Pressure's On! HTN
For newly diagnosed HTN, the RN knows the likely initial treatment plan will be...
What are lifestyle changes?
The RN knows a sign of disease progression with atherosclerosis is...
What is increasing SOB on exertion and progressive activity intolerance?
The RN knows with CHF, education for patients includes...
What is limit Na+ intake to < 2000 mg per day (or as prescribed by physician) to reduce risk of fluid retention; take diuretics in morning and early afternoon; elevate legs above heart level to prevent swelling; no ETOH or smoking; weigh yourself same time everyday; cardiac lifestyle modifications?
The RN knows stable angina...
What is predictable, and is relieved by rest and meds (nitro)?
The RN knows the pain and SOB from this may be relieved by leaning forward...
What is pericarditis?
By leaning forward, gravity helps shift the fluid build up off the heart and eases the pain and work of breathing
The RN knows this anticholinergic is used for symptomatic bradycardia...
What is atropine IV push?
The RN knows it is important to assess pts with known valve disease for this...
What is hypervolemia, including back up into the lungs?
The RN knows if the doppler needs to be utilized to assess for pedal pulses, the pt likely has...
What is peripheral artery disease?
The RN knows, PCI stands for ___ and is used to ___...
What is Percutaneous Coronary Intervention and will improve blood flow to the heart, including improving s/s related to coronary artery disease/atherosclerosis?
Angioplasty refers to the use of a balloon to open the clogged vessel
The RN knows diuretics are used to lower HTN because..
What is diuretics work by lowering fluid volume which will lower HTN?
Kidneys will flush out the fluid volume overload in the vessels that is causing HTN
If the nurse is working with a pt in the hospital and suddenly notes slurred speech and facial drooping, the nurses first priority would be...
What is call a Rapid Response?
The RN knows a pt with CHF should weigh themselves at the same time everyday and report...
What is a 1-2 lb gain in 24 h or a 3 lb gain in 1 week?
The RN knows s/s of unstable angina include ___ and is considered a ___?
What is unexpected and is not relieved with meds or rest; unstable angina is considered a medical emergency!
The RN knows this layer of the heart is composed of 2 layers that when infected, fill with fluid, and cause a friction rub heard on auscultation...
What is the pericardium? (the fibrous sac that encloses the heart & the great vessels)
The RN knows junctional dysrhythmias may be related to this med toxicity...
What is digoxin toxicity?
The RN knows s/p a valve replacement, pt teaching r/t being on anticoags for life includes...
What is the pt will monitor for s/s bleeding, pt will avoid using sharp objects, pt will use an electric razor, pt will be mindful of flossing, pt will use stool softeners to mitigate risk of hemorrhoids that may bleed?
The RN knows s/s of DVT could include...
What is unilateral swelling in an extremity (likely LE), redness, pain, diminished distal pulses; SOB, low O2 sat, tachypneic may indicate pulmonary embolism (clot that traveled to the lungs) or clot that traveled to the heart?
The RN knows these are used in PCI to open arteries and keep arteries open...
What are balloons (angioplasty) and stents?
The RN knows the blood pressure parameters for a hypertensive crisis include...
What is a systolic > 180 and/or diastolic > 120?
pg 664
The RN knows these are risk factors for atherosclerosis...
What are diets high in saturated fat, high triglycerides, low HDLs, high LDLs, high total cholesterol?
The RN knows the pt with CHF may use these medications to improve cardiac output...
What are diuretics to reduce fluid overload and vasodilators to reduce afterload and increase preload which then increases cardiac output?
The RN knows side effects if nitro include ___ and this outcome should be monitored for...
What is light headedness & dizziness related to vasodilation and drop in blood pressure and the pt should be monitored for HYPOtension?
The RN knows this cardiac infection is associated with IV drug users and may present with these lesions and these nodes...
What is endocarditis?
Janeway lesions: painless, flat r/t septic microemboli (small infected blood clots!)
Osler's nodes: raised, painful!, pads of fingers & toes; r/t immune complex vasculitis (inflammation!)
The RN knows the the greatest risk r/t cardioversion of a fib is...
What is risk of a clot due to pooling of blood in the atrium due to the atria not contracting efficiently?
A fib has the highest risk of stroke compared to other dysrhythmias!
The RN knows a TAVR is ___ and the benefits include ___ ...
What is a transcatherter aortic valve replacement that replaces an aortic valve that is narrowed r/t stenosis usually via the femoral artery; the procedure is considered minimally invasive, pt may have some discomfort but recovery time is very minimal compared to open heart surgery?
The RN knows prevention of DVTs includes___ and actions that should be avoided with DVTs includes ___ ...
What are ambulating pts regularly, avoidance of prolonged immobility for prevention and avoiding cold therapy and massage?
The RN knows, although PCI is considered minimally invasive and very safe, it is imperative to immediately monitor for these risks after the procedure...
A later risk to monitor for that requires patient education is...
What is s/s of numbness/tingling in limb of catheter insertion site, new onset chest pain, and bleeding at the insertion site?
What are s/s infection?
The RN knows the txment for a hypertensive emergency is this___ and assess for this___ ...
What is start IV hypertensives and assess for organ tissue damage?
pg 664
The RN knows smoking is a risk factor for cardiac disease because...
What is smoking causes narrowing of arteries and damages the lining of vessels (endothelial lining) which allows for buildup of fatty deposits (plaque)?
