Basic Beat Knowledge
Arteries and Veins carry what kind of blood where?
Arteries= oxygenated blood vessels that carry blood away from the heart
Veins= blood vessels that carry deoxygenated blood to the heart
What diagnostic test do we use to check lipid panel....bonus if you can give the ranges!
total cholesterol <200
triglycerides <150
LDL<100
HDL>60
if these numbers are off that is an indicator that there is too much fat in the arteries or veins
Coronary artery disease is the narrowing of the coronary arteries due to___?
atherosclerosis
atherosclerosis forms and occludes coronary arteries, leading to unstable angina, myocardial infarction, and sudden cardiac death. Reduced blood flow through the coronary microvasculature produces ischemic symptoms.
what are the nursing interventions for Angina?
vitals and EKG, administer O2, Nitroglycerin, semi fowlers, maintain calm and quiet environment, encourage rest, monitor pain.
A client is scheduled for percutaneous coronary intervention. Which three points should the nurse include in teaching?
A. A catheter is inserted into the arteries and a stent may be placed
B. The goal of the procedure is to restore blood flow
C. Any chest pain after the procedure must be reported immediately
D. The procedure eliminates the need for lifestyle changes
E. A vein from the leg will be used to bypass the artery
F. Antiplatelet medication will be stopped after the stent is placed
A. A catheter is inserted into the arteries and a stent may be placed
B. The goal of the procedure is to restore blood flow
C. Any chest pain after the procedure must be reported immediately
Cardiac output is the amount of blood ejected from the heart in 1 full minute. what is the formula for cardiac output?
HR X SV=CO
shows the size, shape, and position of the heart, and may show infiltrates and cardiomegaly
chest X-Ray
what are modifiable risk factors for atherosclerosis
increased total cholesterol, hypertension, diabetes, obesity/ overweight, smoking and alcohol use, physical activity, air pollution, and social determinants.
what medications are we giving for angina?
antiplatelet (prevent clots from forming..ASPRIN)
calcium channel blockers (relax blood vessels AMALODAPINE)
beta blockers (reduce O2 demand on the heart METOPROLOL)
Nitrates (dilates vessels NITROGYCERINE)
this is the single lifestyle change that addresses CAD, angina, PAD, and DVT risk at the same time
smoking
Resistance the left ventricle must overcome to pump blood into circulation
Afterload
PS. if you can manipulate rate, preload, afterload, and contractability, you can explain what every cardiac drug does in this lecture.
Assesses the electrical conduction system and is the INITIAL test when dealing with the heart.
Electrocardiography (EKG/ECG)
P.S.=On ECG, ST depression, flat T waves, and inverted T waves indicate ischemia
what are the symptoms of atherosclerosis?
chest pain, diaphoresis, SOB, heart burn or GERD, N/V, fatigue, pain that radiates down the LEFT arm,
DIABETICS will have no sign or may just report with chest pain
P.S. these symptoms will typically be ASYMPTOMATIC meaning virtually silent until the artery is blocked about 40%
what medications for CAD do we give and what does MONA stand for?
ASPRIN -prevent clots from forming (CHEW THIS -CHRONIC)
STATIN-lower cholesterol (CHRONIC)
NITRO-angina episode
BETA BLOCKER
CALCIUM CHANNEL BLOCKER
ACE INHIBITOR
ARBS (if ace cannot be tolerated)
FOR SUDDEN PAIN---Morphine,Oxygen,Nitro,Asprin....keep o2 above 93%
A nurse is caring for a client admitted with unstable angina. Which findings or orders would the nurse question or report? Select all that apply.
A. The client took sildenafil 8 hours ago and nitroglycerin is ordered
B. New chest pain 1 hour after cardiac catheterization
C. An order to ambulate the client in the hall during active chest pain
D. An order for aspirin on admission
E. An order to place the client in semi-Fowler's position
F. An order to hold all anticoagulants after catheterization
A. The client took sildenafil 8 hours ago and nitroglycerin is ordered
B. New chest pain 1 hour after cardiac catheterization
C. An order to ambulate the client in the hall during active chest pain
F. An order to hold all anticoagulants after catheterization
A client's ejection fraction is 30% (expected 50-70%). Which three findings would the nurse most expect from the resulting drop in cardiac output?
