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E1 Cardiovascular
Care of the patient with cardiac dysfunction
| Question | Answer |
|---|---|
| What is the PMI of the heart? | 5thICSMCL |
| What are the three layers of the heart? | Epicardium, Myocardium, Endocardium |
| What are three characteristics specific to cardiac muscle? | Automaticity, Excitability, Conductivity |
| The contraction phase of the ventricles is known as: | Systole |
| The relaxation phase of the ventricles is known as: | Diastole |
| The three general characteristics which need to be noted when reporting a patient's CP: | Location, Intensity, Duration |
| T-Wave Inverstion or ST-segment depression is indicative of: | Ischemia |
| ST-segment elevation is indicative of: | Injury |
| In a normal EKG, ST-segement should not be elevated more than __mm in standard leads or ___mm in precordial | 1mm2mm |
| List, in order, the conduction system of the heart: | Sinoatrial Node, Atrioventricular Node, Bundle of His, Purkinje Fibers |
| Normal cardiac output: | 4-7L/m |
| What is the formula to determine cardiac output? | HRxSV |
| The #1 cause of death in the country is: | Heart Disease |
| Reduction of the risk of heart disease by living a purdent life style is an example of what type of prevention? | Primary Prevention |
| Early Dx throuhg annual check ups and knowing your lab values is an example of what type of prevention? | Secondary Prevention |
| Maximizing medical management by complying with pharmacological regime is considered what type of prevention? | Tertiary Prevention |
| List 6 changes to the cardiovascular system that relate to age: | Valves calcified;Pacemaker cells decr in # = dysrhythmias and increasing conduction times;Left VentricleVin size;Bld flw distribution chngs=v to coronary art;vessels become thickened and calcified; Baroreceptor V sensitive=Orthostatic Hypotension |
| List 8 nursing diagnoses that pertain to cardiac dysfunction: | Decreased cardiac output; Impaired gas exchange; Pain; Altered tissue perfusion; Anxiety; Knowledge deficit; Altered Nutrition; Self care deficit |
| List 6 types of agents utilized for the treatment of cardiac dysfunction: | Anticoagulants; Nitrates; Blocking agents: Beta blockers, Calcium Channel Blockers; ACE Inhibitors; Stool softeners; Analgesics |
| Symtoms such as sudden sharp stabbing CP, substernal to L side of back, relieved by sitting upright or with anti-inflamatory agents: | Pericarditis |
| Normal sequence of auscultation of heart sounds: | Aortic; Pulmonic; Erb's Point; Tricuspid; Mitral |
| Heart sound heard that is closure of the AV valves, beginning of systole, accentuated by exercise, hyperthyroidism and mitral stenosis: | S1 |
| Heart sound heard that is closure of semilunar valves, assess at aortic pulmonic and Erb's point: | S2 |
| + What are psychosocial precipitators of anginal pain? | Stress and Emotional Provocation, Positive or Negative |
| + Your patient is Post MI and is in the telemetry unit, what is the best position for them to recover? | Semifowlers in bed or cardiac chair to promote rest. |
| + List 4 modifiable precipitating factors for CAD? | Diet, Smoking, Weight, Inactivity |
| + When a patient present to healthcare with in digoxin toxicity; the prudent RN will assess the patient's: | BP and Pulse; If LOW call MD |
| + Two common signs / symptoms of Digoxin toxicity include: | Nausea; Fatigue |
| + The typical elderly post surgery patient received increased amounts of fluids in surgery and may present with what symptomology? | L Ventricular hypertrophy; bibasilar crackles; Fluid overload / Fluid Volume Excess |
| + Your patient just came back from the OR and presents with a cough, pink frothy sputum, respiratory rate: 28 and Lung sounds reveal bibasalar crackles. What condition are they most likely presenting with: | Acute Pulmonary Edema |
| + Loop Diuretics such as _____ are Potassium wasting. Primary concerns of the RN with patients who are taking these medications can be assessed by checking the patient's _____ _____ to determine if there is decreased _____ _____: | Lasix (Furosemide); Blood Pressure; Cardiac Output |
| + A smart food choice for a patient who is on a low cholesterol and low Sodium diet would be: | Baked Potato; Baked Chicken; Vegetables |
| + The inability to have appropriate respirations while laying flat in bed promps some patients to utilize multiple pillows to raise their upper torso during the evening hours: | Orthopenea |
| + Two hallmark signs that specifically present in patients in RIGHT sided Heart Failure include: | JVD; Dependant Edema |
| + Left sided Heart Failure almost always is a result of _____ _____ _____ _____. | Right Sided Heart Failure |
| + List five hallmark Signs / Symptoms of Left Sided heart Failure: | Hepatomegaly; Congestion; Anorexia; Nausea; Vomiting |
| + List an example of an ACE Inhibitor. | Captopril |
| + List a sign of increased Potassium | Peaked T Waves |
| + What should you check prior to administering ACE Inhibitors? | Potassium Levels |
| + What should you do if you check Potassium levels prior to the administration of ACE Inhibitor and they are too high / low? | Get a set of VS and Call MD |
| + What is the best predictor of how well or poor a patient's status is who has Left OR Right sided HF? | Daily Weights |
| + List two common Nursing Diagnosises that are commonly used in Cardiac Patients: | Alteration in Cardiac OutputIneffective Tissue Perfussion |
| + For a patient experiencing cardiac related pain or discomfort you would optimally want the patient to become: | Pain Free |
| + What is a nursing education that is specific to a patient who has received a valve replacement at any point in their life? | Profilactic Antibiotics prior to any invasive procedure or surgery |
