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Med Surg 1
Cardiac
| Question | Answer |
|---|---|
| What part of the heart is the pericardium? | Outside |
| What part of the heart is the epicardium/myocardium? | Muscle |
| What part of the heart is the endocardium? | Inside |
| What part of the heart is the atrium? | Top |
| What part of the heart is the ventricle? | Bottom |
| What type of blood does the superior & inferior vena cava carry? | Deoxygenated |
| What type of blood does the pulmonary vein carry? | Oxygenated |
| What type of blood does the pulmonary artery carry? | Deoxygenated |
| What is the pathway of the deoxygenated blood? | Inferior & superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary semi-lunar valve, pulmonary artery |
| What is the pathway of the oxygenated blood? | Lungs, pulmonary vein, left ventricle, bicuspid (mitral) valve, left ventricle, aortic semi-lunar valve, ascending aorta, aortic arch, descending aorta |
| Where do the coronary arteries supply oxygen & nutrition to? | Heart |
| What is the cardiac conduction cycle? | Heart beat begins in SA node, goes to AV node, then to bundle of his, then to bundle branches, and then to purkinjie fibers |
| What are modifiable risk factors for cardiovascular disease? | Smoking, hyperlipidemia, hypertension, diabetes mellitus, obesity, sedentary lifestyle, stress, oral contraceptives, and psychosocial factors |
| What are non-modifiable risk factors for cardiovascular disease? | Family history, age, sex, race |
| What is angina pectoris? | Chest pain caused by decreased blood flow to the myocardium |
| What symptoms does a person feel with angina pectoris? | Chest pain and a choking feeling |
| What medicine is given to a patient for angina pectoris? | Nitroglycerin |
| What type of medication is nitroglycerin? | Vasodilator / slows the heart rate / relieves the symptoms, but does not relieve pain from myocardium infarction / side effect: headache |
| What is unstable angina pectoris? | Prolonged episode of severe pain or discomfort that occurs at rest, has never occurred before, or is worse than previous episodes (pain onset w/rest, precursor to AMI) |
| What is stable (classic) angina? | Pain w/exertion - relief w/rest |
| What is silent angina? | Unrecognized or truly silent |
| What MUST you know prior to giving nitro? | Blood pressure |
| How many doses of nitro can you give and how often? | 3 / q 5 mins |
| What do you do if pain does not subside after giving 3rd dose of nitro? | Call physician or EMS / administer O2 as ordered |
| How is nitro glycerin tablet given? | Sublingually, while patient is at rest, no food/drink after administered |
| What are nursing interventions for angina pectoris? | Rest, avoid large meals, instruct pt. to stop activity at first sign of anginal pain |
| What is the best way to reduce myocardial oxygen demand during exertion because it helps condition the heart? | Exercise |
| When myocardial/epicardial cells die, body responds to MI w/inflammatory process; what are the signs of inflammatory process? | Body temp elevates, WBC increases, cardiac enzymes (troponin) are released from tissue cells, necrotic tissue of the myocardium is eventually replaced by scar tissue |
| What are the signs/symptoms of MI? | Crushing, vice like feeling, heavy object sitting on the chest, radiating to the neck, jaw, arm, & teeth |
| What is a common symptom of MI? | Denial |
| How are MI symptoms different from angina pectoris? | MI symptoms are more severe and last longer than angina pectoris symptoms |
| What does a MI result in? | Necrosis of the myocardium |
| What are the subjective signs of MI? | Pain, anxiety, dyspnea, weakness/faintness, nausea, and sense of impending doom |
| What are the objective signs of MI? | Pallor, erratic behavior, hypotension, shock, change in cardiac rhythm, vomiting, fever, diaphoresis, and SOR |
| What is the immediate treatment for MI? | MONA (Morphine, Oxygen, Nitro, ASA/Plavix) |
| What is ventricular fibrillation? | Ventricles of heart quiver rather than pump blood |
| What is cardiogenic shock? | Heart is not able to pump effectively resulting in a decreased blood supply to the vital organs. BP is very low or cannot be measured |
