Cardiac
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| What part of the heart is the pericardium? | Outside
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| What part of the heart is the epicardium/myocardium? | Muscle
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| What part of the heart is the endocardium? | Inside
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| What part of the heart is the atrium? | Top
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| What part of the heart is the ventricle? | Bottom
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| What type of blood does the superior & inferior vena cava carry? | Deoxygenated
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| What type of blood does the pulmonary vein carry? | Oxygenated
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| What type of blood does the pulmonary artery carry? | Deoxygenated
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| What is the pathway of the deoxygenated blood? | Inferior & superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary semi-lunar valve, pulmonary artery
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| 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
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| Where do the coronary arteries supply oxygen & nutrition to? | Heart
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| 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
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| What are modifiable risk factors for cardiovascular disease? | Smoking, hyperlipidemia, hypertension, diabetes mellitus, obesity, sedentary lifestyle, stress, oral contraceptives, and psychosocial factors
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| What are non-modifiable risk factors for cardiovascular disease? | Family history, age, sex, race
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| What is angina pectoris? | Chest pain caused by decreased blood flow to the myocardium
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| What symptoms does a person feel with angina pectoris? | Chest pain and a choking feeling
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| What medicine is given to a patient for angina pectoris? | Nitroglycerin
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| 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
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| 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)
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| What is stable (classic) angina? | Pain w/exertion - relief w/rest
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| What is silent angina? | Unrecognized or truly silent
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| What MUST you know prior to giving nitro? | Blood pressure
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| How many doses of nitro can you give and how often? | 3 / q 5 mins
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| What do you do if pain does not subside after giving 3rd dose of nitro? | Call physician or EMS / administer O2 as ordered
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| How is nitro glycerin tablet given? | Sublingually, while patient is at rest, no food/drink after administered
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| What are nursing interventions for angina pectoris? | Rest, avoid large meals, instruct pt. to stop activity at first sign of anginal pain
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| What is the best way to reduce myocardial oxygen demand during exertion because it helps condition the heart? | Exercise
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| 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
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| What are the signs/symptoms of MI? | Crushing, vice like feeling, heavy object sitting on the chest, radiating to the neck, jaw, arm, & teeth
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| What is a common symptom of MI? | Denial
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| How are MI symptoms different from angina pectoris? | MI symptoms are more severe and last longer than angina pectoris symptoms
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| What does a MI result in? | Necrosis of the myocardium
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| What are the subjective signs of MI? | Pain, anxiety, dyspnea, weakness/faintness, nausea, and sense of impending doom
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| What are the objective signs of MI? | Pallor, erratic behavior, hypotension, shock, change in cardiac rhythm, vomiting, fever, diaphoresis, and SOR
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| What is the immediate treatment for MI? | MONA (Morphine, Oxygen, Nitro, ASA/Plavix)
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| What is ventricular fibrillation? | Ventricles of heart quiver rather than pump blood
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| 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
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| What is ventricular aneurysm? | Damage to the ventricle causes the ventricle wall to thin and balloon out
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| What is pericarditis? | Sac around the heart becomes inflamed after the MI damages the ventricle
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| What is an embolism? | When blood clot (thrombus) breaks away and travels (embolus) through the circulatory system
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| What does the presence of troponin indicate? | Ischemic myocardial injury (stays elevated 14 days; most specific for MI damage)
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| 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
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| What is an important nursing diagnosis priority for MI? | Check with doctor about resuming sexual activity
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| What medication is used for ventricular fibrillation? | Amiodarone (Cordarone)
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| What is the purpose of the valves in the heart? | One way doors to keep blood flowing in appropriate direction
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| When to the valves open & close? | When blood pushes through and when the chamber is filled
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| What occurs with valvular heart disease? | Heart valves are compromised and do not open and close properly
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| What occurs with valvular stenosis? | Valve tissue thickens, causing valve to narrow
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| What is valvular insufficiency? | Valve is unable to close completely
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| 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
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| Why does cardiac tamponade occur? | Pericardial effusion (fluid) restricts heart movement
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| What procedure would be performed for cardiac tamponade? | Pericardiocentesis to remove excess fluid
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| What creates the lubb-dubb heart sound? | Closure of the heart valves
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| What does the swishing sound between the normal lubb and dub sound indicate? | Heart valves may not be opening and closing properly
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| What is endocarditis? | Infection or inflammation of the inner lining of the heart, particularly the heart valves
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| What should be given to a patient with existing valvular heart disease prior to any invasive procedure or dental work? | Prophylactic antibiotics
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| What is myocarditis? | Inflammation of myocardium/epicardium
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| What is cardiomyopathy? | Term used to describe a group of heart muscle diseases that affects the structure or function of the myocardium
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| What are possible causes of cardiomyopathy? | Infective (viral, bacterial, etc.), severe nutritional deprivation, alcohol abuse, drugs (chemo), radiation, and cocaine
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| What is the result when the conduction system does not function normally? | Dysrhythmia's
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| What is the pacemaker of the heart? | SA Node
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| What is sinus rhythm? | Heart rate of 60-100bpm
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| What delivers electrical impulses via electrode to myocardium? | Pacemakers
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| What do you need to closely monitor after placement of pacemaker? | Heart rate and rhythm via apical pulse and ECG pattern
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| 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
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| 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
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| What is sinus tachycardia? | Normal rhythm at a rate of 100bmp or more
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| What is sinus bradycardia? | Normal rhythm at rate below 60bpm
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| What is atrial fibrillation? | Atria are quivering rather than pumping blood
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| How high can atrial rate be? | As high as 350-600 bpm
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| What may physician attempt with atrial fibrillation? | Carotid massage to stimulate vagus nerve to slow heart rate
