Quiz #3 Cardiac Flashcards by Angelina Franco

What to do for epistaxis

Can occur during hypertensive crisis
Priority is to administer IV to lower decrease BP by 20%
Blood pressure and ECG monitoring
Neurological assessment

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What is heart healthy diet

Low sodium <2.3 g/day, low fat, low cholesterol, high fiber
DASH - high in fruit, high in vegetables, low fat dairy foods
Consume foods rich in calcium
Increase potassium consumption - apricots, bananas, tomatoes, potatoes

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Teachings on hydrochlorothiazide

Diuretic
- take med first thing in the morning
- be sure med is taken by 1400 to prevent nocturia
- consume food high in K+
- take med with food if GI upset
- report significant weight loss, lightheadedness, dizziness, GI upset

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Primary prevention for hypertension

Eat a heart healthy diet
Exercise
No smoking
Limit alcohol
Get enough sleep

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Secondary prevention for hypertension

Obtain blood cholesterol levels
- this is aimed to screen at risk community members
- focus on further illness or injury

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Tertiary prevention for hypertension

Anti hypertensive therapies
Ex: medication adherence programs
Walking program for those with hypertension

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Adverse effects of digoxin toxicity

Hypokalemia —> can increase toxicity

Anorexia [usually the first sign]
N/V, diarrhea
Blurred vision and halo lights

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Digoxin toxicity reversal agent

Digoxin immune fab (digibind) or DIGIFAB

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Left side heart failure manifestations

Occurs due to inadequate tissue perfusion

dyspnea
pulmonary congestion (cough, crackles)
frothy sputum
S3 heart sound
decreased o2
altered LOC
nocturia

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Right sided heart failure manifestations

Systemic congestion due to fluid outside lungs

dependent edema
ascites
anorexia, vomiting
jugular vein distention
weakness
weight gain
Fatigue
hepatomegaly

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Patient teaching for heart failure

Consume a diet low in sodium
Continue to take meds even if feeling better
Measure weight daily at the same time
- more than 2 lbs in a day or 5 lbs in a week
Report swelling of feet

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Metabolic syndrome risk factors

Inactive
Obesity
Not having a proper diet
Triglycerides > 150 mg/dL
Low HDL
High fasting glucose level

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Nitroglycerin

A vasodilator
Can be used to open up coronary artery in the heart
Helps deliver oxygen to heart muscle
- used for angina, which is chest pain occurs with decreased perfusion or atherosclerosis

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Chronic stable angina

Precipitated by exertion or stress
Relieved by rest or nitroglycerin
Manifestations last less than 15 min
Not associated by nausea or, anxiety, diaphoresis

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Chronic unstable angina

Occurs with exercise or at rest but increases in occurrence, severity, and duration over time

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Risk factors for coronary artery disease

No modifiable
- age, gender, ethnicity
- family history
Modifiable
- increase serum lipids
- cholesterol > 200 mg/dL
- triglycerides > 150 mg/dL
- increase LDL decrease HDL
- hypertension

Others
-obesity, diabetes, metabolic syndrome, substance abuse tobacco use

Example of low cholesterol diet

Oats
Barely
Whole grain
Beans
Skim milk
Veggies
Pears and apples

Nitroglycerin tablet

Can be sublingual tab or spray
S for STABLE
S for STRESS induced

will stop when activity stops

Nitroglycerin patch

U for UNSTABLE
U for UNPREDICTABLE

Take nitro before stressful activity
Can be used for first indication of chest pain

Client teaching for sublingual nitroglycerin (stable angina)

Take first tablet (let dissolve under tongue)
Call 911 if pain not relieved by first tablet, then take 2nd tablet
Make take up to 3 doses and must be 5 min apart

Store NTG away from light and heat source
Replace every six months
Take acetaminophen for headache

Adverse effects of simvastatin

Hepatotoxicity
- anorexia, N/V, jaundice
Myopathy
- muscle aches, pain, tenderness

Drinking grapefruit juice can lead to rhabdomyolysis which can further damage heart and kidneys

Propranolol adverse effects that need immediate action

Bradycardia (hold medication if HR is less than 60)
Orthostatic hypotension
Bronchoconstriction
Heart failure
Sexual dysfunction

Captopril

Drug of choice for hypertensive clients with heart failure
Vasodilator to help lower BP

Captopril adverse effects

C- Cough
A- Angioedema
P- pregnancy problems
T- taste changes
O- orthostatic hypotension (monitor BP for several hours after treatment)
P- proteinuria
R- rash
I- increased potassium
L- low neutrophil count

Captopril client teaching

*TAKE ON AN EMPTY STOMACH* (at least 1 hour before meals) Stop taking diuretic 2-3 days before *NOTIFY HCP IF COUGH DEVELOPS* Monitor blood pressure and heart rate Do not double up on doses Do not stop medication abruptly (can get rebound hypertensive crisis—> stroke) Change positions slowly

What to do if BP meds aren’t working

Maybe ask provider for different medication.

Stress test

Patient walks on treadmill, exercising the cardiac muscle Provides info regarding workload of the heart Test discontinued once heart reaches a certain rate

Nurse is monitoring a client who is undergoing exercise stress test. Which of the following assessment findings require most rapid action by the nurse?

Electrocardiographic changes indicating coronary ischemia (can be shown as newly inverted Twaves)

Cardiac catheterization

Also known as angiography Used to evaluate presence and degree of coronary artery blockage The groin is the most common site used inserted through femoral artery Injection of contrast media

Cardiac catheterization post procedure

After procedure pressure will be held on access site Extremity must be keep straight for a prescribed amount to prevent bleeding Assess vital signs every 15 min x 4 *ASSESS FOR BLEEDING AND HEMATOMA FORMATION AT THE INSERTION SITE* *THROMBOSIS (document pedal pulse, color, and temp)

Cardiac catheterization and what do we need to be concerned about

Bleeding and hematoma formation at insertion site Assess for thrombosis (document pedal pulse, color, and temp) Cardiac tamponade - fluid in the pericardium (which is sac surrounding heart) Artery dissection - puncture on arterial wall

A nurse is reinforcing teaching with a client who has a prescription for simvastatin. Which of the following instructions should the nurse provide?

Take medication in evening hours

Normal cholesterol

Total cholesterol <200 mg/dL LDL <100 mg/dL HDL >60

For someone who had coronary artery bypass

**Low cholesterol Low sodium, low fat High fiber

Cholesterol and warfarin

Using garlic to help lower cholesterol can potentiate effects of warfarin

Warfarin adverse effects

Hemorrhage -bruising, Petechiae, hematoma, and black tarry stools Hepatitis Toxicity