Exam 2 ppt Flashcards

Question

Hypokalemia: serum K+ treatment

Answer 1

Be very careful when administering potassium! It burns! Either slow it down or dillute it more Potassium is NEVER administered by IV push or IM! Their heart stops and they die IV potassium must be administered using an IV pump Concentrations of potassium >20 mEq/100 mls should be administered through a central line No more than 10-20 an hour. Ex if you need to give 40ml, that will take 4 hours typically. Run alongside something else so it doesn't burn Potassium supplements are extremely dangerous for patients who have impaired renal function know heart rate and rhythm

Answer 2

``` Caused by decreased renal excretion, increased intake, medication effects, or a shift of potassium out of the cells as seen in acidosis or musculoskeletal injury muscle weakness paralysis nausea/vomiting colic ```

Answer 3

Clinical manifestations are cardiac, nervous system, and GI

Answer 4

Mild- Restrict potassium intake and/or potassium sparing medications. Serious- Cation exchange resins (e.g. Kayexelate. can be enema. Sticky and constipating. Tries pushing K into cells) Emergent- Intravenous bicarbonate, calcium, and insulin given together with 50% dextrose may be appropriate

Answer 5

Random draw reveals random 7.2 potassium level. If this occurs, redraw and recalculate. False positives can occur from clotted blood. When you look at a patient's labs, notice the trends to see where the patient is headed (upward or downward)

Answer 6

Inadequate intake, increased loss, malabsorption or increased binding of calcium Most of our calcium is in our bones. Calcium is carried by albumin Needed for bone structure,….............list she listed too fast Normally 8.5 to 10.5 mg/dL circulates: 40% bound to protein 10 % chelated (attached to other electrolyetes) 50% “free” or “ionized”-this is what moves into and out of cells. Need vitamin D. Add picture from ppt.

Answer 7

``` Tetany- ↑ neural excitability, spasms Paresthesia- tingling Refractory hypotension Arrythmias Seizures ```

Answer 8

Calcium replacement ! Don't give with phosphorus because it will precitate Seizure precautions!

Answer 9

Malignancy | Hyperparathyroidism

Answer 10

``` ↑ Calcium →↓neuromuscular excitability: Anorexia, N/V, constipation Muscle weakness/incoordination Confusion, lethargy, coma Bone pain Kidney stones/diuresis/thirst Cardiac arrest If your calcium is above 16, youre in trouble ```

Answer 11

``` Treat the underlying cause Increase fluids Restrict intake of calcium Mobilize the patient Monitor cardiac and neurological status Calcitonin: forces Ca into the bone ```

Answer 12

``` Magnesium travels with Potassium Also associated with Calcium Most ICU patients will experience depravation. Normal 1.3-2.3 1/3 bound to protein the rest is free ```

Answer 13

Helps maintain normal muscle and nerve activity Major causes: Chronic alcoholism ↓intake, especially TPN/PPN or tube feeding that lacks Mg (esp. after starvation) Lower GI loss (Mg. absorbed in small intestines) Diabetic ketoacidosis: has effect on potassium, so has an effect on Mg

Answer 14

``` Neuromuscular Neuropsychotic Cardiac dysrhythmias deep tendon reflexes start to really see problems if levels are below 1 We really worry about heart block ```

Answer 15

-Magnesium replacement: diet, PO supplement or IV (if severe) -Patient education: on diet, DKA, diabetic control, and alcohol consumption Replace gradually because it acts as a laxative. (milk of magnesia)

Answer 16

Most common cause: renal failure or laxative addicted/taking too much Mg. If blood drawn with hemolyzed, you see a false high Peripheral vasodilation Don't push magnesium Excessive intake, Lithium therapy, untreated DKA

Answer 17

CNS depression Muscle weakness/paralysis N/V, flushed skin Cardiac: bradycardia, heart block, arrest

