Critical Care Cardiac

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Part 1

A positive Schamroth's sign indicates

clubbing, central cyanosis

Pt's with shiny, pale dry legs are most likely suffering from

Arterial Disease

Upon entering a pt's room the nurse notices that the pt diagnosed with arterial disease has their legs elevated the nurse should

Lower the extremities and explain the importance of keeping the legs lower than the heart

A pt with visible JVD, the nurse would anticipate a preload CVP level of

<3

Pt's with Venouse Disease should be encouraged to sit with their lower extremities

elevated to increase circulation back to the heart

When documenting JVD include

time and elevation of HOB

Upon ausculatation the nurse notices a rubbing sound when the pt inspires, and expects the pt is experiencing cardiac rub. What PRN med ordered should she admin

NSAID such as advil

The post MI pt who is being discharged should be taught about what kind of associated pain that may occur how long post MI

2-7 days

Torsades de point treatment

Magnesium Replacement

After administering magnesium replacement therapy for a pt experiencing palpitations, lightheadedness, and transient SOB r/t torsades de point should have what tests ordered

renal function

A pt with hyperkalemia will exhibit what kind of heart rate

decreased

A permanent solution for hyperkalemia is

Kayexelate

A normal potassium level is

3.5-5.5

CPK-MB elevates within

4-8hrs of injury

How often do you want to run labs for CPK-MB

q6hrs X 4, then q8hrs X 3

Troponin levels are elevated within how long of injury

3-6hrs of injury

How long will troponin levels remain elevated in serum after injury occurs

5-14 days

When should Warfarin be stopped prior to surgery

one week

What should be done for a pt who is on Warfarin therapy and has an INR result of greater than 9

hold Warfarin and give Vitamin K (3-5mg)

Therapeutic aPTT for a pt receiving Heparin should be around

60-65

If pt receiving Heparin has a screen result of 150 for aPTT the nurse should

stop the Heparin

If pt receiving Heparin has an aPTT of 20 the nurse should anticipate to

bolus Heparin then titrate up

The antidote for Heparin is

Protamine Sulfate

The antidote for Coumadin is

Vitamin K

What levels should be assessed before administering statin drugs

Lipid levels

If pt is getting a chest x-ray and is on a ventilator have the machine

sigh the pt

Pt's with diabetes are less likely to experience ________ during an MI

chest pain

Women are less likely to experience what sign of an MI

crushing chest pain

This kind of angina is usually relieved by rest or nitroglycerin

Angina Pectoris

These interventions for angina reduce the workload on the heart

beta blockers, bed rest, ace inhibitors, Calcium channel blockers, morphine

What s/s should the nurse watch for with a pt receiving nitroglycerin

headache, drop in BP, syncope, tachycardia

A pt with a history of an MI might have what long term change in their ECG

separate q wave

A pt having an active heart attack will show what change on the ECG

elevated ST segment

When there is a decrease in blood supply to an area of cardiac tissue but there is not a complete block yet and the pt states they feel funny what might be evident on the ECG

inverted T wave

An elevated ST segment will be treated with

TPA

After reperfusion of STEMI what kind of serum CK-MB do you want to see

dramatic rise in levels-(this indicates reperfusion and flushing out of all the enzymes and cellular trash in to the body so the WBC's can come clean up)

Pt's who have COPD should not be started on oxygen higher than ___________ b/c their drive to breathe is hypoxia

2-3L/min

Before admin of Nitro check

BP

Nitroglycerin can only be used within the first ______ hours of ST elevavtion or depression

24-48

If your pt has a true Right MI the heart needs the preload to be

increased

What intervention is appropriate for a pt with a true Right MI

extra volume by priming the pump-(to flood the pump and force it to work)

Morphine does what to preload and afterload

decreases

Do not administer Beta Blockers to a pt with a systolic BP

<100

Heparin does what to clots

prevents them from forming

ACE inhibitors are given to

reduce BP

Antiplatelet agents are indicated for pt's with

N-STEMI, no ST elevation, No q wave

Time of symptom onset must by _____ for Fibrolytic Therapy

<12hrs

A pt present to the ER because they awoke in the middle of the night with chest pain and their ECG shows ST elevation can they receive TPA(Fibrolytic Therapy)

No

When is TPA indicated

ST elevation, that occured <12hrs ago

If a pt starts to have decreased LOC while receiving Heparin and TPA the nurse should

Turn off the Heparin and call physician

What things need to be ruled out before administration of TPA

facial trauma, uncontrolled hypertension, and ischemic stroke within the last 3 months

If a pt presents to the ER with ST elevation but is unable to indicate when the chest pain started they may receive what to facilitate reperfusion

