Cardiac
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| Cues to Cardiovascular Problems | Fatigue, Fluid Retention, Irregular Heartbeat, Dyspnea, Pain, Tenderness in calf of leg, Syncope, near syncope, Altered neurologic function, Leg pain
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| What drug prolongs the blood clotting time | Aspirin
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| Some major cardiovascular risk factors | Elevated serum lipids, HTN, tobacco use, sedentary lifestyle, and obesity
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| Family history of what non-cardiac conditions should be assessed? | Asthma, Renal disease, liver disease, and obesity
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| Question to ask pt. about weight gain | Can they buckle their pants, are they leaving them unbuttoned?
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| Diabetic pt. may not experience pain as intensely due to __________ ? | Neuropathies
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| Some non-modifiable risk factors for CAD | Positive family history for premature CAD (before age 55), Increasing age, Gender - Men and postmenopausal women, Race (African Amer at highest risk)
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| Some modifiable risk factores for CAD | Hyperlipidemia, HTN, Smoking, DM, Obesity, Physical inactivity, Type A personality (hostility), Use of oral contraceptives
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| Follow what kind of pattern for inspection of heart? | Z pattern
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| Where is the point of maximal impulse (PMI) located? | 5 IC space left of the midclavicular line
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| Vein distention beyond 45 degrees is considered what? | Jugular Vien Distention (JVD)
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| Some other signs and symptoms you may see with JVD are? | Difficulty breathing, Oxygen use, Shortness of breath on exertion, and weight gain
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| S1 is the closure of what valves? | Tricuspid and Mitral
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| S2 is the closure of what valves? | Pulmonic and Aortic
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| Which one can be normal in children and young adults, but becomes a significant finding after age 30 - S3 or S4? | S3
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| S4 has clinical correllation with what? | CAD, HTN and Aortic valve stenosis
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| Paradoxical Pulse - the pulse becomes ________ as one inhales and ________ as one exhales. | weaker, stronger
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| Percardial Friction Rubs are heard best how? | Using a diaphragm with the pt. sitting up and leaning forward.
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| What sounds like a swishing sound and is heard over areas of turbulent flow? | Vascular Bruits (listen with the bell)
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| Cardiac Stress Tests evaluate for? | Cardiac Ischemia
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| If pt cannot walk on a treadmill what drug is given to complete a cardiac stress test? | Dobutamine
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| Some nursing interventions for stress testing are: | Obtain written consent, NPO (if using dobutamine), no caffeine, smoking or alcohol, comfy clothes, rubber-soled shoes (if walking)
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| Thallium and Sestamibi or Cardiolite are? | Two dfferent types of redioisotopes that are used in a cardiac stress test.
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| Myocardial Perfusion Imaging helps to detect and assess what during a cardiac stress test? | Detect myocardial ischemia and infarction and assess left ventricular function
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| Radioisotopes for a cardiac stress test are injected via _______ ? | IV (at least a 20G IV site)
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| Thallium only crosses into what? | Healthy myocardial tissue
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| When is Thallium injected for a cardiac stress test? | 1-2 minutes prior to the end of the test
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| Areas of the heart that do not show thallium uptake may mean what? | Infarction or stress-induced myocardial ischemia
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| When is Sestamibi injected for a cardiac stress test? | Before each exam due to it having a short half life.
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| Multiple Gated Acquisition (MUGA) is similar to what? | An echocardiogram
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| What diagnostic test would be used to measure the ejection fraction for a pt. with lung disease? | Multiple Gated Acquisition (MUGA)
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| Normal Levels for Ejection Fraction are? | 55-65%
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| What diagnostic test would be performed to find out myocardial perfusion and cardiac metabolism? | Positron Emission Tomographic (PET)
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| Radioactive isotope and glucose is given IV during what diagnostic test? | Positron Emission Tomographic (PET)
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| Some post nursing procedures for any test that uses radionuclide are? | Drink fluids to eliminate contrast, monitor BP and pulse, continuous ECG monitoring
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| A cardiac catheterization is performed if what test is positive? | Cardiac stress test
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| Nursing care for cardiac catheterization includes? | Obtain written consent, assess for allergies to shellfish, keep pt. NPO 6-8 hrs, initiate and maintain IV site patency, Administer fluids per MD order/protocol, explain procedure to pt
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| Post procedure for cardiac catheterization includes? | Bedrest, keep affected extremity straight, maintain pressure at insertion site, monitor VS, distal pulses, color and temp of extremity, assess for bleeding at insertion site, maintain IV and fluids to eliminate dye, watch for any development of hematomas
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| What may be used on a pt to evaluate suspected arrhythmias, pacemaker function, and silent ischemia over a 24 hour period? | Holter monitoring
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| What is a pressure bag around the solution for in hemodynamnic monitoring? | delivers 3-5ml of solution per hour to prevent clotting or backflow of blood into the system
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| What pressure should a pressure bag be at for hemodynamnic monitoring? | 300mmHg
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| What is used to convert the pressure from the artery or heart chamber into an electrical signal? | Transducer