Answer 18

IV fluids: with or without calcium Hold magnesium Dialysis

Answer 19

``` Phosphate binds with Ca+ which pulls it out of the bone, giving these two an inverse relationship. If given to fast: tetany. We try to give it by mouth. Seen in: Refeeding syndrome: malnutrition, alcoholism, anorexia. Hyperparathyroidism Malignancies, severe burns Vit. D deficiency Overuse (binds with) of antiacids Post organ transplant ```

Answer 20

Nonspecific, and depend on cause/duration/severity Muscle weakness, numbness, fatigue Bone pain/fractures Altered mental status: anxiety, irritability, confusion, seizures, coma Often dehydrated decrease function of platelets=bruising

Answer 21

-Education on diet -Oral supplementation -IV replacement- GO SLOW Watch the site Monitor Ca + and Phosphorus levels

Answer 22

Common causes: Renal failure Hypoparathyroidism Excessive intake &/or Vit. D toxicity Chemotherapy Acidosis *Signs and symptoms are mostly related to hypocalcemia because they are inversed. Treatment focuses on the underlying disorder, diet and patient education.

Answer 23

Tend to travel with Na and K. Normal 97-107. Usually attached to another electrolyte. If there's a problem, like an electrolyte imbalance, Signs and symptoms are associated with hyponatremia, hypokalemia, and metabolic alkalosis Chloride needed to make hydrochloric acid in the stomach Treatment involves correcting the cause and replacing the electrolyte involved

Answer 24

Doesn’t have its own warning signs: Related to hypernatremia, bicarbonate loss, metabolic acidosis, and hypervolemia Related to hypernatremia, bicarbonate loss, and metabolic acidosis

Answer 25

Lungs and kidneys control pH, but lungs are faster.

Answer 26

Low pH (increased H+ concentration) and a low plasma bicarbonate concentration (

Answer 27

tachypnea confusion hypotension decreased cardiac output

Answer 28

Treatment focuses on the underlying metabolic disorder Less than 7: decreased cardiac output Respiratory rate speeds up

Answer 29

``` High pH (greater than 7.45) (decreased H+ concentration) and a high plasma bicarbonate concentration (26 ml of bicarb) Can be produced by a gain of bicarbonate or a loss of H+ (usually by vomiting or suction) ```

Answer 30

Often accompanies hypokalemia; manifestations are similar to hypokalemia and hypocalcemia Treatment addresses underlying disorder as well as K+ replacement and fluid volume replacement

Answer 31

Always due to inadequate excretion of CO2 with inadequate ventilation

Answer 32

pH is >7.45 and PaCO2 is

Answer 33

Provide salt and water to replace cellular fluid. We don't give water because it's so hypotonic cells take it in so fast, the cells burst Examples: 1/2 normal NS (0.45% normal saline) 1/3 NS (0.33%)

Answer 34

3% or 5% NaCl ``` Given for increasing intervascular volume. The problem (like with D5NS) it starts as hypertonic, but gets metabolized so quickly that it becomes hypotonic. Not used for emergent critical situations …... talks too fast ```

Answer 35

Closest to osmolality of blood itself. Diffuses into extracellular space. Used a lot to give meds because it doesn't interact with meds. Also with burns 0.9% NS Lactated ringer's solution: Used a lot in burns! Contains small amounts of calcium, potassium, ….talks too fast. never use in a patient that's alkalotic because it can be made worse Never use in liver disease 5% dextrose in water-very quickly metabolizes into isotonic solutions

Answer 36

D5- metabolizes too fast D10 - weaning off of something D50-hypoglycemia

Answer 37

There are variations (I: cardiac specific/T:more sensitive) | will peak between 4-24 hours. Will peak early and stay peaked up to 24 hours. Will remain elevated after the event

Answer 38

this form is more Cardiac specific. Peaks at 4-24 hours, but doesn't stay peaked

Answer 39

not cardiac specific at all. Rules out MI. Peaks 1-3 hours. If this is not elevated, it is unlikely there is a cardiac event *at no time will these labs be the deciding diagnostic factor in MI

