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1

what are the common signs and symptoms of myocardial infarction

Signs (objective)
pallor, hypertension, cardiac rhythm changes, vomiting, fever and diaphoresis
-pallor
-erratic behavior
-hypotention
-vomiting
-fever
-diaphoresis

symptoms (subjective)
heavy pressure or squeezing pressure in the chest, pain radiating to left arm and jaw, anxiety, nausea and dyspnea

2

why do elderly present different symptoms with MI

Arterial stiffening
Increased blood pressure
decreased maximal heart rate
Increased recovery time from activity

*Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity

3

why are women frequently misdiagnosed with MI

classic symptoms are far less common; most frequently early symptoms are:
-unusual fatigue
-sleep disturbances
-shortness of breath
-weakness
-Indigestion
-Anxiety

*acute chest pain is not present and commonly misdiagnosed as indigestion, gallblader disease, depression, or anxiety

4

what is stable angina

Stable angina (exertional angina) occurs with exercise or emotional stress and is relieved by rest or nitroglycerin (Nitrostat).

5

what is unstable angina

occurs at lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction. (preinfarction angina)
-it increases in occurrence, severity, and duration over time.

6

what is prinzmetals angina

-is prolonged and severe and occurs at the same time each day, most often at rest.

Variant angina (Prinzmetal's angina) is due to a coronary artery spasm, often occurring during periods of rest.
-Generally it is treated with calcium-channel-blocking agents

7

approx how many years would it take to decrease a smokers risk for coronary artery disease compared to that of a non-smoker

"If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years."

8

what are the dietary recommendations for a patient with coronary artery disease (CAD)

Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly

-The use of polyunsaturated oils is recommended to control hypercholesterolemia.

-Should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat.
- These foods contribute to increases in low-density lipoproteins.

9

what are the common nursing assessments for a patient with complaints of chest pain

-assess original pain and location, duration, radiation, and onset of new symptoms
-administer prescribed analgesic
-bed rest
-administer oxygen
-provide calm environment

*focus on achievement of 5 pt outcomes:
comfort
promote tissue perfusion
encourage activity and rest
reduce activity and promote feelings of well being
promote pt education

10

why is oxygen administered to patient complaining of angina pectoris
-how many liters is given via nasal cannula

The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells.

Supplemental oxygen will help to meet the added demands on the heart muscle.

oxygen via nasal cannula at 2 L/min for 24-48 hrs or longer

11

what is the most common diagnostic tool to determine the location of MI

ECG

12

what is the common electrocardiogram (ECG) change seen in relation to myocardial infarction

ECG - will show pathogenic Q waves (necrosis), ST increase (myocardial infarction), T wave inversion (ischemia)

* A women experiencing an MI is far less likely than a man to have concurrent ST-increase, resulting in misdiagnosis and failure to receive correct treatment.

13

what is the difference between troponin and CK-MB in regards to MI

Troponin is a sensitive cardiac marker that is NOT influenced by skeletal muscle trauma or renal failure

14

why may a patient be prescribed nitroglycerin

Nitroglycerin used to prevent coronary artery vasospasm and reduces preload and afterload, decreasing myocardial oxygen demand

15

what is the method of action for nitroglycerin

dilate blood vessels by reducing coronary artery spasm, increase coronary artery blood supply and decrease oxygen demands

16

nitroglycerin patient teaching

-taught to take nitroglycerin before any activity that previously caused the pain and to take the medication at the first sign of chest discomfort.
-take 1 nitroglycerin tablet sublingual up to 3 tablets 5 minutes apart
-always carry medication
-store in a dark bottle and keep dry
-replace every 6 months or before exp date

17

nitroglycerin side effects that should be provided with this medication

-May cause headache as a common side effect
-Encourage patient to sit and lie down slowly
-burning sensation on the tongue-indicates activation
-throbbing sensation in head and flushing may occur

18

nitroglycerin-when should a patient call 911 after taking this medication

call 911 after the third tablet, if pain does not subside.