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| Normal pressure for right atrium and ventricle at the end of diastole? | 0-8 mmHg
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| Good way to measure an unstable patient's fluid status? | Central Venous Pressure Monitoring
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| An increased CVP > 8mmHg may be due to what? | Hypervolemia or CHF
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| Placement for CVP is confirmed by? | xray
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| Most common problems with CVP are? | Infection and air embolism
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| Normal systolic/diastolic pressures in the pulmonary artery is? | 25/9 mmHg
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| Normal pulmonary capillary wedge pressure is | 4.5-13 mmHg
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| Pulmonary artery pressure monitoring is usually done on clients with? | Congestive heart failure, post MI and pulmonary hypertension
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| What test checks collateral circulation? | Allen's test
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| Medications with angioplasty | Aggrastat and Integrilin (both used with heparin)
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| Where is the angioplasty usually inserted? | Femoral Artery
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| Medications post-stent | Plavix for two weeks, Anticoagulant or antiplatelet agent (75mg tabs)
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| How long will a pt be on aspirin after stent placement? How many mg/day? | Lifetime, 80mg/day
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| With integrilin and aggrastat what does the nurse need to monitor? | Bleeding at IV site and urine
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| Bleeding in the pericardial sac or fluid accum. in sac is? | Cardiac tamponade
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| What meds promote cardiac perfusion but restrict perfusion to kidneys? | Levophed and dopamine
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| What meds lower the volume returing to the heart, decrease BP and cardiac work? | Nipride, Primacor and Tridil
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| Two positive inotropic meds (increase cardiac contractility) | Dobutamine, dopamine
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| First letter of a pacemaker identifies what? | the chamber or chambers being paced
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| The second letter of a pacemaker describes what? | the chamber being sensed by the pacemaker
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| The third letter of a pacemaker describes what? | the response by the pacemaker to what is sensed
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| Most common cause of acute pericarditis? | Viral
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| What shows s&s of substernal or pain beneath clavicle, radiating to neck, friction rub, fever, malaise and dyspnea | Acute pericarditis
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| Friction rub is best heard how? | with diaphragm of stethoscope when client holds their breath
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| What changes in the ECG happen with acute pericarditis? | ST & T wave elevations followed by inverted T waves when ST returns to baseline
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| S&S of chronic pericarditis? | increasing dyspnea, fatigue leading to signs of heart failure
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| Medical management for pericarditis | treat the cause, assess & manage pain, monitor SO2 administer O2
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| Medication management for pericarditis | analgesics for pain, NSAIDS - if that doesn't work steroid therapy...antibiotic therapy if cause is bacterial
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| What needs to be monitored during steroid therapy | Blood glucose
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| S&S of pericarditis with Effusion | pulsus parodoxus, elevated venous pressure (CVP), distended neck veins with clear lungs, kussmaul's sign, hypotension, narrowing pulse pressure, muffled/distant heart sounds
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| What is pulsus parodoxus | BP lowest in inspiration with pulse commonly not palpable
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| What are Kussmaul's signs | Distended neck veins on inspiration
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| What is rheumatic heart disease | a condition where permanent damage to heart valves is caused from rheumatic fever
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| How does rheumatic heart disease usually begin | with strep throat - group A strep
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| Management of Effusion | pericardial aspiration (pericardiocentesis)
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| Persistent inflammation in the valves and endocardium with rheumatic heart disease puts a patient at risk for | bacterial endocarditis
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| S&S of rheumatic heart disease | fever, rash on chest, back and ab, swollen, tender and painful joints, nodules over swollen joints, weakness or shortness of breath, uncontrolled movements of arms, legs or facial muscles
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| best treatment for rheumatic heart disease | prevention and antibiotic therapy for strep throat
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| Treatment for rheumatic heart disease once inflammation has developed | bed rest, meds (aspirin, steroids or non-steroidal meds), antibiotics for strep, otehr meds for CHF (lasix, digoxin)
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| Endocarditis | inflammation of the inner layer of the heart, caused by microorganisms in the blood
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| One very typical sign with a pt who has endocarditis | splinter hemorrhages in nail beds
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| treatment for endocarditis | IV therapy for up to 6 weeks, periods of rest, moderate exercise, antiembolism stockings and activity restriction
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| Teaching for endocarditis | S&S to report (fever, malaise, anorexia), gentle and thorough oral care, *prophylactic antibiotics and routine dental care*
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| Cardiac serem markers? | CK-MB, Myoglobin, Troponin I
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| CK-MB normals | Elevates within 4 hrs, peaks at 24 hrs, returns to baseline in 3 days...normal values is 0-7 U/L
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| Myoglobin normals | rises in 1-3 hrs, peaks in 4-12 hrs, returns to baseline in 24 hrs
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| Troponin I | rises in 3-12 hrs, peaks 24-48 hrs, returns to baseline in 5-14 days
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