Answer 40

Goals will vary. A general set of numbers can act as a guideline, but goals vary according to number of risk factors. Pt specific. Instruct pt that they need to be fasting! No eating or drinking at least 4 hours preferably 12 hours. NPO after midnight, draw first thing in the morning. Total Cholesterol: should be less than 300 ish LDL: bad. Range for CAD pts-you want it less than 70 Triglycerides: go hand in hand with LDLs... less than 150 HDL: good: go in opposite direction of LDL. Varies with sex and CAD. In general remember you want it above 40

Answer 41

*Your body needs cholesterol, just the right kind. Different cholesterols are different sizes. LDL are the big sticky ones. HDL is a dumptruck that comes around to pick up cholesterol trash... you want a big, fat dumptruck

Answer 42

released when the heart is stretched too much due to heart failure. You want it less than 100.

Answer 43

quickly becoming something drawn along with BNP. Targets heart failure a little more specifically. Want less than 300 Pro-BNP of more than 300 correlated with an ejaction fraction of less than 40%

Answer 44

not cardiac specific, shows if there's inflammation in the body. Elevated with muscular trauma or statin medication. (statins can cause muscle aches. Doc might have them stop statin then retest in two weeks to see if that's the cause)

Answer 45

PT/INR/aPTT: usually all drawn together "coag panel" | normal values depend on hospital's equipment. Changes according to location.

Answer 46

Norm 11.0-12.5 how many seconds for blood to clot clotting is easy at less than 11

Answer 47

Norm 21-35 thicker sticker blood with low number high number thinner blood

Answer 48

Norm 0.8-1 regulated values from powers that be Normal person not on Warfarin should be in this normal range pt on warfarin, the target ratio is adjusted. Cardiologists will set range in general between 2-3.5. These patients take longer to clot than a normal person 5 would be an awfully long time: they take a long time to clot dangerous bleeding easy bruising

Answer 49

Noninvasive way to look at electrical activity of the heart. Doesn't assess pt symptoms, just looks at trends. Telemonitors are portable ways to measure electric activity. Continuous reading. As this patient walks around, you still see what they're doing. Tele tech watches it all the time. Hardest part is practicing where to place the leads. Difference between this and 12-lead: 12 lead is just a snapshot of what a patient does in a limited point of time. Prepping patient: try to pick a spot without much hair. NO RAZORS. use clippers

Answer 50

We're talking about regular, treadmill stress test. Important to understand what patient needs to know ahead of time. wear shoes with traction comfy clothes can't have anything that altars your heart rate: coffee, tea, beta blockers, chocolate No bed rest afterwards results need to be read by cardiologist "they may be nervous, so you can say if we saw anything immediately dangerous, we wouldn't let you leave here today." The treadmill increases speed and incline every three minutes. Will measure blood pressure and rate how hard they feel like they’re working. All is recorded. If at anytime, they complain of dizziness, nausea, or chest pains. We are trying to recreate the symptoms they came into the clinic in the first place. Can be fasting, but depends on the doctor and the kind of stress test they’re doing.

Answer 51

``` Cardiac biomarkers -Troponin -Myoglobin -Creatinine Lipid panel -LDL -HDL -Triglycerides -Total cholesterol Brain Natriuretic Peptide (BNP) -Pro-BNP C-Reactive Protein (CRP) Coagulation tests -a-PTT -INR* -PT ```

Answer 52

Ultrasound of the heart. Estimates ejection fraction. Some involve injecting radioactive isotope to show the blood. Can be bubbles pumped through the heart to see if there are holes in the heart. Required at Research.

Answer 53

Another kind of invasive ultrasound. A long tube goes down pts esophagus. Gives you an electrocardiogram closer to the heart. Might do a shock to see heart blocks.

Answer 54

``` They will have to sign informed consent conscious sedation pt monitored all the way through recovery for at least an hour. Sedative + something down their throat=NPO for the first hour. ice chips first, then clear liquids, then food. Can't drive themselves home or take a taxi. someone needs to be in charge ```

Answer 55

- To assist in identifying the cause of cardiovascular signs and symptoms - To identify abnormalities in the blood that effect the prognosis of a patient with CVD - To assess the degree of inflammation - To screen for risk factors associated with CAD - To determine baseline values before initiating therapeutic interventions - To ensure that therapeutic levels of medications are maintained - To assess the effects of medication

Answer 56

plasma levels of cardiac biomarkers are used to diagnose acute MI in conjunction with the history, physical examination, and ECG. These substances leak into the bloodstream after injured myocardial cells rupture their cell membranes.