19

what discharge teaching should be given to a patient receiving a transdermal nitroglycerin patch

avoid drugs to treat erectile dysfunction.

20

transdermal nitroglycerin patch common side effects

Dizziness or light-headedness; headache; irritation at site of patch.

21

transdermal nitroglycerin patch how should it be applied

-Apply the patch to a hairless area and rotate sites
-Apply a new patch each morning and remove at bedtime to prevent development of tolerance
-Apply the patch at the same time every day.
-Wash your hands thoroughly before and after applying the patch.

22

why are thrombolytic agents used for MI

-thrombolytics salvage heart muscle by minimizing infarct size and maximizing heart function
-they lyse the clot thus allowing perfusion of the heart muscle

23

thrombolytic agents- when should this medication be administered

therapy starts within 30 to 60 minutes of symptom onset
* before administration obtain thorough history
DO NOT USE IF : active internal bleed
suspected aortic dissecting aneurysm
recent head trauma
hx of hemorrhagic stroke w/in year
surgery w/in past 10 days

24

thrombolytic agents- side effects of this medication

Remind the client of the risk for bruising and bleeding while on this medication.

25

which laboratory blood test is specific for MI damage

Triponin 1- a sensitive cardiac marker; increased levels indicate that an MI has occured; normal value 0.04-0.4

26

how does the nurse prepare the patient going for an exercise stress test

-The client should wear loose, comfortable clothing for the procedure.
-Lead placement is enhanced if the client wears a shirt that buttons in the front.
-The client should receive nothing by mouth after bedtime or for a minimum of 2 hours before the test.
-The client should wear rubber-soled, supportive shoes, such as athletic training shoes.
- The client should avoid smoking, alcohol, and caffeine on the day of the test.
* Inadequate or incorrect preparation can interfere with the test, with the potential for a false-positive result.

27

exercise stress test-patient teaching (clothing and diet )

The client should wear loose, comfortable clothing for the procedure.
-nothing by mouth after bedtime or for a minimum of 2 hours before the test.
-wear rubber-soled, supportive shoes, such as athletic training shoes.
-avoid smoking, alcohol, and caffeine on the day of the test.

28

what is cardiac catheterization used for

invasive procedure used to visualize the hearts chambers, valves, great vessels, and coronary arteries
-this procedure aids in diagnosis, prevention, of progression of cardiac conditions and accurate evaluation and treatment of the critically ill patient.

29

cardiac catheterization-patient teaching for this procedure

-is taught to report chest pain or any unusual sensations immediately.
- is told that he or she may be asked to cough or breathe deeply from time to time during the procedure.
- is informed that a warm, flushed feeling may accompany dye injection and is normal.
-Because a local anesthetic is used, the client is expected to feel pressure at the insertion site.
-It is common for the client to feel fatigued after the cardiac catheterization procedure.
- General anesthesia is NOT used.
-Other preprocedure teaching points include the fact that the procedure is done in a darkened cardiac catheterization room. The x-ray table is hard and may be tilted periodically, and the procedure may take 1 to 2 hours. The client may feel various sensations with catheter passage and dye injection.

30

cardiac catheterization- what are the contraindications

Iodine allegy
Uncooperative patients
Pregnancy (due to radiation exposure to fetus)-may do open heart surge instead
Patients with renal disorders
Patients with bleeding disorders

31

cardiac catheterization-what is the preparation for this procedure

explain the procedure
ck if allergies to dye that is used
have pt sign consent



32

cardiac catheterization- nursing interventions post procedure

assess circulation to the extremity used for cath insertion
peripheral pulses
color
sensation of extremity
puncture site observed for hematoma & bleeding
monitors vital signs & ck for abnl heart rate, dysrhythmias and signs of pumonary emboli
ensure pt lies supine for designated period with compression device over the pressure dressing at the insertion site to prevent hemorrhage

33

cardiac catheterization- why is it important to palpate the pulses distal to the insertion site

circulation

34

what are the discharge instructions for a patient recovering from an MI

should not consume caffeinated beverages. Caffeinated products can produce a vasoconstrictive effect, leading to further cardiac ischemia.

