Pharm and labs
This lab value is diagnostic of heart failure.
BNP >100
During and after a suspected MI, this lab (whose normal range is 0 - 0.04) should be trended until it peaks.
Troponin
What item of clothing is essential for patients with PVD (peripheral venous disease)?
compression stockings (Remember that even if they have open wounds, they still need compression stockings!!!)
Your patient has hypertension and wants to know if he will have to change his diet. How would you instruct him?
Yes. Dash diet. Low fat, sodium. See ppt for more info.
When can sexual activity be resumed after MI? And what drug should you tell your hypertensive male pts to avoid?
When pt can climb 2 flights of stairs; sildenafil
After AAA repair, what organ (other than the heart) requires close monitoring? Why?
kidneys; potential for decreased renal perfusion
Monitor UO and labs closely!
You are about to meet a pt dx with CHF. During assessment, you want to try to determine if he has right-sided or left-sided HF.
1.) Describe what symptoms you would would notice unique to Right HF.
2.) What symptoms you notice with left HF?
1.) JVD, organ enlargement (hepatosplenomegaly), edema of LEs.
2) SOB, crackles in lungs, cap refill >3 seconds, pallor
Pts with a history of these two conditions will require lifelong antibiotic prophylaxis prior to invasive procedures.
Infective endocarditis and rheumatic fever (no carditis: until age 20; carditis: lifelong)
You have 3 pts. Who should you see FIRST:
Pt 1: mitral valve regurgitation with audible murmur
Pt 2: acute pericarditis with a pericardial friction rub
Pt 3: Has just returned to the unit s/p balloon valvuloplasty.
Pt 3: balloon valvuloplasty. Needs assessment for bleeding and hypotension. (Acute ALWAYS > chronic). The other conditions are consistent w/dx.
What is pulsus paradoxus and when is it seen?
1) Drop in BP during inspiration >10 mmHg; cardiac tamponade
A patient with newly diagnosed AFib is placed on warfarin for anticoagulation. The RN questions this order because...
Warfarin takes several days to begin preventing clots. The pt will also need LMWH (lovenox) until the warfarin begins to work.
While doing a head-to-toe assessment, what finding would make you suspect a AAA (abdominal aortic aneurysm) and which part of your stethoscope would you use?
Auscultation of abdominal bruit
Bell of stethoscope
Describe the three factors of virchow's triad. What does virchow's triad tell us?
Endothelial damage, hypercoagulable state, venous stasis. Describes the physiology of venous thrombo-embolism (VTE) formation
Your pt has just been diagnosed with Prinzmetal's (variant) angina. Explain what drug (or type of drug) she will likely be prescribed and how it works
Calcium channel blocker such as diltiazem (cardizem). It works by decreasing SNS effects on the heart -> decreases coronary artery spasms (vasoconstriction)
What is the relationship between nitroglycerin and aortic stenosis?
You have to be careful with nitroglycerin in pts with AS because the nitro causes a drop in preload (venous blood/fluid return to the heart) which can lead to severe hypotension.
Digoxin toxicity:
1) Name 2 s/s
2) Name the most common cause
1) N/V, seeing halos, yellow vision, dysrhythmia, confusion, delirium, anorexia, fatigue, abdominal pain
2)Hypokalemia
A pt in for a ROUTINE appointment at a PCP office has his vitals taken. His BP is 178/90. Before alerting the doctor, what should you do first?
Your pt denies any symptoms then asks, "do I need to be admitted to a hospital?" How would you respond?
1. Re-check the blood pressure.
2. You will need to get a diagnosis, treatment, and ongoing monitoring. But no, you do not need to be admitted. (Remember hypertensive urgency vs. emergency)
A pt has suspected infective endocarditis (IE).
1) Name 2 risk factors for IE
2) What 2 valves are most often affected
3) Name 3 labs likely to be ordered
4) Name 2 clinical manifestations
1) IVDA, marfan's syndrome, pacemaker, prior IE, valvular disease, congenital heart disease, CM
2) Aortic and mitral
3) Blood cultures (over 1 hr from 3 sites), ESR (non-specific inflammation), CRP (non-specific inflammation), CBC
4) FEVER, chills, weakness, fatigue, malaise, anorexia, back pain, finger clubbing, splinter hemorrhages, petechiae, osler's nodes on fingertips or toes (pea size red/purple lesions), etc. p. 779
A pt with PAD complains of leg pain when walking the block that is sometimes relieved by rest. You know that this condition is called ---- and you advise your patient to -----.
Intermittent claudication; dangle legs to improve circulation and relieve pain.
What are the 6 Ps of acute ischemia?
Pallor, pulselessness, pain, poikilothermia (inability to regulate temperature), paresthesia, paralysis
UAP reports to the RN that s/p AAA repair, pt's UO over the past 2 hours is 35mL. After notifying the MD, the RN anticipates:
1) The MD will order which lab?
2) The normal lab value is...?
3) What is likely happening to the pt?
1) BMP/serum creatinine
2) Normal is <1.1
3) renal artery occlusion
1.) Your pt just came into the ED and is having a suspected MI. What is the first thing you do to confirm?
2.) You have confirmed MI and your pt is still conscious. After notifying the MD, what 4 treatments will you expect to administer and which will be last?
3.) Your pt requires PCI (percutaneous coronary intervention)/angioplasty. What time limit do hospitals have to get the pt from door to balloon?
1) ECG/EKG.
2) MONA (morphine last, oxygen, nitroglycerin, aspirin)
3) 90 minutes
1.) What does TEE stand for?
2) Describe the procedure.
3) What is its purpose?
4) Will your pt be awake or sedated
5) What dietary considerations should be made for this pt?
1) Transesophageal echocardiogram
2) Pt sedated, doppler transducer down esophagus to visualize heart
3) Better visualize heart, determine if pt needs surgery, used during valvular surgery (esp. MV repair)
4) pt is sedated
5) Pt needs to be NPO to prevent aspiration
Your patient has pericarditis and is complaining of pain.
1) How do you relieve the pain?
2) What are the two complications of pericarditis
3) How are these complications treated? (name 1)
4) What is Beck's triad?
1) Lean forward, sit HOB>45 degrees.
2) Effusion, tamponade
3) Treat cause, steroids, NSAIDS, pericardiocentesis
4) JVD, muffled heart sounds, hypotension w/ narrow pulse pressure. Used for tamponade
Explain the relationship between HTN, Afib, stroke, and pulmonary embolism.
Your teacher will tell you. :)