Nursing in Health & Illness I: Cardiology
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| Name the major contributing factors to heart failure. | Advancing age, CAD, MI, arrhythmias, HTN (3X), Rheumatic heart disease, cardiomyopathy, valvular disorders, diabetes, obesity...
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| What are the three contributing factors of stoke volume or VS (hint: not talking HR or CO) | Preload, afterload, and contractility.
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| What is preload? | Volume of blood in the LV at the end of diastole (filling).
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| What is afterload? | Resistance against which the ventricles pump (BP).
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| What is contractility? | Force of myocardial contraction.
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| What is ejection fraction (EF), and it's normal value? | % of blood ejected from LV; normal is 60-67 if healthy
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| What end-goal to all cardiac compensatory mechanisms have? | Keep up O2 sats for all organs.
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| What are some S/S of hypoxia? | Confused, restlessness, tachycardia, tachypnea, 
angina, cyanosis (late)
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| T/F: In populations over 55, HTN has > incidence in women? | Ture. More common in men below 55.
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| What are the four non-modyfiable risk factors of HTN? | Age, gender, family hx, ethnicity
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| What are the s/s of mild-moderate HTN? | There are none.
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| What are the s/s of severe HTN? | Fatigue, reduced activity tolerance, dizziness, palpitations, angina, dyspnea, *h/a, *nosebleeds (*very high BP > 190-200/120-ish)
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| What are complications of HTN? | CAD, left ventricular hypertrophy, heart failure, CVD, PVD, nephrosclerosis, retinal damage
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| What are the three major physical problems associated with HTN? | Renal failure, COPD, cardiac issues (valvular disorders)
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| What are some assessment clues that one may be at risk for severe HTN? | Symptoms of severe HTN: H/A, nocturia, vision changes, edema, nosebleeds; stress levels, type A personality...like Liz.
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| What is the first step in tx of HTN? | Modifiable risk factors...d/c smoking, fix diet, etc.
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| In HTN crisis, what range of diastolic pressure would one expect to see? | >140 mm Hg
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| What are the S/S of HTN crisis? | H/A, N, V, seizures, confusion. Tx: bring down BP SLOWLY.
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| What are the main causes of atherosclerosis? | BP, genetics, high lipids, DM, smoking, stress
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| What are the risk factors for metabolic syndrome? | Must have 3/5: Waist circ of 40/35", HTN, HDL of 40/50 or less, fasting BG>100, triglycerides >150
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| How do symptoms differ when a client is experiencing angina R/T drug abuse, vs. natural causes? | Clients will likely have: sinus tacky, anxiety, and even coronary spasms (lead to damage)
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| What does PQRST stand for, r/t questioning a client c/o angina? | P - precipitating events
Q - quality of pain
R - radiation
S - severity
T - timing
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| What is ACS (Acute Coronary Syndrome)? | Acute coronary syndrome (ACS) refers to any group of symptoms attributed to obstruction of the coronary arteries
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| If a client comes in to the ED having c/o chest pain one exertion that ended up being relieved by rest, what would his tx plan likely look like? | Stress test, taught to modify risk factors, may need angiography/stent/CABG or something...considered stable angina.
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| What are proper Rx's for a client Dx'd w/ stable angina? | ASA (and/or coumadin), nitrates, ACE inhibitors, beta blockers
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| What do we use to tx MI? | MONA: Morphine, oxygen, nitrates, and asprin
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| How do Troponin levels change post-MI, and at what times? | Rises in 4-6 hours, peaks in 10-24, normalizes in 10-14 days
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| How do CK-MB levels change post-MI, and at what times? | Rises at 6 hours, peaks at 18 hours, normalizes in 24-36 hours
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| What do clients headed for a PCI need? | Nitro (watch BP, give tylenol for H/A), Morphine, REAL HEPARIN, tPA?
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| What is the main goal for a client post-MI? | STOP NECROSIS OF CELLS
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| What are normal BUN and creatinine levels? | BUN: 10-20, creatinine: 04. to 1.3-ish.
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| What preparations should be made pre-cath-lab PCI? | NPO, EKG, leg prep, Ativan, consent, video, ask: allergies to iodine/shellfish, labs (renal-ridding of dye)
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| What percentage of arterial occlusion must be present to necessitate installment of a stent? | 85%
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| What would a client take to prevent thrombosis associated w/new stent placement? | Integrelin (eptifibatide)...NOT heparin, as post-tx will already have > aPPt
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| What are some post-PCI implications? | Supine until aPPT <150 (1-2+ hours)
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| What are some possible post PCI meds? | ASA, Plavix, Nitrates, beta-blockers (-olols), calcium channel blockers (diltiazem), and ACE inhibitors (-prils)
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| How do beta-blockers affect cardiac workload? | Reduce contractility, HR, and after-load.
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| How does lasix affect cardiac workload? | Reduction of pre-load
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| How do calcium channel blockers act to affect hemodynamics | Reduce HR and contractility
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| How do ACE inhibitors act to affect hemodynamics? | Reduces vasoconstriction
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| What are some reasons one may have chronic stable angina? | Coronary spasms, prinzmetal's, or cocaine
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| What is the most serious complication of MI? | Cardiogenic shock (85% mortality)
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| What are some common results of cardiogenic shock? | Marked decrease in CO, loss of 45-50% of the myocardium,
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| What is the primary physiological goal when a client is in cardiogenic shock? | Increase contractility and workload of the heart to maintain blood flow.
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| What are the S/S of cardiogenic shock? | Decrease LOC, oliguria, hypoTN, cold/moist skin, metabolic acidosis, acute HF
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| What are complications of MI? | Cardiogenic shock (worst), thromboembolism, ventricular rupture (least common), dysrhythmias (most common - 80%), pericarditis, valvular issues (rare)
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| What are the S/S of left-sided HF? | Dyspnea, orthopnea, crackles, cough, increased HR, anxious
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| What are the S/S of right-sided HF? | Increased CVP (s/b 2-8), edema, nocturia, SOB
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| How does one measure ejection fracture? | Cardiac catheterization.
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| What sort of test will help rule out lung issues with a client the c/o SOB, increased WOB, and has crackles on auscultation? | Brain naturetic peptide or bNP. S/B 5-450, but will typically be in 1000s in CHF.
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| Describe class I heart failure... | No symptoms w/activity, client doesn't know.
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| Describe class II heart failure... | Fatigue with exertion, maybe some angina if CAD is present.
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| Describe class III heart failure... | Noticeable dyspnea, fatigue, palpitations w/ activity
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| Describe class IV heart failure... | Can't do shit w/o discomfort.
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| What are some complications of HF? | Thank CLAP: Pleural effusion, hepatomegaly (liver), left ventricular thrombus (clot), arrhythmias
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| What kind of sodium intake would a nurse be recommending for a client with mild to severe CHF? | 2g for mild; 500-1000mg severe
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| What kind of daily weight gain would a client with CHF need to report? | >= 3lbs in one day
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| What are the S/S of heart failure? | F - fatigue
A - activity intolerance
C - cough/congestion
E - edema
S - shortness of breath
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| If a client has all of the symptoms for MI, but cardiac markers show no elevation, what should be suspected? | Aneurism
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| What are the S/S of acute arterial ischemia? | Remember the P's: Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia.
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| What is the pharmacotherapy for Reynaud's? | CCB
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