35

what teaching instructions must be given to patients wearing cardiac telemetry monitors

electrodes on chest attached to transmitter and carried in pts pocket or pouch. Make sure electrodes are on tight, gel can dry out and need to be changed frequently. Never remove telemetry device so pt can shower!!! Unless dr order.

36

what is the method of action for lidocaine hydrochloride

decreases automaticity
(explanation) Depresses the automaticity of the purkinje fibers, raising the depolarization threshold in the ventricular fibers decreasing the tendency to fibrillate

37

how should a nurse instruct a patient to avoid the valsalva maneuver during a bowl movement after the patient has had an MI

- stool softeners prescribed to prevent rectal straining
(the valsalva maneuver may cause severe changes in blood pressure and heart rate which may trigger ischemia, dysrhythmias or cardiac arrest)
- offer the use of a bedside commode to minimize strain
-teach mouth breathing to help decrease the severity of straining
-instituting a bowel regimen to prevent straining and constipation

38

why would an MRI be contraindicated for a patient with a pacemaker

may cause interference, placing the pacemaker in a fixed mode and interfering with its functioning

39

what is the recommended exercise goal for a patient recovering from an MI

-engage in a regular exercise program, such as walking program or yoga to improve collateral circulation
-space exercise period with rest
-take nitroglycerin before exertion
- Exercise tolerance is judged by the client's response, such as heart rate and endurance.
-Planning regular rest periods, pacing activities, and avoiding outdoor activities during the heat of the day are appropriate client activities.

40

what is a thallium scan used for

Assesses for ischemia or necrosis. Radioisotopes cannot reach areas with decreased or absent perfusion, and the areas appear as "cold spots."

41

thallium scan- what do the dark or cold spots indicate

tissue with inadequate perfusion

42

what is the heart rate for sinus bradycardia

less than 60 bpm
Causes: sleep, vomiting, intracranial tumors, MI, drugs (digtoxicity), carotid sinus massage, vagal stimulation, endocrine disturbances, ICP, hypothermia
TX: atropine (increases HR), pacemaker

43

what is the heart rate for normal sinus rhythem

60-100 bpm
Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute.

44

what is the heart rate for sinus tachycardia

100-150 bpm
Causes: exercise, anxiety, fever, shock, meds, HF, caffeine, drugs, tobacco

45

why can a run of premature ventricular contractions (PVC) be harmful to patient

ventricular tachycardia --may lead to death
rate greater than 100
rhythm is regular or slightly irregular

46

why is coumadin prescribed to patients

to thin the blood and prevent blood clots

47

coumadin-what are therapeutic levels for this medication

maintain an INR between 2 and 3

48

coumdin-patient teaching

-take at the same time everyday
-Monitor PT & INR frequently during therapy to assess blood clotting.
-Avoid any trauma or injury
-Do Not take Aspirin or any herbal products
-Limit alcohol
-avoid dark green and yellow vegetables in diet d/t high in Vit K which counteracts drug

49

coumadin-patient precautions

-Any bleeding that does not stop after reasonable time with direct presure
-Blood in urine or stool or black tarry stools
-Unusual bleeding from gums, throat, skin, nose or heavy menstrual bleeding
-Severe headache, or stomach pains
-Weakness, dizziness, mental status changes
-Vomiting blood
-Cold, blue or painful feet

50

what is the most common non-invasive diagnostic tool to evaluate a patient with heart failure

D-dimer (normal range is 68-494 ng/mL)
Echocardiogram -and is done to assess the valves and chambers of the heart

51

what is the difference between right sided and left sided heart failure

* LEFT sided heart failure: when the left ventricular is unable to pump enough blood to meet the body's demands