Answer 57

Helps evaluate a person's risk for developing atherosclerosis or to diagnose a specific lipoprotein abnormality Contains: - cholesterol - HDL - LDL - Triglycerides

Answer 58

• Assist patient to develop exercise routine: we want them to be active! They might complain of numbness or of leg tingling. Work with PT to walk a little further each day. Helps develop collateral circulation. • Prevent anything that causes vasoconstriction: cold, crossing legs, up and moving every hour or so. • No heat on numbness because they wouldn't know when they're getting burned. • Educate patient ○ Avoid crossing legs ○ Avoid exposure to cold ○ Never put heat on extremity ○ Inspect skin daily for breakdown ○ Avoid smoking ○ Take medications as prescribed ○ Elevation of lower extremities may decrease blood flow and increase pain. A dependent position (dangling feet) may improve flow and decrease pain.

Answer 59

``` • Assess: ○ pain, ○ color, ○ temperature, ○ sensation, ○ pulses • Nursing Management and Patient Education ○ Monitor pulses ○ Smoking cessation ○ Avoid injury to extremities ○ Vasodilators ```

Answer 60

``` • Assess: ○ color, ○ temperature, ○ sensation, ○ edema • Nursing management and patient education ○ Monitor pulses ○ Administer vasodilators ○ Assist patient to ID/avoid triggers (stress) ○ Instruct to wear warm clothing during cold weather ○ Avoid smoking ○ Avoid injuries to hands: wear gloves ```

Answer 61

outpouching of arteries. If found early enough, monitor the size. Once its big enough for surgery, they'll correct. If it's not big, make sure they don't aggrevate it. (monitor BP daily, blood pressure meds taken correctly)

Answer 62

S/S: Pulsating abdominal mass with bruit. Don't push on it! | • Imminent rupture: Severe Low back/abdominal pain

Answer 63

S/S: Cough, dyspnea, dysphagia | • Imminent rupture: Constant/Boring down pain when supine

Answer 64

*medical emergency. Needs to be repaired if possible. Sudden Tearing/ripping pain SOA, diaphoresis, tachycardia

Answer 65

Prevent Rupture | Monitor: VS, aneurysm size

Answer 66

``` Prevention (TJC Core Measure) • Movement: up and moving as much as possible as soon as possible. • SCD’s • Compression Stockings • Anticoagulants ```

Answer 67

``` Signs and Symptoms: most common at knee or below • Redness, spot • Edema • Warm, red skin • Pain ```

Answer 68

If present • Bed rest • Avoid massage • Measure calf/thigh circumference because we want it to get smaller, not bigger. ○ Swelling can cause circulation problems in leg ○ Thrombolytics: risk it will travel to the lungs or somewhere else you don't want it to be.

Answer 69

* Avoid prolonged sitting: for every hour, get up and walk. * Avoid crossing legs: compresses artery behind the knee. * Progressive walking program * Avoid smoking * Elevate feet ~20 min every few hrs daily * Wear antiembolism stockings as prescribed

Answer 70

Edema in extremities d/t accumulation of lymph Risk Factors: congenital lymphedema, node dissection S/S • Pitting edema • Firm/thick skin (late)