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| 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
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| What is cardioversion? | Electric shock to the heart that helps restore normal sinus rhythm using two paddles to patients chest
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| What must you do immediately following cardioversion? | Check airway patency, check v/s, and check telemetry pattern
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| What are premature ventricular contractions (PVC's)? | Heartbeats that originate in the ventricle, not in the SA node
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| What are possible causes of PVCs? | Irritability of ventricle wall, exercise, stress, electrolyte imbalance (K+), digitalis toxicity, hypoxia, and MI
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| What is a concern when PVCs occur in pairs or runs? | Can cause ventricular tachycardia which could lead to death
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| What is the medical treatment for PVCs? | Lidocain - Antidysrhytmics
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| If you notice telemetry is abnormal, what is the first thing you do? | Check the patient
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| 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
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| What will occur if treatment of v-fib is not quickly instituted? | Death
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| 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
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| 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
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| What is the treatment for third degree AV block? | Usually a pacemaker
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| 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
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| What does it indicate when a patient's hr is in the 30's? | Complete heart block
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| What part of the body will be affected when the right or left side of the heart fails to pump blood effectively? | Lungs
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| What is congestive heart failure (CHF)? | When the heart can no longer effectively pump blood throughout the body
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| What are s/s of CHF? | Fatigue, angina, anxiety, oliguria, decreased gastrointestinal motility, pale/cool skin, weight gain, restlessness, decreased activity intolerance
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| When does left ventricular failure occur? | When the left ventricle can not pump enough blood to meet the needs of the body
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| Why does congestion occur in the lungs? | Blood is not able to leave the lungs and go to the left ventricle
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| What does left sided failure create? | Respiratory issues
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| What are major symptoms of left ventricular failure? | Dyspnea, paroxysmal nocturnal dyspnea (PND), orthopnea, pulmonary crackles, hemoptysis, and cough
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| When does right ventricular failure occur? | When the right ventricle cannot pump blood efficiently to the lungs
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| Where does the blood back up to when it cannot be pumped forward into the lungs? | Systemic circulation
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| What is the first sign of right ventricular failure? | Peripheral (dependent) edema
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| 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
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| 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
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| When does pulmonary edema occur? | Extensive amounts of fluid accumulate in the lungs
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| What is the cardinal sign of pulmonary edema? | Hemoptysis (pink frothy sputum)
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| 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
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| 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
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| What do you report to the MD immediately with pulmonary edema? | Persistent productive cough; dyspnea, pedal edema, and restlessness
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| 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)
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| How do you differentiate pain by non-cardiac problem? | Ask the patient if the pain gets worse when they breath in
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| 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
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| What do dopamine and other inotropic agents do? | Increase myocardial contractility without increasing oxygen consumption. Raise systemic arterial pressure and increase cardiac output
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| What do anticoagulants do? | Decrease incidence of clotting and do not allow existing thrombus to grow larger
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| What do antiplatelets do? | Decrease vasoconstriction and platelet clumping (aggregation) on vessel walls
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| What do antidysrhythmic (Lidocain) treat? | Ventricular dysrhythmias
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| What do nitrates do? | Dilate coronary blood vessels and increase blood flow to the myocardium, may cause headache (vasodilator)
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| 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
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| What does atropine do? | Increase heart rate with symptomatic bradycardias
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| What does Cardizem do? | Decreases heart rate and BP in tachycardic patients such as SVT and atrial tachycardia
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| What must you check prior to giving potassium supplements? | Serum K+ levels
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| 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
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| What are the signs of digitalis toxicity? | Bradycardia, n/v, anorexia, dysrhythmias, headache, blurred or colored vision
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| What must you check prior to administering digoxin? | Digitalis level and apical pulse
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| What is normal digitalis range? | 0.5-2 ng/mL
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| When do you hold digitalis medication? | If apical pulse is less than 60bpm or digitalis serum level is out of normal limits
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| What does digitalis do? | Slows the heart rate and strengthens contractions
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| What is the normal K+ serum level? | 3.5mEq/L , below that is hypokalemia and above is hyperkalemia, both may cause fatal dysrhythmias
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| What is cardiac catheterization? | Procedure used to visualize the hearts chambers, valves, great vessels, and coronary arteries
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| 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
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| What is angiography? | Injection of dye into the heart and blood vessels, a record of the dye's circulation is made
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| 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
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| What is a holter monitor? | Portable EKG recorder; patient keeps a diary for 24 hrs while wearing the monitor, physician compares diary to dysrhythmias
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| What is thallium? | Intracellular ion that is transported into normal cells, will not enter abnormal cells
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| What is the normal WBC range? | 5000-10000
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| What is a echocardiogram? | High frequency ultrasound that shows the size, shape and position of cardiac structures
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| What can an elevated ESR indicate? | MI or infective endocarditis, rheumatic fever, RA, SLE lupus
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| What does an elevated HDL indicate? | Decrease in the risk for cardiac disease
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| What is the ideal LDL range? | Less than 100mg/d
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| What is ideal HDL range? | More than 40mg/d
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| What is coronary artery bypass graft (CABG)? | Using saphenous vein in the legs or internal mammary to graft around occlusions in the coronary arteries.
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| What must you do prior to ambulating a CABG patient? | Medicate with analgesics
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| What is the post procedure assessment for ednomyocardial biopsy? | Watch for bleeding, cardiac tamponade, and pneumothorax
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| What must you do after a transesphageal echocariography? | NPO until gag reflex returns, assess LOC, V/S, and pulse ox
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| 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
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