 6

what drugs are used for CAD

Answer 6

Antiplatelets
Statins
Aspirin sometimes
Plavix
Clopidogrel
Atorvastatin
Beta-blockers
nitro

Question 7

nursing interventions for CAD

Answer 7

Lipid panel- cholesterol: LDL very high; HDL very low
 EKG for changes in ST segment
 Stress test
 Cardiac cath
 Educate in heart healthy diet
 Control HTN
 Control diabetes
 Stop smoking
 Regular physical activity
 Weight management
 Encourage to adopt a healthy lifestyle
 Monitor chest pain

Question 8

side effects of CAD

Answer 8

Asymptomatic
Angina sometimes
SOB
Palpitations
Tachycardia
N/V
Cold clammy skin
Fatigue particularly in women

Question 9

What is HTN

Answer 9

 Asymptomatic
 Angina sometimes
 SOB
 Palpitations
 Tachycardia
 N/V
 Cold clammy skin
 Fatigue particularly in women

Question 10

What does HTN affect

Answer 10

 Vision changes, damages blood vessels in retina, blurred vision, inability to focus on objects, hemorrhagic stroke, CHF renal failure

Question 11

What are risk factors for HTN

Answer 11

African Americans, increase Na intake, smoking, decreased K+, decreased Vit D, family history, advanced age, increased cholesterol, too much caffeine, obesity, restricted activity, sleep apnea, stress

Question 12

what are symptoms of HTN

Answer 12

Blurred vision, headache, chest pain, nosebleeds

Question 13

What is treatment of HTN

Answer 13

 Reduce BP, control BP
 Quit smoking
 Lose weight
 Restrict sodium
 Restrict alcohol
 Exercise
 Get on a low fat diet & control stress

Question 14

What are meds for HTN

Answer 14

• Ace inhibitors (-pril)
• Beta blockers (-lol)
• Calcium channel clockers (-pine, -amyl)
• Diuretics
• atenolol

Question 15

What is hypertensive emergency

Answer 15

LIFE THREATENING
BP higher than 180/120
 Indication of target organ damage
 Symptoms: headache, blurred vision, seizures, nausea & change in LOC

Question 16

Nursing care for MI

Answer 16

 Assess VS
 Admin MONA
 Monitor for cardiogenic shock
 Monitor for arrhythmias

Question 17

nursing action for MI

Answer 17

 Give nitro 5 min apart up to 3x; if still in pain after 3x contact provider

Question 18

acute MI nursing actions

Answer 18

• EKG
• Stress test

Question 19

Symptoms of acute MI

Answer 19

• Chest discomfort (elephant on chest)
• Pain/ discomfort in arms, shoulder, back, neck, jaw, or top of stomach
• Dyspnea
• Nausea/ vomiting
• Wheezing
• Ashen, clammy, cool skin

Question 20

MI symptoms in women

Answer 20

• Discomfort in middle of chest or back, jaw pain, back pain
• Fatigue
• indigestion

Question 21

labs associated for MI

Answer 21

• Troponin <0.01
• CK-MB <3
• Myoglobin

Question 22

What is TEE

Answer 22

provide images of wall thickness, heart valve structure & function, atrial septum and presence of clots, and can calculate ejection fraction

Question 23

nursing implications of TEE

Answer 23

 Place patient on left side
 Test takes about 20 min

Question 24

preop for TEE

Answer 24

 NPO 4-6 hours before test
 IV access for sedation
 Apply ECG leads for monitoring
 Monitor pulse ox, end-tidal CO2, BP
 Observe patient after test until sedation has worn off

Question 25

diagnostic tests for HF

Answer 25

 Chest x-ray: will show enlargement of the hear or pulmonary infiltrate  Echocardiogram  Ejection fraction  Cardiac stress test  Cardiac cath  BMP

Question 26

nursing management of HF

Answer 26

 Antihypertensives * Ace inhibitors * Beta blockers * digoxin  diuretic

Question 27

nursing assessment of HF

Answer 27

 Daily weights  Elevated H&B  Periods of exercise and rest  Lung assessment  Assess diet  Stop smoking

Question 28

exacerbation of HF

Answer 28

 Uncontrolled HTN  Anemia  alcohol

Question 29

labs for HF

Answer 29

 BNP less than 100  Monitor Na, K+

Question 30

Right Sided HF S&S

Answer 30

 Fatigue  Increased peripheral venous pressure  Ascites  Enlarged liver and spleen  Distended jugular veins  Anorexia/ GI distress  Weight gain (greater than 3 Ib)  Dependent edema

Question 31

Left Sided HF S&S

Answer 31

 Dyspnea  Elevated pulmonary capillary wedge pressure  Pulmonary congestion * Cough * Crackles * Wheezes * Blood-tinged sputum * Tachypnea  Restlessness  Confusion  Orthopnea  Tachycardia  Fatigue  cyanosis pulmonary edema

Question 32

What is claudication

Answer 32

 Cramping pain in muscles brought on by exercise and relieved by rest  Decreases quality of life  Makes it hard for the patient to do physical activities

Question 33

Thrombophlebitis S&S

Answer 33

 Warmth  Redness and tenderness along course of vein accompanied by swelling  Firm, chord like  Occurs in superficial vein

Question 34

what is PAD

Answer 34

prevents oxygenated blood to get to distal extremities

Question 35

S&S PAD

Answer 35

 Pain: sharp, gets worse at night  Intermittent claudication- pain with exercise  Pulse- weak almost absent  No edema  Leg cold, pale, hairless  Dry, scaly, very think skin  Red sores in irregular shape with round punched out appearance  Gangrene

Question 36

treatment of PAD

Answer 36

 Dangle arteries to get blood moving  Daily skin care using moisturizers  Avoid smoking  Avid tight & restrictive clothing  Avoid heating pads  Vasodilators  Antiplatelets  exercise

Question 37

nursing assessment of PAD

Answer 37

 Cardiac assessment  Modifiable and nonmodifiable risk factors  Assess BP and monitor sitting to standing

Question 38

5 P's of PAD

Answer 38

 Pain  Pulseless  Pallor  Paresthesia  paralysis