PCI-(percutaneous corornary intervention)

After recieving a dose of TPA the nurse notices PVC's present on the pt's ECG this needs what intervention

none (reperfusion PVC's if this becomes too frequent 3-5X can treat with 150mg Amiodarone)

A blood draw showing 98% oxygen pulled from the pulmonary artery indicates what complication post MI

Ventricular septal defect (left to right shunt)

Pt's with pericarditis may have pain greater with deep inspiration because it

increases thoracic pressure

Peripheral clogging, increased CVP, dependant edema, weight gain, and peripheral edema are all s/s of what kind of heart failure

right sided failure

Crackles, pulmonary congestion, cough, confusion, SOB, and cyanosis are all seen in pt's with

left sided heart failure

An appropriate medication used to treat CHF is

Digoxin

A post MI pt who had an infarction in the right coronary artery should be monitored for what kind of reperfusion dysrhythmia's

PVC's, bradycardia, heart blocks

A post MI pt who had an infarction in the left anterior descending should be monitored for what kind of reperfusion dysrythmia

PVC's, BBB, 2nd degree blocks

The nurse should be monitoring the pt closely for _____ around the 5th day post MI

Ventricular Free wall rupture

Small raised tender areas most commonly found in the pads of fingers and toes

Osler nodes

Osler nodes are seen in cardiac pt's exhibiting

Infective Endocarditis

Round or oval spots seen in the retina that can lead to hemorrhage are

roth spots

Before starting antibiotics or antifungal in the treatment of possible infective endocarditis the nurse needs to

obtain cultures

Treatment for Infective Endocarditis usually consists of

Antibiotic/Antiinfective through PICC line at home until stable enough for surgery to repair or replace the damaged valve

3 early signs of infective Endocarditis are

level of consciousness, visual changes (blurred usually), headache

Pt's with cardiac tamponade will have _____ cardiac output, _____ preload, and ______afterload

decrease CO, increased preload, and increased afterload

If your pt is hemodynamically unstable and presents with cardiac tamponade they need and immediate

needle aspiration

S/S associated with cardiac tamponade include

syncope, orthopnea, tachycardia, JVD, chest pain, pulsus paradox

Rheumatic fever as a child can cause you to have what cardiac complication as an adult

Valvular stenosis

This valvular disease presents with HTN related to left ventricular hypertrophy

Aortic Valve Regurgitation

Treatment for Restrictive Cardiomyopathy is

Beta Blockers, Diuretics, Low Na+ diet

Pt's with restrictive cardiomyopathy need to be taught to report what kinds of s/s of breathlessness

increased SOB, sleeping upright or with additional pillows than normal, wheezing

Pt's with any valvular problem need to be taught to take prophylactic antibiotics for what kind of treatments

dental or invasive procedures

Pt's who are lean and fit but have SOB with exercise, syncope, chest pain, and tachycardia are exhibiting s/s of

Hypertrophic Cardiomeyopathy

To diagnose PAH the PAP must be what at rest and with exercise

25 at rest, 30 with exercise

Endothelial Receptor Agonists that can be used in the treatment of Pulmonary Hypertension are

Bosentan, Sitaxsentan, Ambrisentan

Phosphodiesterase inhibitors that can be used for the treatment of pulmonary hypertension are

Sildanafil, ProstanoidsEpoprostenol(IV), Treprostinil, Iloprost

What grade aortic aneurysm is operable

4

How and where is an aortic aneurysm usually detected

routine abdominal assessment as a palpable pulsatile mass in umbilical region left of the midline

A pt reports to the ER with sudden onset of extreme pain in the abdomen and while waiting in the ER the pt reports the pain has started to radiate into their back, and HTN, the nurse assumes this pt is suffering from

aortic dissection

If the pt who is suffering from an aortic dissection presents with hypotension, and shock their tear has

progressed and ruptured the aorta, (medical emergency)

Where is pain usually associated with an ascending aortic dissection

central chest or midscapular region of chest

Where is pain usually associated with a descending aortic dissection

back, abdomen, or legs

Pre-op for an aortic dissection the nurse anticipates what kinds of medications

vasodilators to control hypertension(nitro and nipride) and pain control

Postop for an ascending aortic dissection surgery the nurse needs to monitor which pulses

radial

Postop the nurse needs to asses which pulses after surgical repair of a descending aortic dissection

Pedal and femoral

Pt's with Peripheral Arterial Disease would present with what during an ankle-brachial index screen

strong radial pulses and weak pedal pulses

Pt's with PAD need to keep their affected extremity

dependent to maximize blood flow to limb

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