A. Cool extremities with weak peripheral pulses
B. Capillary refill greater than 3 seconds (expected within 3 seconds)
C. Bounding pulses in all four extremities
D. Fatigue and exercise intolerance
E. Blood pressure 160/94 mm Hg from the low output itself F. Warm, flushed, pink skin
A. Cool extremities with weak peripheral pulses
B. Capillary refill greater than 3 seconds (expected within 3 seconds)
D. Fatigue and exercise intolerance
Echocardiography (ECHO) is an ultrasound of the size and pumping function of the heart and measures ejection fraction. They're two different kinds. Can you name them and what makes one special.
Transthoracic echo (TTE) is through the skin
transesophageal echo (TEE) goes down the esophagus **** THIS CLIENT IS SEDATED***
what would the nurse do for a TEE patient before and after? (talk it out)
A nurse is teaching a community class on coronary artery disease. Which statements are accurate? Select all that apply.
A. CAD results from atherosclerosis narrowing the coronary arteries.
B. CAD is virtually silent until the artery is about 40% blocked.
C. Smoking, hypertension, and diabetes are modifiable risk factors.
D. Age, gender, race, and family history cannot be modified.
E. Chest pain relieved by rest rules out coronary artery disease.
F. Untreated CAD can progress to myocardial infarction and sudden cardiac death
A. CAD results from atherosclerosis narrowing the coronary arteries.
B. CAD is virtually silent until the artery is about 40% blocked.
C. Smoking, hypertension, and diabetes are modifiable risk factors.
D. Age, gender, race, and family history cannot be modified.
F. Untreated CAD can progress to myocardial infarction and sudden cardiac death
what are the rules for nitroglycerine
no more than 3 doses can be given, any more and you need to call 911
A nursing student is reviewing normal cardiac structure and flow. Which statements are accurate? Select all that apply.
A. The right atrium receives blood returning from the body.
B. The left ventricle pumps blood to the body.
C. The tricuspid valve lies between the left atrium and left ventricle.
D. Semilunar valves prevent backflow from the arteries into the ventricles.
E. The left atrium receives blood returning from the lungs.
F. Veins carry oxygenated blood away from the heart.
A. The right atrium receives blood returning from the body.
B. The left ventricle pumps blood to the body.
D. Semilunar valves prevent backflow from the arteries into the ventricles.
E. The left atrium receives blood returning from the lungs.
What makers are used for acute cardiac damage or injury? and can you name their specifications?
Creatinine Kinase-general marker of cell injury
Myoglobin-is released in response to muscle damage and is NOT cardiac specific.
CK-MB (CK myocardial bands)-is specific to cardiac tissue and remains elevated about 36 hours.
BNP-is released when ventricular tissue is stretched and indicates heart failure.
Troponin- specific to heart and elevates within 4 hours of injury and remains elevated for 10 days
these two test can be separate or go hand in hand....
1.this one is invasive and goes through the femoral and radial artery, using fluoroscopy to visualize the heart and vessels with die
2.this one is also invasive and inspects coronaries for blockage or stenosis; it is a LEFT sided catheterization and is the GOLD standard treatment id
1.cardiac catheterization
***Chest pain after a cardiac cath is an EMERGENCY, not soreness. Report and treat it immediately.
2.coronary angiography
1.this angina occurs with triggers....
2.this angina occurs at rest and more frequent ...
3.this one is caused by coronary vasospasms ...
which one is the emergency?
1. stable angina----relived with rest and nitrates
2. unstable angina ***EMERGENCY***--usually NOT relived with rest and nitrates
3. prinzmetal/variant. --- occurs at rest and is relives by NITRATES & CALCIUM CHANNEL BLOCKERS
P.S. weakness, fatigue, dyspnea are reported more in WOMAN and DIABETICS will present with either no sign or just chest pain
how many appointments does one have to have with Elevated BP to be diagnosed with HTN
do you remember the MAP formula and what number would we worry about perfusion?
2
MAP=(SBP+(2*DBP))/3
anything less than 70 we worry
During inspection of a client with suspected cardiovascular disease, which findings should the nurse document as abnormal? Select all that apply.
A. Capillary refill of 5 seconds (expected within 3 seconds)
B. Clubbing of the fingers
C. Jugular vein distention while the head of the bed is elevated
D. Bilateral pitting edema of the ankles
E. Pink nail beds with no cyanosis
F. New restlessness and confusion
A. Capillary refill of 5 seconds (expected within 3 seconds)
B. Clubbing of the fingers
C. Jugular vein distention while the head of the bed is elevated
D. Bilateral pitting edema of the ankles
F. New restlessness and confusion