COD N2 2012 Cardiac test
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| Digoxin is a | + inotrope (improves contractility, Increases force of contraction) & -chronotrophy (slows the HR)
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| Digoxin Classification | Therapeutic: antiarrhythmics, inotropics
Pharmacologic: digitalis glycoside
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| Use Digoxin Cautiously in: | Digibind, charcoal
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| Symptoms of Digitalis Toxicity | Anorexia, Abd pain, Nausea /Vomiting, Blurred, yellow vision, Bradycardia, Arrhythmias
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| Do not administer Digoxin if | < 60 bpm or > 100 bpm
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| Digoxin Action | Increases the force of myocardial contraction. Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes.
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| Digoxin Therapeutic Effects: | Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect).
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| Before Administering Digoxin you need to: | Monitor apical pulse for 1 full min before administering.Observe IV site. Monitor I&O ratios and daily weights. Assess for peripheral edema, and auscultate lungs for rales/crackles.
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| Digoxin Lab Test Considerations | potassium, magnesium, and calcium, renal and hepatic functions,
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| Digoxin Drug/ Drug interaction: | Thiazide and loop diuretics, verapamil may ↑ levels and lead to toxicity, Additive bradycardia may occur with beta blockers, diltiazem, verapamil, clonidine, and other antiarrhythmics
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| furosemide (Lasix); bumetanide (Bumex); toresemide (Demadex) | Class: Diuretics; loop diuretics
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| Spironolactone(Aldactone) | Class; diuretics, potassium sparing diuretics
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| Labs to monitor during Diuretic therapy | BUN, creatinine, electrolyets, potassium levels, glucose, uric acid levels, hypotension,
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| Inhibits aldosterone, causing Na to be excreted in the distal tubule, but sparing potassium. | Potassium-sparing diuretic
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| Diuretics: Prevent Na and water reabsorption in the distal tubules while promoting potassium excretion | Thiazide
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| Thiazide diuretics are contraindicated in clients with? | Renal failure. Cumulative effects of the thiazide may develop in patients with impaired renal function. In such patients, thiazides may precipitate azotemia (increased urea).
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| Blocks epinephrine from interacting with beta receptor sites. | Beta Blockers
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| Cardio Selective Beta-Blockers | acebutolol (Sectral); atenolol (Tenormin); betaxolol (Kerlone); bisoprolol (Zebeta); esmolol (Brevibloc); metoprolol (Lopressor
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| Selective Beta-Blockers: | Lower b/p by blocking beta receptors in the heart and peripheral vessels, reducing heart rate, myocardial contractility, and cardiac output.
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| Nonselective beta-blockers | block beta2-adrenergic receptors on the smooth muscle of the bronchioles and blood vessels. Does not only work specially on the heart.
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| nadolol (Corgard); propranolol (Inderal); timolol (Blocadren) | Nonselective beta-blockers
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| Sudden stop of beta-blockers administration can lead to what | HTN crisis
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| before taking beta-blockers med the nurse should assess the ______ which must be over ______ before giving to patient | apical pule rate; 50 bpm
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| Inotropic Agents | Stimulate the heart to increase the force of contractions, thus boosting cardiac output
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| Positive chronotropes ________ heart rate; negative chronotropes _________ heart rate | Increase, decrease
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| Blocks the conversion of angiotensin I to angiotensin II, one of the most powerful vasoconstrictors in the body, thereby decreasing b/p. | Angiotensin-Converting Enzyme Inhibitors (Ace-inhibitors)
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| Ace Inhibitors also blocks the release of_________to reduce Na and water retension. | aldosterone.
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| ACE inhibitors | benazepril (Lotensin); captopril (Capoten); enalapril/enalaprilat (Vasotec, Vasotec IV), fosinopril (Monopril), lisinopril (Prinvil, Zestril); moexipril (Univasc); perindopril (Aceon); quinapril (Accupril); ramipril (Altace); trandolapril (Mavik)
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| Cardio drugs that cause severe dry cough | Ace inhibitors
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| lab tests considerations for Ace inhibitors | BUN, creatinine, electrolytes, serum potassium, CBC, AST, ALT.
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| Hydrochlorothiazide | Thiazide diuretic most commonly used for HTN. Check K+. Less potent, less effective than Lasix & Bumex (won't get massive outputs)
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| Zaroxolyn | Mild diuretic used for HTN, not a thiazide but it acts as one.
