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Med Surg 1


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