| What is ventricular aneurysm? | Damage to the ventricle causes the ventricle wall to thin and balloon out |
| What is pericarditis? | Sac around the heart becomes inflamed after the MI damages the ventricle |
| What is an embolism? | When blood clot (thrombus) breaks away and travels (embolus) through the circulatory system |
| What does the presence of troponin indicate? | Ischemic myocardial injury (stays elevated 14 days; most specific for MI damage) |
| What is PTCA (percutaneous transluminal coronary angioplasty)? | Balloon tipped catheter is inserted into an obstructed coronary artery; balloon is inflated intermittently to push back the plaque that is causing the occlusion |
| What is an important nursing diagnosis priority for MI? | Check with doctor about resuming sexual activity |
| What medication is used for ventricular fibrillation? | Amiodarone (Cordarone) |
| What is the purpose of the valves in the heart? | One way doors to keep blood flowing in appropriate direction |
| When to the valves open & close? | When blood pushes through and when the chamber is filled |
| What occurs with valvular heart disease? | Heart valves are compromised and do not open and close properly |
| What occurs with valvular stenosis? | Valve tissue thickens, causing valve to narrow |
| What is valvular insufficiency? | Valve is unable to close completely |
| What is important to teach patient with valvular heart disease? | Inform/remind HCP of their condition so the providers can give prophylactic antibiotics prior to invasive procedures |
| Why does cardiac tamponade occur? | Pericardial effusion (fluid) restricts heart movement |
| What procedure would be performed for cardiac tamponade? | Pericardiocentesis to remove excess fluid |
| What creates the lubb-dubb heart sound? | Closure of the heart valves |
| What does the swishing sound between the normal lubb and dub sound indicate? | Heart valves may not be opening and closing properly |
| What is endocarditis? | Infection or inflammation of the inner lining of the heart, particularly the heart valves |
| What should be given to a patient with existing valvular heart disease prior to any invasive procedure or dental work? | Prophylactic antibiotics |
| What is myocarditis? | Inflammation of myocardium/epicardium |
| What is cardiomyopathy? | Term used to describe a group of heart muscle diseases that affects the structure or function of the myocardium |
| What are possible causes of cardiomyopathy? | Infective (viral, bacterial, etc.), severe nutritional deprivation, alcohol abuse, drugs (chemo), radiation, and cocaine |
| What is the result when the conduction system does not function normally? | Dysrhythmia's |
| What is the pacemaker of the heart? | SA Node |
| What is sinus rhythm? | Heart rate of 60-100bpm |
| What delivers electrical impulses via electrode to myocardium? | Pacemakers |
| What do you need to closely monitor after placement of pacemaker? | Heart rate and rhythm via apical pulse and ECG pattern |
| What does patient need to do after pacemaker is placed? | May be on bed rest with arm on the pacemaker side immobilized for first few hours |
| What are discharge instruction for patient with pacemaker? | No lifting arm on surgical side over head, check pulse daily at same time each day and again if symptoms of vertigo or weakness occur. Report s/s of pacemaker failure: weakness, dizziness, chest pain, pulse changes |
| What is sinus tachycardia? | Normal rhythm at a rate of 100bmp or more |
| What is sinus bradycardia? | Normal rhythm at rate below 60bpm |
| What is atrial fibrillation? | Atria are quivering rather than pumping blood |
| How high can atrial rate be? | As high as 350-600 bpm |
| What may physician attempt with atrial fibrillation? | Carotid massage to stimulate vagus nerve to slow heart rate |
| What medications may be used with atrial fibrillation? | Linoxin (slows hr), Calcium channel blockers (slows hr), Antidysrhytmics, anticoagulants (since thrombi may form in atria as result of ineffective atrial contraction |
| What is cardioversion? | Electric shock to the heart that helps restore normal sinus rhythm using two paddles to patients chest |
