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90 terms

Critical Care Cardiac

Part 1
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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