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| Effects of Angiotensin II | Vasoconstriction & Release of aldosterone which retains Na+ & H2O causing increase workload of heart
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| Used for: HTN, heart failure, MI, Diabetic & non-diabetic nephropathy & high cardiovascular risks. | ACE inhibitors
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| Side Effects: HTN, cough, hyperkalemia, renal failure, fetal injury, angioedema. Does not allow angiotension I to convert to angiotensin II | ACE inhibitors
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| Angiotensin II Receptor Blockers (ARB's) | Dilates arteries & veins, prevents pathological changes to heart, decreases release of aldosterone. Used for: HTN, Heart Failure, Diabetic Nephropathy, MI, Stroke prevention
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| Angiotensin II Receptor Blockers (ARB's) drugs | losartan & valsartan (end in sartan)
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| Angiotensin II Receptor Blockers (ARB's)Side Effects: | Angioedema, fetal harm, renal failure. Allows Angiotensin I to go to Angiotensin II but it doesn't work, it blocks receptor site. Use this if develop cough from ACE inhibitor
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| Calcium Channel Blocker Actions: | Reduces heart rate, converts Afib to sinus or rate control, positive inotrope (contractility = increases efficiency of myocardium). Used for: HTN, Afib, cardiac dysrhythmias.
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| Calcium Channel Blockers Drugs | Calan (verapamil), Cardizem (diltiazem), Procardia (NIFEdipine), Norvasc (amlodipine)
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| Calcium Channel Blockers Side Effects: | Bradycardia, constipation, edema of ankles & feet
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| Alpha-2 Agonist drug | clonidine (Catapres)
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| clonidine (Catapres) actions: | Blocks sympathetic stimulation. Causes vasodilation & lowers BP. S/E: dry mouth and sedation. Do NOT stop abruptly b/c you get reflux HTN
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| peripherally acting antiadrenergics | Lowering of blood pressure. Decreased cardiac preload and afterload. Decreased symptoms of prostatic hyperplasia (urinary urgency, urinary hesitancy, nocturia)
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| Alpha Adrenergic Antagonist drugs | prazosin (Minipress), Terazosin, Doxazosin (end in azosin)
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| Prazosin, Terazosin, Doxazosin | Prevents stimulation of Alpha I receptors (vasoconstriction. Used for HTN & BPH. S/E: orthostatic HTN especially w/ 1st dose. Start w/ small dose & may get sinus tachy with that
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| Sodium Nitroprusside (Nipride) & Nitroglycerin | Vasodilators
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| Sodium Nitroprusside (Nipride) | Venous & Arterial dilator (decreases BP drastically fast), metabolizes to Nitric Oxide causing cyanide poisoning. Only given in hypertensive emergencies in ICU on continuous drip for max 3 days. Needs to be light protected (brown plastic bag)
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| Nitroglycerin | Nitroglycerin is in a group of drugs called nitrates. Nitroglycerin dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump. Nitroglycerin is used to treat or prevent attacks of chest pain
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| CHF Medications~ To reduce preload: | Diuretics
ACE Inhibitors
Digoxin (Lanoxin)
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| CHF Medications~ To reduce afterload | Beta-blockers
ACE Inhibitors
Nitrates (low dose)
Hydralazine
Nesiritide (Natrecor)
Eplerenone
Spironolactone (low doses)
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| Treating CHF (UPLOAD FAST) | Upright position
Nitrates (low dose) (PO form, not nitro)
Lasix
Oxygen
Ace Inhibitors
Digoxin
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| Angina Pectoris Medical Management (Medications) | 1.Oxygen 2.Nitroglycerine ~ Dilates coronary arteries to increase blood flow to myocardium 3.ASA 4.Morphine 5.Beta Blocker- reduces heart rate and vasoconstriction & or Calcium Channel Blockers- prevent calcium entering the cell wall/ causing contraction
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| What forms does Nitroglycern come in | extended release capsules, I.V. translingual spray, ointment, sublingual, transdermal
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| indications of Nitro SL and Translingual | Acute Anginal Attacks
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| Oral and Transdermal Nitro are indicated in what? | long term management of angina pectoris PO: adjunct treatment in CHF
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| I.V. Nitro in indicated in what paitient? | Adjunt Tx of accute MI. Production of controlled HTN during surgical procedures. Tx of HTN with acute MI
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| Atenolol | Beta Blocker
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| Carvedilol | Beta Blocker (Coreg)
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| Lab Test considerations for Ace Inhibitors | Renal Finction, may cause hyperkalemia (K+, may cause elevated AST ALT Alkaling phosphate & serum billirubin
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| This drug is a combination of a positive Inotrope and a negative Chronotrope | DIGOXIN
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| antidote for Coumadin | Vitamin K
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| 3 common classes of drugs used alone and in combination to reduce blood pressure: | Beta Blockers, Ace Inhibitors, diuretics
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| Most common used Diuretic to assist in blood pressure control | THIAZIDES
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| NORVASC | Calcium Channel Blocker, Causes vasodilation at arterioles
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| ALPHA BLOCKERS | Central acting causes a decrease in sympathetic neuro firing (clonidine)
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| the complication of CHF can best be described as "drowning in accumulation of extravascular fluid" "pink frothy sputum" | pulmonary edema
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| this usually occurs when a clinet sits up immediately after an angiogram | Hemotoma
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| These two non-mofiable risk factors may result in CAD | race and family history
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| This may be a complication of Raynauds or Buergers disease. | gangrene
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| this vitamin may cause anti-coagulation therapy of warfarin (Coumadin)to be decreased | Vitamin K