| What must you do immediately following cardioversion? | Check airway patency, check v/s, and check telemetry pattern |
| What are premature ventricular contractions (PVC's)? | Heartbeats that originate in the ventricle, not in the SA node |
| What are possible causes of PVCs? | Irritability of ventricle wall, exercise, stress, electrolyte imbalance (K+), digitalis toxicity, hypoxia, and MI |
| What is a concern when PVCs occur in pairs or runs? | Can cause ventricular tachycardia which could lead to death |
| What is the medical treatment for PVCs? | Lidocain - Antidysrhytmics |
| If you notice telemetry is abnormal, what is the first thing you do? | Check the patient |
| Why is there no blood pressure with v-fib? | The heart is no longer pumping blood to the vital organs or the rest of the body |
| What will occur if treatment of v-fib is not quickly instituted? | Death |
| If your patient is in v-fib what must you do? | Call for help, DON'T leave patient alone, begin CPR while waiting for crash cart |
| What is Atrioventricular (AV) block? | When impulses from the SA node are slowed or impaired as they attempt to go through the AV node to ventricles |
| What is the treatment for third degree AV block? | Usually a pacemaker |
| What indicates the worst impairment in the AV junction? | Complete/third degree AV block, the impulse does not get from the atria to the ventricles |
| What does it indicate when a patient's hr is in the 30's? | Complete heart block |
| What part of the body will be affected when the right or left side of the heart fails to pump blood effectively? | Lungs |
| What is congestive heart failure (CHF)? | When the heart can no longer effectively pump blood throughout the body |
| What are s/s of CHF? | Fatigue, angina, anxiety, oliguria, decreased gastrointestinal motility, pale/cool skin, weight gain, restlessness, decreased activity intolerance |
| When does left ventricular failure occur? | When the left ventricle can not pump enough blood to meet the needs of the body |
| Why does congestion occur in the lungs? | Blood is not able to leave the lungs and go to the left ventricle |
| What does left sided failure create? | Respiratory issues |
| What are major symptoms of left ventricular failure? | Dyspnea, paroxysmal nocturnal dyspnea (PND), orthopnea, pulmonary crackles, hemoptysis, and cough |
| When does right ventricular failure occur? | When the right ventricle cannot pump blood efficiently to the lungs |
| Where does the blood back up to when it cannot be pumped forward into the lungs? | Systemic circulation |
| What is the first sign of right ventricular failure? | Peripheral (dependent) edema |
| What are major symptoms of right ventricular failure? | Distended jugular veins (DJV), anorexia, nausea & abdominal distention, liver enlargement, ascites, edema of feet, ankles and scrum |
| What does the nurse look for in right ventricular failure? | Dependent edema, ascites, anorexia, nausea & abdominal distention, cyanosis of nail beds, anxious & frightened & depression, and weight gain more than 2lbs/day |
| When does pulmonary edema occur? | Extensive amounts of fluid accumulate in the lungs |
| What is the cardinal sign of pulmonary edema? | Hemoptysis (pink frothy sputum) |
| What are additional signs of pulmonary edema? | Restlessness, agitation, disorientation, diaphoresis, severe dyspnea, tachypnea, tachycardia, pallor or cyanosis, productive cough of large amounts of hemoptysis, audible wheezes/crackling, cold extremities |
| What is the treatment for pulmonary edema? | O2, diuretic, vasodilator, morphine, digitalis, semi-fowlers position, foley catheter, frequent heart & lung assessments, dietary restrictions (low sodium), planned rest periods, weigh daily |
| What do you report to the MD immediately with pulmonary edema? | Persistent productive cough; dyspnea, pedal edema, and restlessness |
| What medications are used to treat pulmonary edema? | Analgesic (morphine), coronary vasodilators (nitro), peripheral vasodilators (nitroprusside), diuretics (Lasix), inotropics (Linoxin), oxygen (40-100% O2 via non-rebreather mask) |
| How do you differentiate pain by non-cardiac problem? | Ask the patient if the pain gets worse when they breath in |