Answer 71

• Decrease edema • Compression garments Diuretics

Answer 72

``` • Avoid BP cuff/needle sticks on affected limb: could push fluid someplace where it can't drain • Report redness/pain/heat/rash/fever • Elevate affected limb • Skin clean/dry • Education ○ Lifestyle modification ○ Medication ```

Answer 73

UNSYNCHRONIZED (untimed) delivery of high voltage shock • Tx: Lethal dysrhythmias like VF and pulseless VT Nursing: Never defibrillate a conscious pt with a pulse • Doesn't matter when you shock them: unsynchronized

Answer 74

I addressed some of this in the thread talking about VT from the ECG packet. I guess it is misleading to say "never shock a patient with a pulse". Really, we care about stablity of the patient (are they perfusing with their rhythm) and we care about timing of the "shock". My apologies for confusing you with that. If the patient has a pulse then you're more likely going to do synchoronized cardioversion because you dont' want to risk shocking the patient on the T wave (think of the VT patient with a pulse or afib patient; we sometimes do synchronized cardioversions for those patients). If the patient does not have a pulse and is in ventricular fibrillation (where there is NO perfusion happening), then it's a lethal rhythm. You MUST defibrillate as soon as possible and it won't be synchronized (because there isn't anything to synchronize with). So, it's not that you'll NEVER "shock" a patient with a pulse. It's more that you'll want to determine when to do a synchronized cardioversion vs defibrillation (which is not synchronized).

Answer 75

SYNCHRONIZED (Timed) with QRS, no shock on T wave • Tx: tachyarrhythmias like afib Nursing Considerations: • Consent • NPO prior • r/o thrombus • pt take anticoagulants • O2 • sedation & pain control provided • assess VS • LOC during & post More considerations: • Be sure no one touching bed during electrical discharge. • Cannot shock during the T wave. Synch to the top of the QRS. ○ A-fib: atria are quivering and occasionally toss out a beat. Blood swirls around risking blood clots. Once it does pump, the clot can be pushed through to create pulmonary embolism or stroke. ▪ These patients need an anticoagulant ▪ If medications don't work, we will check to make sure there are no clots before trying a synchronized cardioversion

Answer 76

Temporary • Tx: after open heart surgery Nursing: • Wear gloves when handling leads/connecting cables • Don’t touch pacemaker components on first entering room • Keep dressings dry

Answer 77

• Tx: symptomatic bradycardia, 3rd degree blocks, sick sinus syndrome Nursing • Device programmed when inserted/checked by HCP • Educate patient • Insertion site initial care • Report s/s infection • Immobilization of arm until cleared by cardiologist • Avoid electromagnetic fields (notify airport security) • Avoid contact sports • Wear medic alert bracelets

Answer 78

``` May be combined with pacemaker • Tx: lethal dysrhythmias Nursing: • Same as pacemaker • Do not place defib pads on/near generator • Address concerns r/t shock delivery ```

Answer 79

* HA * Vision Changes * Numbness/tingling in extremities * SOA * Fatigue * Epistaxis: nose bleeds * May have some shortness of air

Answer 80

- assess for manifestations - patient education - --weight reduction - --diet changes (DASH and Mediterranean) - --Sodium reduction/ alcohol reduction - --regular exercise - --sugar reduction - --smoking cessation - --medications

Answer 81

``` Acute and life threatening: risk of stroke Signs and Symptoms • BP usually > ~ 180/120 • HA • Confusion/change in neuro status • Blurred vision • Tachycardia and tachypnea • Dyspnea ```

Answer 82

• Maintain patent airway: ○ Airway problems would come from pulmonary edema ○ Have emergency equipment ready (tubes, suction) • Administer antihypertensive medications IV: ○ start slowly! Could be on these for hours-days • Assess for hypotension or fluid volume overload • Slowly reduce BP (over hours/days) • Monitor VS and I&O’s • Bed rest, HOB ~ 45 degrees. Being up and around can increase pressure. • Keep the head of the bed up to keep ICP down. • Must have emergency equipment available

Answer 83

predictable. occurs with activity. Better at rest or with nitroglycerin.

Answer 84

unpredictable and doesn't get better with rest or nitro.

Answer 85

• Assessment-COLDSPA • Medication history • Treat as emergency until determined otherwise • Correct O2 supply/demand • Control Comorbidities /Prevent Disease Progression ○ Hypertension ○ Diabetes: blood is sticky. Damage to blood vessels ○ Hyperlipidemia: cholesterol buildup causes atherosclerosis and causes hypertension ▪ Life Style modifications/Reduce Risks of the comorbidities are all very similar • Patient Education • Disease process • Risk Factor Modification/Prevention • Medications • Nitroglycerin-Pg 403

Answer 86