Increases risk for atherosclerosis
The RN knows s/p an MI, elevated B-type Natriuretic Peptide (BNP) indicates...
What is BNP rises significantly in the first 24 h s/p an MI; BNP is a hormone released by the ventricles r/t increased pressure & muscle damage; the more elevated the BNP, the greater the damage to the L ventricle, increased mortality risk, increased risk of heart failure, and overall poor prognosis?
Specific to Heart damage!
The RN knows labs to rule out MI include...
What are troponin, CK-MB (creatinine kinase indicates muscle breakdown that is specific to heart), cardiac biomarkers, and myoglobin?
Myoglobin carries O2 in muscles like Hemoglobin carries O2 in blood; increased levels of myoglobin in blood indicates muscle breakdown/damage (like an MI) but is not specific to cardiac muscle
The RN knows this cardiac infection may present with chest pain, palpitations, dyspnea, dysrythmias (because this IS the muscle!), syncope, and heart failure...
What is myocarditis?
The RN knows if a pt is identified in pulseless V fib or pulseless V tach, the RN should...
What is start CPR?
Meds are administered AFTER CPR is started
The RN s/p a valve replacement, there are these patient considerations (same as other cardiac procedure considerations including this 1 recommendations shared w endocarditis pts)...
What is educate pt r/t anticoags for life, monitor BP regularly, avoid excessive lifting during recovery period, monitor for s/s infection around catheter insertion site, contact provider r/t SOB or chest pain, daily weights and report wt gain AND report valve replacement BEFORE dental procedure r/t risk of infection?
The RN knows s/s of PAD include...
What are diminished pedal pulses, pale skin on LEs, calf pain relieved with rest, intermittent claudication, decreased ankle-brachial index?
The RN knows pt education s/p angioplasty (balloon to widen artery) includes...
What is to report chest pain, SOB, swelling at the insertion site; avoid lifting anything > 10 lbs for 2 weeks; take prescribed antiplatelets & anticoagulants to prevent thrombosis; follow up with provider as ordered?
The RN knows women's risk for HTN, stroke, and heart failure is greater than mens after this age...
What is age 65?
BONUS!
The RN knows to reduce Preload, this med is used...
The RN knows that preload is...
What is diuretics are used to reduce preload?
What is the "load" on the heart in the ventricles before it "pumps"?
Preload: Degree of ventricular stretch (tension) on the heart muscle at the end of diastole (filling) just before the contraction
The RN knows s/s of L sided heart failure include...
What are bilateral crackles in lungs, SOB w activity?
The RN knows, if a pt complains if chest pain, especially unstable angina, labs & diagnostics will likely include...
What is an ECG, lipid panel, cardiac enzymes, and CXR?
The RN knows this cardiac infection may be related to viral infections like Coxsackie and autoimmune diseases, like Lupus, where the autoimmune system attacks the heart...
What is myocarditis?
The RN knows with pulseless Ventricular dysrhythmias, the first med to be administered is...
What is epinephrine (adrenaline!) 1mg IVPush q 3-5 min while continuing CPR?
The RN knows if a pt is having trouble breathing, a priority action is to...
What is raise the head of bed?
The RN knows intermittent claudication is a s/s of PAD and is characterized by...
What is cramping, aching, fatigue in leg muscles during exertion but subsides with rest; primarily caused by atherosclerosis and the consequent diminished blood flow to the muscles related to the narrowing of the vessels?
The RN knows a cardiac catheterization is used for ___ and a PCI is a therapeutic intervention that may be performed during a cardiac catheterization...
What is diagnosis?
An angiography may use a camera to see what is happening in the arteries and heart; PCI is the use of balloons (angioplasty) and stents to open the identified blockages
The RN knows pt education related to cardiac disease in general should always include these points...
What is med adherence, stop smoking, limit ETOH, lifestyle modifications, regular exercise, stress management and written instructions should be provided?
BONUS!
The RN knows to decrease afterload, this class of medications are administered...
What are antihypertensives?
Reduces systemic vascular resistance & improves output
The RN knows cor pulmonale refers to ___ and risk factors include...
What is R sided heart failure that is related to pulmonary HTN usually cause by a chronic respiratory condition like COPD and other risk factors include classic risk factors for heart disease like DM2, metabolic syndrome, obesity etc?
The RN knows the shape of the heart used to represent love likely is derived from...
What is...The strongest theory is that the shape originates from the seed or fruit of the silphium plant, a giant fennel used by the ancient Greeks and Romans in Cyrene as a spice, medicine, and early form of birth control. Because of its connection to love and contraception, the heart-shaped seed appeared on coins. You're welcome.
The RN knows this part of the heart lines the interior of the heart and the valves...
What is the endocardium?
The RN knows if a pt is in V tach with a pulse, this med will be administered and this action will be taken...
What is IV amiodarone (antiarrhythmic!) and cardioversion?
BONUS!
The RN knows a triple A stands for ___ and presents with ____ ...
What is a difference in BP between the L & R arm and sudden onset of chest tearing chest pain?
The RN knows patient education related to vascular disease should include...
What is elevate legs for 20-30 minutes several days a week to allow for blood return and reduction of swelling; compression stockings may be used but should be avoided if ulcer develops?
The RN knows s/p a cardiac catheterization, the physician should be notified if...
What is the pt reports new onset groin pain (femoral insertion site), decrease in urine output, and/or absent pulses?