| Compare MI & CHF? | MI has sudden onset / CHF is chronic condition; MI damages the heart muscle, the larger the MI damage, the worse pump failure which causes CHF |
| What do dopamine and other inotropic agents do? | Increase myocardial contractility without increasing oxygen consumption. Raise systemic arterial pressure and increase cardiac output |
| What do anticoagulants do? | Decrease incidence of clotting and do not allow existing thrombus to grow larger |
| What do antiplatelets do? | Decrease vasoconstriction and platelet clumping (aggregation) on vessel walls |
| What do antidysrhythmic (Lidocain) treat? | Ventricular dysrhythmias |
| What do nitrates do? | Dilate coronary blood vessels and increase blood flow to the myocardium, may cause headache (vasodilator) |
| What do stool softeners do? | Reduce straining when having a bowel movement to reduce the chance of valsalva's maneuver which could cause severe changes in heart rate, blood pressure and rhythm |
| What does atropine do? | Increase heart rate with symptomatic bradycardias |
| What does Cardizem do? | Decreases heart rate and BP in tachycardic patients such as SVT and atrial tachycardia |
| What must you check prior to giving potassium supplements? | Serum K+ levels |
| What do Angiotensin Converting Enzyme (ACE) inhibitors do? | Reduce peripheral vascular resistance (dilate peripheral arteries) and help improve cardiac output, decrease in Na+ retention, decrease in BP, and decrease in heart size |
| What are the signs of digitalis toxicity? | Bradycardia, n/v, anorexia, dysrhythmias, headache, blurred or colored vision |
| What must you check prior to administering digoxin? | Digitalis level and apical pulse |
| What is normal digitalis range? | 0.5-2 ng/mL |
| When do you hold digitalis medication? | If apical pulse is less than 60bpm or digitalis serum level is out of normal limits |
| What does digitalis do? | Slows the heart rate and strengthens contractions |
| What is the normal K+ serum level? | 3.5mEq/L , below that is hypokalemia and above is hyperkalemia, both may cause fatal dysrhythmias |
| What is cardiac catheterization? | Procedure used to visualize the hearts chambers, valves, great vessels, and coronary arteries |
| How is cardiac catheterization performed? | Catheter inserted in femoral artery, threaded to heart. Must check patient for shellfish or iodine allergy, and may need to administer nitro if patient experiences chest pain |
| What is angiography? | Injection of dye into the heart and blood vessels, a record of the dye's circulation is made |
| What does the physician use angiography for? | Visualize size and shape of the heart changes and to see narrowing or obstruction of the coronary arteries |
| What is a holter monitor? | Portable EKG recorder; patient keeps a diary for 24 hrs while wearing the monitor, physician compares diary to dysrhythmias |
| What is thallium? | Intracellular ion that is transported into normal cells, will not enter abnormal cells |
| What is the normal WBC range? | 5000-10000 |
| What is a echocardiogram? | High frequency ultrasound that shows the size, shape and position of cardiac structures |
| What can an elevated ESR indicate? | MI or infective endocarditis, rheumatic fever, RA, SLE lupus |
| What does an elevated HDL indicate? | Decrease in the risk for cardiac disease |
| What is the ideal LDL range? | Less than 100mg/d |
| What is ideal HDL range? | More than 40mg/d |
| What is coronary artery bypass graft (CABG)? | Using saphenous vein in the legs or internal mammary to graft around occlusions in the coronary arteries. |
| What must you do prior to ambulating a CABG patient? | Medicate with analgesics |
| What is the post procedure assessment for ednomyocardial biopsy? | Watch for bleeding, cardiac tamponade, and pneumothorax |
| What must you do after a transesphageal echocariography? | NPO until gag reflex returns, assess LOC, V/S, and pulse ox |
| What is valve replacement surgery? | Replacing stenosed or insufficient heart valve with mechanical valve, porcine valve, or cadaver valve. Old valve is removed and replacement valve is sutured in place |
Created by:
tandkhopkins
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