| + What is a patient with a valve replacement at risk for should they require invasive procedures? | Endocarditis |
| + What is a specific nursing teaching plan that is specific to the use of Halter Monitors? | Make certain the patient is writing a journal of daily activities with times so the MD can correlate the physical activity with the cardiac rhythms captured by the halter monitor |
| + Any patitent who presents to the ER with a pulse rate below or above normal ranges may be at risk for decreased _____ _____ and this may result in increased _____ _____ _____. Thus predisposing the patient to an MI. | Decreased Cardiac Output; Increased Myocardial Oxygen Demand |
| + Symptoms such as: Nausea, Vomiting, Back Pain, Diaphoresis are considered _____ CP; and are common in which two groups of patients? | Atypical; Elderly and Diabetic patients with neuropathies |
| + Lab tests that will indicate whether or not a patient is having an MI : | Troponin T 1 |
| + A patient complains of CP for approximately 4-5 days; what lab value will be useful to determine if patient is having an MI? Why? | Troponin T 1; Peaks in hours to 2 weeks |
| + Increased LDL and decreased HDL indicates a _____ risk for CAD | High |
| + What is a homocystine level indicative of? | Arthrocslerosis building in the ateries |
| + To calculate the rate on an ECG tracing, Brunner suggests that you should count the "small" boxes between the R and R and divide _____ by that number | 1500 |
| + When one person takes the pulse at the radial and another takes an apical pulse simutaneously and this number is different this is refered to as a _____ _____. | Pulse Deficit |
| + You are working as an RN on the telemetry unit and your patient suddenly switched from a NSR to a dysrhythmia; your first order of business is to: | Take VS / BP and P |
| + NSR P-R = | 0.16 - 0.20 |
| + For the medication to be effective a patient experiencing CP / MI must receive thrombolytic therapy within _____ hours. | 3 |
| + A patient who received PCTA will be at risk from what? (2) | Risk for Bleeding; Risk for Fluid Volume Deficit |
| + Males or Females usually experience atypical angina marked by dyspnea, nausea and vomiting. | Females |
| + What are common complaints from elderly patients who are having CP or an MI? | Fatigue / Weakness |
| + What is the prodocol for the administration of NTG? | 3 SL Tab / Spray 5 min apart until CP a Zero or Max of 3 tabs |
| + An elderly patient who has CAD who presents with signs or symptoms relating to that disease will probably present with ____ first: | Dyspnea |
| + Younger patients who present with high cholesterol levels should be using _____ to curb the high levels. | Exercise |
| + You are at your home and notice your neighbor mowing his lawn. He develops chest pain; what would your first piece of advice be to the patient? | Rest |
| + You are caring for a patient on the floor with a foley. Their urinary output is approx 25ml/hr. What should you check and what would be your primary concern? | Vital Signs / Decreased Cardiac Output |
| + You are caring for a patient on the floor who presents with new onset bibasilar crackles. You should: | Call MD |
| + Relating to obtaining an ECG on a patient; your patient teaching should include what two facts about what the patient will experience when getting an ECG? | Painless / NonInvasive |
| + BNP is Natriuretic Peptide and it is high in people suspected of _____ | HF |
| + A nursing diagnosis that is specific to unstable angina: | Ineffective Cardiopulmonary Tissue Perfusion related to CAD |
| + You have a patient who has been taking an ACE inhibitor and presents with a dry cough. The MD will most likely: | Change the patient's medication |
| + You notice a "friction rub" while assessing lung sounds / heart sounds; how can you determine with some degree of certainty whether the patient has a Pleural Friction Rub or a Pericardial Friction Rub. | A pericardial friction rub will continue if you have the patient hold his breath while auscultating the thorax |
| + A nursing diagnosis for a patient in Atrial Fibrillation may be: | Neurological |
| + Norvasc is an example of a: | Calcium Channel Blocker |
| + Calcium Channel Blockers do what? | Decrease SA and AV conduction and decrease myocardial workload |
| + A patient is to be scheduled for labwork that requires their Cholesterol and Lipids to be checked. What is proper nursing teaching for this patient? | Fast 12 hours prior to the test. |
| + You are caring for a patient whose heartrate drops to 45 BPM on the ECG Telemetry screen. What should you do next? What is your primary concern overall? | Check a pulse and vital signs. Concerns related to decreased cardiac output |
| + According to the NYHA, a patient who doesn't have any symptoms during physical activity, No pulmonary congestion or peripheral hypotension and has no limitations of ADL is a LEVEL ____ and has a _____ prognosis. | I GOOD |
| + According to the NYHA, a patient who has symptoms of cardiac insufficiency at rest is a Level ____ and has a _____ prognosis. | IV POOR |
| + According to the NYHA, a patient who has marked limitation on ADL and feels comfortable at rest but less than ordinary activity will cause symptoms is a Level ____ and has a _____ prognosis. | III FAIR |
| + According to the NYHA, a patient who has slight limitation on ADLs, but reports no symptoms at rest but increased physical activity will caus symptoms, Basilar crackles and S3 murmor may be detected is a Level ____ and has a _____ prognosis. | II GOOD |
Created by:
Ringtail
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