``` • teach on angina patho and risk factors ○ angina ○ diabetes ○ lifestyle • Medication teach (pg. 403) ○ place under tongue, wait 5 minutes. If the pain doesn't go away, take a second one and call 911. If they're still in pain, take a third. ○ Nitro can cause a headache ○ Nitro makes the BP drop ```

Answer 87

We can tell with cardiac markers whether this is a risk. • STEMI: tissue injury happening (fire hat=emergency) • ST depression: ischemia occurring in the tissue. Injury has not occurred yet. • Non STEMI: We could have a pt with elevated lab values, with no ST change. Collateral circulation could be a cause.

Answer 88

``` • Chest Pain/discomfort • Palpitations • Fatigue • ECG and BP changes • Limb numbness/tingling • SOA/tachypnea • Diaphoresis • Anxiety/restlessness • Dizziness/Lightheadedness • Backpain (women, diabetics, and elderly) • N/V (women, diabetics, and elderly) ○ look in book for differences between manifestations of men and women ```

Answer 89

○ labs: CBC, BMP, BNP, BUN/creat, PTT, INR, Cardiac enzymes (CPP, Myoglobin, troponin) ○ VS ○ 12 Lead ECG: If it comes back showing ST elevation, its an emergency. ST depression means there is ischemia with no injury yet.

Answer 90

• Oxygen (if indicated): Administering oxygen won't hurt, but it is not always indicated. Keep saturation above 94% • Aspirin: 325 mg chewed to absorb faster. If all you have are baby aspirin, tell them to chew 4. • Nitroglycerin (if indicated) or Morphine (if indicated): if the pt has taken nitro and their BP is low, you won't give morphine • Start 2 IVs: 18 gauge. One in each Antecubital (elbow bend) • If a candidate for TPA, they need it within 30 minutes of walking in the ED. • If not a candidate for TPA, they get PCI ○ consent needed. Explain they might go straight from cath lab to surgery ○ Assess for allergy to dye or shellfish to see if Benadryl is needed before cath lab • bed rest/semi-fowlers • IV

Answer 91

○ BNP ○ BMP ○ Triponin ○ Coagulation labs ○ CBC-to look at other factors of the body ○ Hb and Hct ○ BUN/Creat: to make sure they can take contrast dye. If greater than 1, they might have trouble with the contrast dye

Answer 92

• Conscious sedation • Angioplasty or a stint • CABG: coronary artery bypass graft • percutaneous • peripheral entry ○ They'll cut a vessel from another part of the body: saphenous vein of the leg most likely or mammary vein ○ Valves will be stripped of the valves so it could be used as an artery

Answer 93

• Straight from OR to ICU • 1:1 for a while until they're off the ventilator. • Looking for hemostatic stability • Docs might not want systolic BP over 120 at any time. Drips will be ordered ahead of time. ○ that graft is weak and needs time to heal. High BP will push it out of place. • Fluid volume overload will be a risk • Pain from surgery • ICU to telemetry • Patient education • identify risk factors that got them there

Answer 94

Tissue Plasminogen Activator (t-PA) | • If candidate for TPA, door to drug time

Answer 95

``` • Hemodynamic Stability • Adequate gas exchange • Fluid-volume balance • Pain management • Sternal precautions/Wound care ○ sternum is wired together. We have to help them move. ▪ We put them on sternum precautions • can't drive • can't pull or push • Brace with a pillow during movement ○ Infection control: ▪ hand washing ▪ keep area clean ```