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| Lab that is the "GOld Standard" for cardiac markers | Troponin
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| this lab has to be checked before giving Loop diaretics | Potassium
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| this is the formula for finding the IV rate when Heparin if prescribed at 5000 units/ hour and the pre-mixed heparin is 25000 in 250ml |
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| this vascular disorder may ne the result of prolonged bedrest or even prolonged sitting | DVT
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| the spouse of a client is recalling the modifiable risk factors for coronary heart disease. He tells you, Coronary heart disease includes all of the folloeing EXCEPT: Age, DM, obeasity, sedentary lifestyle | Age
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| Before giving digoxin you must ascultate the PMI, this is usually called the | apical pulse
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| the term for a medication that increases the force of a contraction and increases the rate | + inotrope & + chronotrope
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| May relieve angina in a client whe is doing aerobic exercise | Rest
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| This is what you do before giving Nitro | talk a BP and have patient sit or lay down
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| The childrens heart disease that is treated with gamma globulin & ASA | Kawsaki disease
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| this is what you get when you subtract the paical pulse from the radial pulse | pulse deficit
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| arteriosclerosis | hardening of the arteries, the major contributing factor in CAD
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| atherosclerosis | the development of plaques in the intimal layer of the larger arteries, eventually developing blockages
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| GI distress may ne caused by this consequence of right sided heart failure | venous engorgement within the ABD organs (liver / spleen enlargement)
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| JVD | Jugular Vein Distention
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| JVD may be an indication of this type of heart failure | Rt sided heart failure
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| most important teaching for a person going home with Coumadin | have your labs drawn as prescribed by your doctor
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| side effect of Coumadin that can be fatal | bleeding
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| If the heparin order is "if aPTT is 76-90 seconds, decrease rate by 2units/ hr" this is what the nurse does if the current aPTT is 77 | decrease the rate to 68 units/hr
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| this cardiac disorder can result form kawaski disease ot cardiomyopathy in children | CHF
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| Thrombophlebitis | occurs when a blood clot causes swelling in one or more of your veins, typically in your legs. Rarely, thrombophlebitis (sometimes called phlebitis) can affect veins in your arms or neck.
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| An aneurysm is | a bulge or "ballooning" in the wall of an artery. occur in the aorta, the main artery traveling from heart through the chest&abd can happen in arteries in the brain, heart and other parts of the body. If an one in the brain bursts, it causes a stroke.
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| A patient with hyperlipidemia, treatment will include: | diet therapy, exercise and lipid lowering agents
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| LDL cholesterol | is known as "bad" cholesterol, it can build up on the walls of your arteries. The fatty deposits of bad cholesterol, along with other substances, can attach to the arterial walls of blood vessels, narrowing them over time and blocking normal blood flow
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| HDL cholesterol | is known as "good" cholesterol. Experts believe that HDL helps remove the excess cholesterol from the heart's arteries and carries it back to the liver, where it is passed from the body. If your good cholesterol is low, your doctor may try to raise it.
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| HDL recommended level _____ LDL recommended level _____ Serum Cholesterol _______ | HDL > or = to 35 mg/dL
LDL < or = to 100 mg/dL
Serum Cholesterol < or = to 200 mg/dL
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| Thrombophlebitis can lead to | PE
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| This is the first question you would ask a cardiac patient complaining of Chest Pain | Where is it
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| This is the most important patient teaching about Plavix | Don't stop taking it unless ordered by your doctor
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| Side Effects of Calcium Channel Blockers | Bradycardia, Hypotension, CHF, PVD, bronchospasims, & impotence
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| precordium | The anterior chest
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| Apical pulse: | point of maximum intensity
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| Are Sinus Arrhythmias normal in children | yes
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| normal HR of a newborn | 100-170 (120)
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| are muffled heart sounds in children normal | no, there is some kind of defect
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| S3 heart sound is called a | Venous Hum and it is normal
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| Valve defect that sounds like wooshing could be a | murmur
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| Varicose veins | effect approx. 60% of the adult population, whites more than blacks
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| S/S of PE | Fever, ABD pain dyspnea are 3 major symptoms
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| a client that comes to the ER complains of horsness, dysphagia & trachael displacement. Symptoms common with: | thoracic aortic aneurysm. symptoms are related to the pressure of the aneurysm on the esophagus laryngeal nerve
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| Ulcers characterized by irregular margins, ulcer beds are pink, and there is edema and swelling | Venous Ulcer
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| rebound HTN | rapid increase in BP after sudden stop of medications
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| Reaction to group A beta-hemolytic strep | Rheumatic Heart Disease
