Heart Failure
This type of diuretic can lead to the loss of electrolytes (especially potassium) which can manifest as fatigue, muscle pain, tingling, numbness, abnormal heart rhythms, and more.
loop diuretic (examples: furosemide, torsemide, bumetanide)
Ace-Inhibitors, Angiotensin II Receptor Blockers, and loop diuretics all can lead to increased levels of what electrolyte that can affect cardiac conduction.
Potassium
This class of drugs can help reduce cardiac workload (& HR) by suppressing renin activity, allowing the heart to reduce stress in ACS.
Beta-Blockers (metoprolol, carvedilol, etc.)
While planning the care of a patient with heart failure the nurse correctly understands that trending daily weights should be performed like this.
Weight should be obtained at a similar time every day, patient should be weighed on same scale if possible, clothing should be removed (or same amount) every day during weighing
The nurse understands that a patient complaining of chest discomfort should have this test performed as soon as possible to rule out acute infarction of myocardial tissues.
EKG - an EKG can reveal if a STEMI is present which indicates acute myocardial tissue necrosis (infarction) and if emergent PCI is required
Clients with heart failure should avoid foods high in this electrolyte (ex: salted nuts, processed meats, fast food, cheese, pickled foods, and more) due to it's water retention properties
Cardiac arrest can occur with these specific pulseless arrhythmias.
Patients with anterior wall MIs have high mortality and dysrhythmias because it primarily affects this side of the heart
Left
A patient arrives in severe exacerbation of their chronic heart failure. There are obvious signs of fluid overload including respiratory distress. The nurse correctly understands this lab value to be elevated in response to the stretching of the ventricles.
B-type (brain) natriuretic peptide (BNP)
A client with an INR >3, on daily warfarin, and chronic atrial fibrillation presents to the ER for weakness. Upon assessment the RN notes atrial fibrillation w/ RVR on the monitor (rate 170s-190), BP 60/40, and decreased level of conciousness. The nurse anticipates this emergent treatment of the arrhythmia.
Synchronized cardioversion will likely be performed emergently due to the patient's hemodynamic instability and anti-coagulated state at baseline (decreased risk of dislodged thrombus).
This class of drugs can help increase efficiency of contractions in HF patients but decrease the sympathetic response (& the HR). They may also be used in dysrhythmias or Acute Coronary Syndromes. Hint: olol
Beta-Blockers
These "pril" drugs block the conversion of angiotensin I to angiotensin II (a vasoconstrictor). This decrease in vasoconstriction results in increased vasoDILATION, lower vascular resistance, lower fluid retention, and decreased afterload. However, potassium may be retained.
Ace-Inhibitors
A patient reports feeling like their heart is skipping beats and dizziness. Upon palpating the client's radial pulse, the nurse feels an irregularly irregular beat. The nurse suspects this underlying cardiac disorder.
atrial fibrillation; condition in which the atria are rapidly depolarized in a chaotic manner
These types of meds may be used to maintain organ perfusion (increase the MAP) in states of cardiovascular shock states but increase the myocardial workload, increase systemic vascular resistance, and can worsen ischemia so they require frequent and close monitoring.
Vasopressors (vasoconstrictors, ) and positive inotropes (sympathomimetics, catecholamines - epinephrine, norepi, dopamine, etc.)
Patient positioning in high-fowler's or tripod (orthopneic), maintenance of SpO2 >90%, and rest can help promote ....
Oxygenation/gas exchange
anticoagulants to prevent dislodgment of clots to lungs or brain
These types of drugs are vasodilators that require close monitoring of blood pressure for hypotension, reduce preload, and commonly used in treatment of ACS to allow increased blood flow to damaged heart tissues.
Nitrates (nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, etc.)
A patient arrives to the ER via EMS after developing chest pain while shoveling snow. The nurse correctly understands that elevation of the ST-segment is indicative of this pathophysiological damage occurring in the heart.
myocardial infarction w/ tissue necrosis
This technique is utilized in the cath lab to restore perfusion to the coronary arteries in cases where lesions are not complex. After this procedure, patients are typically prescribed dual antiplatelet therapy (DAPT), nitrates, beta-blockers, and ACEI/ARBs.
Percutaneous Coronary Intervention (PCI)
This cardiac glycoside is used for patients with chronic HF and Afib. Not typically considered first line due to risk of toxicity.