Answer 96

• Progressive activity: Phase I of cardiac rehab in the hospital ○ goal is sitting up and dangling within 24 hours. Up for meals within 24 hours. Up and walking as soon as possible. ○ Ambulation is progressive and measured in feet in the hallway • Cardiac rehab: phase II of cardiac rehab outside the hospital ○ telemetry monitoring during progressive exercise ○ education on diet, medication, and exercise • Phase III cardiac rehab ○ vitals monitored ○ further education

Answer 97

○ diet plans ○ make sure theres an intent for cardiac rehab ○ meds in addition to the drugs they started getting at the hospital ▪ nitro: teach that they go bad, how to take it, and that it might cause burning under the tongue and headache. May cause drop in BP. ▪ metoprolol-extended release: beta blocker. Teach that it causes fatigue, but it will go away in about 30 days. They can take it at night. Orthostatic hypotension. ▪ lisinopril: ACE inhibitor. If this doesn't work, they can take an ARB. He needs to record if there's a dry hacking cough. Must keep BP log ○ Medication reconciliation ○ Education: all must be documented ▪ teach back on lifestyle changes, medications ▪ sternal precautions ▪ when to call doc or 911

Answer 98

* DVT * anticoags/lovonox * stockings/SCDs * leg movement * Pneumonia * incentive spirometer: act like it’s a giant straw. suck in as much as they can. Measured how much air is inhaled. * deep breathing Fall risk

Answer 99

* Determine what likely got them in that situation * Smoking Cessation Counseling (TJC Core Measure) Every single person gets smoking cessation education * Meds (SAAB-TJC Core Measures) Start on the lowest dose. They will be on a: * Statin or if they can't handle that, document some other anti-cholesterol medication * Aspirin: to thin blood * Ace Inhibitor or ARB: for BP * Beta Blocker: for BP * Risk Factors & life style modifications that need to be made * When to call physician and/or 911 * Psychological factors

Answer 100

Inability of heart to pump effectively. They will think their heart doesn't work anymore. TJC Core Measure r/t high readmission • Discharge Instruction/Education material documented • Evaluation of ejection fraction (EF) on chart • Document Medications

Answer 101

* Genetics * Lifestyle Factors: diet, exercise, alcohol or tobacco usage * Psychological stress * Low socioeconomic status: less likely to eat healthy foods or exercise regularly * Complications from disease processes

Answer 102

``` Peripheral Congestion • JVD • Dependent Edema • Ascites • Hepatomegaly • Splenomegaly • Anorexia/Nausea • Weight Gain-occurs with both sided heart failure, but more common with right ```

Answer 103

``` Pulmonary Congestion Dyspnea/tachypnea Orthopnea/PND Wheezing/crackles Cough with pink, frothy sputum Anxiety Dizziness/confusion Tachycardia ```

Answer 104

* ECG to find distortions * Echocardiogram * BNP to know if it's sending out warning signals * Pro-BNP * Measure ejection fraction

Answer 105

* same as CAD/hypertension/MI | * they'll have activity limitations, but we want them to be as active as possible

Answer 106

• will center around diuretics to get the extra fluid out of the body • Either strengthen the beat, or decrease the workload of the heart ○ diuretics: track daily weights to make sure the drugs are working. Put the weights on the same spreadsheet as their daily BPs. Have them weigh at the same time every day. More than 3-5 lbs in a day or 7 lbs in a week. If so, it will be due to fluid.

Answer 107

• Ultrafiltration: IV dose of diuretic that forces the fluid out

Answer 108

* if heart remodels and stretches electrical pathways, they may need surgical repair * Cardiac resynchronization * Pacemaker/defibrillators * Ventricular access device * Transplant

Answer 109

* High Fowler’s position * Oxygen administration * Rapid assessment * VS, lung sounds, LOC, perfusion, wt, etc. * Ask about cough. Dry/wet. Sputum color and character * IV; prepare to administer medications * ACE inhibitor/ARB * diuretics * I&Os * Prepare for administration of medications * Diuretics (furosemide), ACE/ARB, digitalis (Digoxin), etc.) * Labs: * ABGs, * electrolytes, especially potassium * BNP * Psychological support