* RIGHT sided heart failure: when the right ventricular is unable to pump effectively against increased pressure in the pulmonary circulation

52

right sided heart failure-common signs and symptoms

distended jugular veins
anorexia, nausea, abd distention
liver enlarged w/ rt upper quad pain
ascites
edema-feet, ankles, sacrum

53

left sided heart failure-common signs and symptoms

dyspnea
cough
frothy, blood tinged sputum
orthopnea
pulmonary crackles

54

what are the stages of the New York Heart Association Classification of Heart Failure

is universal gauge of heart failure severity based on physical limitations
Class I, minimal
Class II, mild
Class III, moderate
Class IV, severe

55

what is an echocardiogram used to help diagnose

-used to help identify valvular heart disease and detect the presence of pericardial fluid

56

echocardiogram- what are the normal limits

Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively

P wave - depolarization of atria
QRS complex - depolarization of ventricles and repolarization of atria
ST segment - isoelectric status
T wave - depolarization of ventricles

57

echocardiogram- which action should the nurse take to prepare the client for this procedure

-Tells the client that the procedure is painless and takes 30 to 60 minutes
-Echocardiography is a noninvasive, risk-free, pain-free test that involves no special preparation.
- It commonly is done at the bedside or on an outpatient basis.
-The client must lie quietly for 30 to 60 minutes while the procedure is being performed.

58

what is the major cause of cardiac valve disease

history of rheumatic fever

Heart valve (mitral & aortic valve) inflames then thickens and hardens. This causes either stenosis (valves don't open effectively) OR regurgitation (valves don't close properly)

59

the increase incidence of cardiomyopathy in young adults is attributed to which factors

cocaine

60

what are your nursing interventions for a patient with pulmonary edema that suddenly becomes short of breath, increased heart rate and frothy red sputum

Nursing Management Elevate HOB-high fowlers position
Administer 100% oxygen by mask
Monitor VS and O2 Saturation
IV Access
Medications
Ventilation
*Diuretics, Nitroglycerin, Digoxin, Morphine

61

why would a doctor prescribe a patient Lasix for heart failure

Treats fluid retention/overload caused by heart failure, renal dysfunction, cirrhosis; hypertension; acute pulmonary edema

*. Reduce preload.

62

Lasix-what is this medications mode of action

reduces pulmonary edema by decreasing the fluid in the lungs and increasing excretion through the kidneys

63

Lasix- what time of day should this medication be taken

Take in the morning not at night to prevent sleep disturbance and nocturia.
Rise slowly from standing or sitting to prevent dizziness resulting from fluid loss. Take with food to avoid nausea

64

Class I of New York Heart Association Classification of Heart Failure

MINIMAL
no limitations
ordinary physical activity does not cause undue fatigue, dyspnea, palpitations or angina

65

Class II of New York Heart Association Classification of Heart Failure

MILD
slightly limited physical activity
comfortable at rest
ordinary physical activity results in fatigue, palpitations, dyspnea or angina

66

Class III of New York Heart Association Classification of Heart Failure

MODERATE
markedly limited physical activity
comfortable at rest
less than ordinary activity causes fatigue, palpitations, dyspnea or angina

67

Class IV of New York Heart Association Classification of Heart Failure

SEVERE
unable to perform any physical activity w/o discomfort
anginal or symptoms of cardiac inefficiency may develope at rest, physical activity increases discomfort

68

Lasix-side effects

Nausea, diarrhea, electrolyte imbalances, vertigo, abdominal cramping, constipation, rash, headache, weakness, ECG changes, blurred vision, photosensitivity, muscle cramping

69

Name the two types of myocardial infarction (MI).

STEMI or transmural and non-STEMI or subendocardial

70

What is the difference between STEMI and non-STEMI?

ST-elevated myocardial infarctions involve damage through all the layers of the heart

non-ST-elevated MIs involve damage to layer just beneath the endocardium

71

What causes non-STEMIs?

a temporarily blocked coronary artery