During an attempted synchronized cardioversion the patient deteriorates into ventricular fibrillation. The nurse anticipates this priority intervention.
defibrillation (turn off synchronization of shock to deliver) and CPR
This commonly used antiplatelet can cause GI upset due to NSAID properties but is linked to decreased mortality in patients experiencing ACS. There is evidence that also links it to reduced vasoconstriction.
Aspirin
A patient arrives to the ER via EMS for altered mental status. Upon assessment the nurse find the client to be confused, tachypneic, hypoxic, and cyanotic w/ crackles in bilateral lungs. The nurse suspects this cardiac diagnosis to be the underlying cause.
Left Heart Failure
This type of therapy dissolves thrombi within the coronary arteries and restores myocardial blood flow
A patient complains about their shoes feeling tighter than normal and weight gain over a few weeks. Lung sounds are clear and abdomen is tight/round. The nurse suspects this type of heart failure.
Right
These specific types of arrhythmias are more life threatening because they affect the pumping mechanism of the heart directly and perfusion is immediately impaired.
ventricular
These type of medications may be administered to reduce myocardial demand, reduce circulating catecholamines, relax smooth muscle, and relieve pain of a patient experiencing ACS.
Opiates (morphine, dilaudid)
A young male athlete collapsed on the field and received CPR until ROSC (return of spontaneous circulation) was achieved. The nurse suspects an undiagnosed dilated cardiomyopathy and anticipates this potential plan of care.
Diuretics, cardiac glycosides (digoxin), vasodilators, to increase cardiac output; beta-blockers (avoidance of arrhythmias), defibrillator placement
A patient experiencing a cardiac shock state is hypotensive with a MAP <65 and has decreased level of consciousness. The nurse prepares to administer the ordered vasopressor (epinephrine) medication to maintain perfusion. The nurse correctly understands that this medication may increase perfusion but also have these negative side effects on the cardiac function.
sympathetic stimulation increases vasoconstriction which then increases blood pressure, however it also increases workload of the heart and systemic vascular resistance (therefore increasing afterload)
A client w/ PMH of chronic heart failure comes to the ER via EMS in severe respiratory distress and hemoptysis. The nurse suspects this complication of severe heart failure exacerbation.
pulmonary edema
A client in complete (3rd degree) heart block has already received a dose of atropine but is now starting to lose consciousness. The nurse would anticipate this emergent intervention to be completed next.
emergent transcutaneous pacing (bridge to placement of transvenous or implanted pacemaker after)
The unnecessary application of supplemental ________ has been linked to increased coronary vascular resistance, decreased coronary blood flow, and increased mortality.
Oxygen
A patient in a heart block is critically hypotensive and emergent pacing is initiated. The nurse understands that they must assess for both _____________ capture and ___________ capture to ensure the myocardial tissue is actually perfusing.
electrical and mechanical
Cardiac catheterization (angiogram/angiography) can be diagnostic or interventional. The nurse would educate about these potential complications when preparing the patient for the procedure.
cardiac tamponade, bleeding at insertion site, pulmonary edema, contrast-induced kidney damage, allergic reaction to contrast dye, dysrhythmias
A patient diagnosed w/ heart failure exacerbation is confused why they have been prescribed nitrates. The nurse correctly educates the patient by telling them this.
nitrates can decrease preload, increase activity intolerance, reduce symptoms, and help normalize pressures within the heart chambers
asystole; immediate interventions include CPR
After an MI the physician is likely to prescribe these two types of drugs at discharge to prevent the development of ventricular remodeling and heart failure.
ACEI & ARBs
The nurse likely suspects angina because the patient's pain resolved w/ rest. Angina is the imbalance of cardiac demand and supplied oxygen to the heart tissues.
A patient arrives via EMS for reports of sudden onset severe chest pain 15 mins ago that is radiating into their neck and shoulders. EKG reveals mild ST-segment depression and T-wave inversion. The nurse suspects this underlying cardiac disorder and anticipates this potential plan of care.
NSTEMI - non ST-segment elevation MI; trend troponin, continuous monitoring, treat hypoxia w/ O2, aspirin, nitrates, pain relief (opiates), beta-blockers if VS within parameters, ACEI/ARBs within 24 hours, frequent reassessment