Heart failure/Cardiogenic shock
what is a priority nursing intervention for patients with SOB/heart failure
alternate rest and activity
describe sinus bradycardia and sinus tachycardia
P wave is normal, rhythm is regular, QRS is normal.
bradycardia: less than 60 bpm
tachycardia: more than 100 bpm
main difference between pericarditis and endocarditis
endocarditis involves the inside of the heart, where pericarditis involves the pericardial sac outside the heart.
Metoprolol 25 mg twice daily by mouth has been prescribed. Which vital signs listed would require the nurse to hold the medication?
1. T 98.1°F, RR 18, Apical Pulse 88, BP 100/68.
2. T 98.5°F, RR 16, Apical Pulse 50, BP 98/64.
3. T 100.4°F, RR 20, Apical Pulse 100, BP 148/88.
4. T 99.2°F, RR 16, Apical Pulse 80, BP 96/76.
2. T 98.5°F, RR 16, Apical Pulse 50, BP 98/64.
Metoprolol is a beta blocker, which blocks the beta response in the heart receptors, slowing the heart rate. Metoprolol should be held whenever the heart rate is 50 or below as demonstrated by bradycardia
The nurse is caring for a client recently admitted with acute coronary syndrome. The client states that he is experiencing an increase in chest pain. What action should the nurse implement first?
1. Obtain a 12-lead electrocardiogram.
2. Administer prescribed pain medication.
3. Ensure client is receiving supplemental oxygen.
4. Notify the healthcare provider of the increase in pain.
3. Ensure client is receiving supplemental oxygen
Pain can be managed by medication and oxygen. Since oxygen can have an immediate effect and hypoxia is detrimental to the client, ensuring adequate oxygen is priority followed by administering pain medication such as nitroglycerin or morphine. An ECG requires an order, which can be obtained when the healthcare provider is notified, if pain not resolved with prescribed treatments
Which finding would you report to the provider immediately:
1. Shortness of breath
2. crackles in lungs
3. weight gain of 2 pounds in the last 5 days
4. fatigue when resting
2. Crackles in lungs
indication of pumonary edema, cause of cardigenic shock, and can lead to respiratory distress
The nurse is examining the electrocardiogram (ECG) of a patient just admitted with a suspected myocardial infarction (MI). Which ECG change is most indicative of prolonged or complete coronary occlusion?
1. Sinus tachycardia
2. Pathologic Q wave
3. Fibrillatory P waves
4. Prolonged PR interval
2. Pathologic Q wave
The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion.
what is endocarditis? what causes it? what is the treatment?
bacteria enters the heart and causes infection of the aortic valves
IV drug use, or infection of teeth/dental procedures.
treatment: antibiotics
An older patient is in the ER with substernal chest pain. Which priority action will the nurse complete before administering sublingual nitroglycerin?
1. Administer morphine sulfate IV
2. Auscultate heart and lung sounds
3. Obtain a 12-lead electrocardiogram (ECG)
4. Assess for coronary artery disease risk factors.
3. Obtain a 12-lead electrocardiogram (ECG)
If a patient has chest pain, the nurse should institute the following measures: (1) administer supplemental oxygen and position the patient in upright position unless contraindicated, (2) assess vital signs, (3) obtain a 12-lead ECG, (4) provide prompt pain relief first with a nitrate followed by an opioid analgesic if needed, and (5) auscultate heart sounds. Obtaining a 12-lead ECG during chest pain aids in the diagnosis.
What would be seen on an ECG that needs to be immediately reported to the provider?
ST elevation
what labs would be effected in cardiogenic shock? (4)
BNP
BUN
creatine
glucose
describe Afib versus Aflutter and an intervention to fix it.
afib: no p wave, QRS normal, rhythm is irregular.
aflutter: saw tooth pattern, normal WRS, regular rhythm
fixes: cardioversion
what are some causes of pericarditis?
what something you would hear for pericarditis?
chest trauma, viral infection, autoimmune diseases
you might hear pericardial friction rub
The nurse providing postoperative care for a patient after coronary artery bypass graft (CABG) surgery would monitor for which common complication?
1. Dehydration
2. Paralytic ileus
3. Atrial dysrhythmias
4. Acute respiratory distress syndrome
3. Atrial dysrhythmias
Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days after CABG surgery. Although the other complications could occur, they are not common complications.
Which items would the nurse anticipate administering during emergent care for a patient with a suspected myocardial infarction (MI)?
1. Oxygen, nitroglycerin, aspirin, and morphine
2. Aspirin, nitroprusside, dopamine, and oxygen
3. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine
4. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)
1. Oxygen, nitroglycerin, aspirin, and morphine
MONA
These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. The other medications may be used later in the patient’s treatment.
What medication stimulates heart muscle and improves blood flow by helping the heart pump better. It is a short-term treatment used for cardiogenic shock/
Dobutamine
describe PVC's VS. V-Tach
PVC's: no P wave, irregular rhythm, wide and bizarre QRS.
V-TACH: 3 or more consecutive PVC'S. p not visible, QRS bizarre, rhythm may be regular. Life threatening
BONUS POINTS - question is worth 500
what is the priority cardiac biomarker for chest pain?
troponin
Which labs are for heparin, warfarin, and lovenox?
Heparin: PTT
Warfarin: PT/INR
Lovenox: labs are not necessary
The nurse would assess a patient with reports of chest pain for which manifestations associated with a myocardial infarction (MI)? (Select all that apply.)
1. Flushing
2. Ashen skin
3. Diaphoresis
4. Nausea and vomiting
5. S3 or S4 heart sounds
2. Ashen skin
3. Diaphoresis
4. Nausea and vomiting
5. S3 or S4 heart sounds
The nurse is caring for a client experiencing chronic heart failure. Which diagnostic test results require immediate follow-up by the nurse? Select all that apply
1. Magnesium 1.3 mEq/L.
2. Sodium 122 mEq/L.
3. Digoxin level 0.8 ng/mL.
4. Potassium 3.3 mEq/L.
5. Second-degree heart block on electrocardiogram.
6. BUN 25 mg/dL
2. Sodium 122 mEq/L
4. Potassium 3.3 mEq/L.
5. Second-degree heart block on electrocardiogram.
6. BUN 25 mg/dL
Hyponatremia can result in fluid imbalance, hypokalemia can cause dysrhythmias, heart block can cause a decreased cardiac output, and a high BUN can indicate dehydration, kidney impairment or other concerns
describe the difference between a pacemaker and an ICD
a pacemaker is used for bradycardic patients to prevent pauses and the heart to stop. used for maintaining a consistent heart rate
an ICD is a defibrillator under the skin to shock the patients heart when noticing a life threatening arrhythmia.
which carditis causes cardiac tomponade?
what are some main signs and symptoms?
paricarditis, since it is fluid accumulation in the pericardial sac.
S/S: chest pain, SOB, hypotension, Jugular vein distension, muffled heart sounds
what is the difference in nursing interventions for a radial stent placement or a femoral stent placement?
femoral needs to remain on bedrest
time of pain. Angina no longer than 15 minutes, an MI doesnt go away.