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| Monthly IM injections, for 5 years or until 25yrs old, of Penicillin G to prevent recurrence. | Treatment for Rheumatic Heart Disease
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| if a patient has Mitral Stenosis and is on Coumidin is at risk for: | Atrial Thrombosis
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| Medical Management for Rheumatic Heart Disease | Digoxin, diuretics, sodium restricted diet, 02
Prophylactic antibiotics pre/post dental care
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| Influenza S/S | a sudden rise in Temp, Soar throat, weakness, stuffy nose, Poss. runny nose & cough, nausea, poss. vomiting
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| Strp Throat S/S | Sudden onset, Extremely sore throat, severe inflammation of the throat (bright red), fever, headache, weakness, possible skin rash, swollen glands, elevated WBC
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| a patient with Mitral Stenosis, their first S/S: | Dyspnea on exertion
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| pulse deficite | the difference between the apical pulse and radial pulse
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| pulse pressure | difference between systolic and diastolic
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| What is the Blood Pressure | The pressure pushing against the walls of the arteries
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| Alpha I receptors effect the | heart
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| Beta II receptors effect | lungs
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| prehypertension | 120-139 SBP 80-90 diastolic
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| Importance of homocysteine lab tests | an elevated level of homocysteine in the blood (hyperhomocysteinemia) is believed to cause narrowing and hardening of the arteries (atherosclerosis).
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| what is PQRST? | P = Provokes: What causes pain? makes it better? Worse? feel like? Sharp, dull, stabbing constant, squeezing
R = Radiates: Where? Is it in one place? Does it go anywhere else? localized to one spot?
S = Severity: scale of 1 - 10?
T = Time: how long
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| Coronary artery bypass grafting (CABG) | a surgical procedure in which veins and arteries are used as a conduit to bypass the coronary artery stenosis
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| Hypotension | Blood pressure lower than needed for adequate tissue perfusion and oxygenation.
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| ejection fraction | it is the percentage of the end-diastolic volume that is ejected with each stroke
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| S1 first heart sound | closure of the mitral & tricuspid valves creates the first heart sound
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| S2 second heart sound | closing of the aortic and pulmonic valves produces the second heart sound
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| afterload | the amount of resistance to ejection of blood from the ventricle, is the second determinant of stroke volume
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| preload | the degree of stretch of thecardiac muscle fibers at the end of diastole
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| stroke volume | the amount of blood ejected per heartbeat
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| LDL | is referred to as the ‘bad cholesterol.’ It is the main lipid component of the atherosclerotic plaque and is considered bad cholesterol because increased levels reflect increased tendency to CAD.
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| Pulmonic Valve | The pulmonic valve divides the right ventricular outflow tract from the pulmonary artery
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| Hypertention | A sustained elevation of systemic blood pressure to a level that places the patient at increased risk for target organ damage
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| Diastole | The pressure measured when the ventricles are relaxed is called diastolic blood pressure.
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| Cardiac Output | refers to the amount of blood pumped by each ventricle during a given period
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| This valve disorder may cause left ventricular hypertrophy | Aortic regurgitation
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| these side effects are typical of calcium channel blockers | Bradycardia, hypotension, CHF, PVD, bronchospasms & impotense
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| a drug in this classification is considered a negative chronotrope and a negative inotrope | Beta Blocker
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| This adrenergic is very often ordered PRN with RCC orders | Clonidine (Catapres)
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| this principle of this mechanism is: the greater the stretch of cardiac muscle fibers, the greater the force of contraction | Frank Starling Mechanism
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| This is the classic sign of a congenital heart defect | Cyanosis that doesn't respond to O2
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| endocarditis | inflammation of the endocardium
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| Hypertrophic cardiomyophy | increase size and thickness of the heart muscle
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| Systole | when ventricles contract, begins with S1 ends S2, shorter than diastole
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| Diastole | when ventricles relax, begins with S1, no heart sounds audible
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| How do we assess for cardiac pain or chest pain | - location: where is pain/discomfort located
- Duration: how long has pain been going on, is it similar to previous
- Intensity 0-10
- Assess respiratory pattern
- history of drug abuse
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| What veins and pulses do we assess | - jugular vein distention
- pedal pulses, femoral pulses
- blood pressure both arms
- pulses should be equal bilaterally
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| Treadmill Stress Test | You walk on a treadmill while being monitored to see how far you walk and if you develop chest pain or changes in your ECG that suggest that your heart is not getting enough blood
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| Adenosine Stress Test | A drug is given to make the heart respond as if the person were exercising. This way the doctor can still determine how the heart responds to stress, but no exercise is required
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| What are some ischemic heart disorders | Angina Pectoris, MI, CAD
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