Heart Failure
Describe pulmonary edema.
Pulmonary edema is a life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe HF.
Describe the differences between a DVT and PE, and explain their relationship.
A DVT refers to a thrombus formation in the deep veins, usually in the thigh or calf but sometimes in the arm. A PE is an embolus originating from a DVT when a thrombus is dislodged and clogs a pulmonary vessel.
What medications might be given for a DVT or PE? Which medication is usually given first?
Heparin is usually given before or with warfarin because heparin works faster. Other medications that may be given are a thrombolytic, aspirin, and factor X inhibitors.
What labs are important for detecting a DVT? (mention at least 3 labs)
D-dimer, CBC with differential, clotting factors (PT, aPTT, platelets, Inflammatory markers (CrP, SED rate)
Calculate pulse pressure for a BP of 142/88.
The pulse pressure is 54.
What is cardiomyopathy?
Cardiomyopathy is an inherited or acquired disease of the heart muscle that makes it difficult for the heart to pump blood and can lead to HF. (Problem with the PUMP)
Name three risk factors for a DVT.
Orthopedic surgery (hip, TKR), HF, immobility, pregnancy, oral contraceptive, cancer, ulcerative colitis, central venous and dialysis access catheters, factor V
What are 3 important things you would teach your patient that is taking nitro for angina?
The mouth should be moist (do not swallow saliva until the tablet dissolves), and carry at all times as a precaution (keep in the original dark container, the medication is inactivated by heat, moisture, air, and light, must renew prescription every 6 months, take prior to anticipation of activity that might produce chest pain (exercise), can repeat dose every 5 mins up to 3x, sit down when taking med, be aware of SE such as flushing, throbbing headache, hypotension, and tachycardia.
What labs do you monitor for heparin? What labs for warfarin?
aPTT for heparin and PT & INR for warfarin
Name 4 out of the 5 risk factors for metabolic syndrome.
Increased waist circumference, elevated triglycerides, reduced HDL, HTN, elevated fasting glucose
Describe the difference between right and left-sided heart failure. Include common symptoms of each.
In left-sided HF, blood backs up into the lungs, causing dyspnea, orthopnea, nocturnal dyspnea, fatigue, pulmonary congestion, and frothy blood-tinged sputum. In right-sided HF, blood backs up into the body and causes edema in the legs, ankles, and sacrum. Additionally, ascites, JVD, weight gain, fatigue, and weakness are other symptoms.
What are the expected findings for a PE? (Name 3 findings)
Anxiety, feelings of impending doom, sudden onset of chest pressure, pain upon inspiration and chest wall tenderness, dyspnea and air hunger, cough, hemoptysis (blood in sputum)
Describe the therapeutic uses for ACE inhibitors, statins, and beta blockers.
ACE inhibitors treat hypertension, HF, and MI. Statins treat hyperlipidemia. Beta Blockers treat hypertension, stable angina, chronic/compensated HF (not acute HF), and dysrhythmias.
What are cardiac enzymes, and name at least 3 labs?
Cardiac enzymes are released into the blood when the heart muscle suffers ischemia. Labs include CK (CPK) cardiac and skeletal muscle, CK-MB (more sensitive to myocardium), Troponin 1 & T (Check 1-2 hrs after MI), and myoglobin.
Calculate the MAP for a BP of 134/92.
MAP = 2(DBP)+SBP/3
MAP = 106
Describe the difference between systolic and diastolic HF. How does the EF relate to each of these types of HF? Which is more common?
Systolic HF is the impaired contraction of the heart and is most common. Diastolic HF causes pulmonary or systemic congestion because less blood enters the ventricles.
In systolic HF, the EF will be poor, usually less than 40%. In diastolic HF, the EF is usually normal.
Name 4 nursing interventions for a patient with a PE.
Bedrest, manage oxygen therapy, prevent thrombus formation, monitor anticoag/thrombolytics, minimize pleuritic CP, alleviate anxiety, watch for complications
How does captopril contribute to a reduction of the client's blood pressure?
A. dilating peripheral arteries and relaxing vascular smooth muscle.
B. Increasing rebel excretion of sodium and water.
C. blocking the conversion of angiotensin I to angiotensin II
D. blocking the BP raising effects of angiotensin II
C. blocking the conversion of angiotensin I to angiotensin II
What is the difference between a transthoracic ECHO and a TEE?
A traditional or transthoracic ECHO is done by putting a transducer on the surface of the chest. A Transesophageal ECO (TEE) is done by inserting a probe with a transducer down the esophagus.
How do HR and SV impact each other? If my HR goes up, what happens to my stroke volume?
Your SV is the amount of blood your heart pumps each time it beats, and your HR is the number of times your heart beats per minute. As HR increases, so does SV.
What is a pericardial tamponade? Describe how the heart will sound with this condition.
A pericardial tamponade happens when the pericardium fills with fluid (usually pericardial fluid or blood). Because the fluid has nowhere to go, the heart runs out of room and cannot expand enough to fill effectively.
Heart sounds will be muffled.
Describe the symptoms of a DVT (at least 3), or is a DVT asymptomatic?
A DVT can be asymptomatic or symptoms can include calf or groin pain, tenderness, sudden onset of edema to extremity, warmth, hardness over the involved blood vessel, changes in circumferences of the L & R calves over time
During an ongoing assessment of a client receiving an antihyperlipidemic drug, what should the nurse collect? (select all that apply)
A. blood glucose
B. vitals
C. assessment of bowel function
D. input and output
E. stool sample
B. vitals
C. assessment of bowel function
What is an EKG and what is it used for?
An EKG is a graphic representation of the electrical currents of the heat. An EKG is obtained by placing disposable electrodes in standard positions on the skin of the chest wall and extremities.
An EKG is used to diagnose arrhythmias, conduction abnormalities, chamber enlargement, MI, and it can also suggest cardiac effects of electrolyte disturbances and the effects of antiarrhythmic medications.
Calculate cardiac output with a BP of 120/70, a stroke volume of 75 ml, and a HR of 84 BPM.
CO = SV X HR
CO = 6,300 ml/min