Answer 110

``` Cardiogenic Shock: Signs and Symptoms • Cerebral hypoxia (restlessness, anxiety) • Hypotension (fatigue/dizziness) • Tachycardia, poor peripheral pulse • Urinary output ```

Answer 111

* Cyanosis * Pink, frothy sputum * Restlessness, anxiety * Cool, moist skin * Cyanotic nail beds * Tachycardia Wheezing, crackles

Answer 112

* Priority is oxygenation * O2 administration * Rapid assessment * IV; prepare to administer meds * Bronchodilator * Foley as prescribed

Answer 113

``` Causes: Pericarditis: inflammation get inflammation down to prevent fluid buildup around the heart that would compress it advanced HF, trauma ```

Answer 114

``` Fullness in chest CP Dyspnea Muffled heart sounds Distended neck veins Pulsus paradoxus ```

Answer 115

Hemodynamic Monitoring IVF Prepare for CXR or Echo Prepare patient for interventions

Answer 116

- Pericardiocentesis | - Pericardiotomy

Answer 117

needle to draw out fluid around the heart

Answer 118

cut window of tissue around pericardial sack

Answer 119

In this step you should measure the interval from where the P wave begins until the beginning of the QRS complex. Calipers, marked paper or counting small boxes methods can be used to determine PR Intervals. Normally this interval is 0.12 to 0.20 seconds (3 to 5 small boxes) in adults, longer in elderly people. This interval shortens with increased heart rate. Also evaluate if PR Intervals are constant or varying across the EKG strip. If they vary, determine if the variations are a steady lengthening until the point where an expected QRS does not appear.

Answer 120

In this step, measure the QRS interval from the end of the PR interval to the end of the S wave. Use calipers, marking paper or by counting small boxes. Normally this interval is 0.06 to 0.12 seconds (1.5 to 3 boxes).

Answer 121

It is measured from the beginning of the QRS complex to the end of the T wave. Normally, the QT interval is 0.36 to 0.44 seconds (9-11 boxes). The QT interval will vary with patient gender, age and heart rate. Another guideline is that normal QT Intervals is less than half of the R-R Interval for heart rates below 100 bpm.

Answer 122

The ST segment is the line that from the end of the QRS complex to beginning of the T wave. Normally the ST segment is flat relative to the baseline.

Answer 123

Causes Hypoglycemia, hypoxia, hypothermia, hyper/ hypokalemia, hypovolemia Thrombosis (PE/MI), toxins, trauma, tension pneumothroax, Tamponade

Answer 124

``` Loss of consciousness No pulse Decreased blood pressure Ineffective/absent respirations Seizures ```

Answer 125

Rheumatic Fever Infectious Endocarditis Congenital abnormalities Other disorders that cause inflammation (Rheumatoid arthritis, systemic lupus erythematosis)

Answer 126

``` May not be s/s until significant damage CP/palpitations Dyspnea on exertion/orthopnea/Paroxysmal nocturnal dyspnea Lightheaded/syncope Fatigue Anorexia Nausea/Vomiting Murmur (sound depends on type of valve issue, location and severity) ```

Answer 127

``` Auscultation (Murmur) Echocardiogram Electrocardiogram (ECG) CXR Possible Cardiac Cath ```

Answer 128

``` No treatment if asymptomatic Treat underlying issue Eradicate infection Treat HF Valve Repair Stenosis Valvuloplasty Commissurotomy Prolapse Leaflet Repair Annuloplasty Chordoplasty Options for Repair/Replacement Open heart surgery Transcatheter Valve Replacement ```

Answer 129

- mechanical | - bioprosthetic

Answer 130

durable; long lasting Disadvantage: Lifelong anticoagulation Wouldn’t want for someone in whom anticoagulants are contraindicated.

Answer 131

No Anticoagulation, but not as durable and more prone to infection

Answer 132

Post op care same as CABG or PCI Prevent Complications Antibiotics as prescribed

Exam 2 ppt Flashcards

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