ANGINA / CAD
A patient with known chronic stable angina reports experiencing chest pain after shoveling snow. what is the underlying pathophysiological reason for this pain?
The pain is caused by atherosclerosis aka fatty plaque buildup in the arteries. This leads to narrowed coronary arteries, which results in decreased blood flow and oxygenation to the heart muscle (ischemia) during physical exertion like shoveling snow.
marker of choice for distinguishing between a cardiac or respiratory cause of dyspnea & why?
BNP - Released from the ventricles when they are stretched from too much blood volume
A nurse is assessing a patient with suspected PAD. what is the "hallmark sign" of PAD, and what causes it?
intermittent claudication
muscle pain that is caused by a constant level of exercise → build up of lactic acid from anaerobic metabolism and relieved by rest
The presence of this on echocardiography is a hallmark of infective endocarditis
vegetations on heart valves
T / F : patients who have undergone EVAR need monitoring for the rest of their lives
TRUE
A patient with chronic stable angina is prescribed sublingual nitroglycerin. The nurse provides education on how to take the medication for an acute angina episode. in what order should the patient take their sublingual nitro?
Take 1, if not relieved in 5 mins, call 911
Take another, wait 5 mins
Take another, STOP HERE (3 max)
A patient with heart failure asks the nurse, "What is an ejection fraction?" how should the nurse respond?
Ejection fraction is the amount of blood that the left ventricle squeezes out into the aorta. This is cardiac output.
A nurse is discharging a patient with PAD and educating on foot care. Which of these responses by the patient require follow up? SATA
a. i will wear open toed shoes so i can ensure blood flow is flowing to my toes
b. when my feet get cold at night i can use a heating pad
c. i will apply a thin layer of moisturizer to my foot but not in between the toes
d. i will report any new blisters, swelling, or redness
e. i am so excited to get a pedicure during the summer!
A - make sure they wear close-toes loos shoes
B - NO extreme temperatures especially on the extremities
E - patients should get their nails cut by their podiatrist and should avoid the hot water used in pedicures regardless of the season
a 20 year old patient has acute endocarditis. what topics would the nurse ask the patient about during the health history? (SATA)
A. renal dialysis
B. IV drug use
C. recent dental work
D. cardiac catheterization
E. recent urinary tract infection
A, B, C, D, E
recent dental, urological, gynecological, surgical, or IV drug use ALL increase risk of infective endocarditis
A patient is diagnosed with an aneurysm. The healthcare provider explains that all three layers of the artery wall are involved and are bulging outward, but the wall remains intact. what type of aneurysm does this patient have?
bonus (50 points): what are the 2 subtypes?
true aneurysm
1. fusiform
2. saccular
A nurse is reviewing the ECG of a patient during an episode of chest pain. The ECG shows ST-segment elevation. However, the patient reports the pain began suddenly while they were sleeping and they have no history of plaque buildup. Which type of angina does this presentation most likely suggest, and what is the direct cause of the pain in this condition?
This presentation most likely suggests Prinzmetal's angina due to a spasm of a major coronary artery
A nurse is assessing two patients with heart failure. Patient A presents with dyspnea, crackles, orthopnea, and paroxysmal nocturnal dyspnea.
Patient B presents with jugular vein distention, hepatomegaly, and bilateral lower extremity edema.
1. which type of heart failure is each patient experiencing?
2. patho behind each heart failure
3. which should the nurse see FIRST?
patient A = left sided HF evidenced by dyspnea, crackles, orthopnea, and paroxysmal nocturnal dyspnea; the left ventricle is not pumping as it should so the blood backs up into the lungs
patient B = jugular vein distention, hepatomegaly, and bilateral lower extremity edema; the right ventricle is not pumping as it should so the blood backs up into the body
nurse should see patient A first
a 67 year old male client diagnosed with PAD has a history of smoking, HTN, and hyperlipidemia. the nurse understands the modifiable risk factors are?
smoking, HTN, and hyperlipidemia
a patient is admitted to the hospital with a suspected acute pericarditis. what is the best method for the nurse to use when assessing the presence of a pericardial friction rub?
place the stethoscope on the lower left sternal border, patient leans forward and holds their breath
A nurse is assessing a patient's risk factors for developing an aortic aneurysm. what is the most important modifiable risk factor?
tobacco use
A nurse is reviewing the chart of a patient with a history of CAD and diabetes. The patient reports progressive fatigue and shortness of breath over the last week, but have consistently denied any chest pain or discomfort. considering the patient's history what complication should the nurse suspect and why?
- Silent Ischemia because they may have decreased sensation due to diabetic neuropathy, which can result in the heart muscle becoming ischemic without triggering the normal pain signals. It may instead present as fatigue, weakness, or shortness of breath
A patient with acute decompensated heart failure presents with pulmonary edema, crackles, peripheral edema, hypotension, cool extremities with mottled skin, and altered mental status.
1. what category of ADHF does this patient fall into?
2. what is management required?
1. wet - cold * the worst*
2. aggressive therapy, IV diuretics, inotropes, vasodilators, possible mechanical ventilation
A patient with PAD and claudication asks the nurse how much they should exercise. what specific exercise prescription should the nurse provide?
Walking is the most effective exercise in those with claudication
30-45 minutes daily, 3 times a week for a minimum of 3 months
what is the main cause of rheumatic fever?
what does rheumatic fever lead to?
Group A Strep (GAS)
rheumatic heart disease
A patient presents to the clinic with complaints of hoarseness, difficulty swallowing, and swelling in the neck and face. what type of aneurysm might this patient have, and what is causing these symptoms?
Ascending aorta + aortic arch aneurysm: pressing on the SVC = JVD, edema
other s&s : angina, transient ischemic attacks, coughing, SOB, hoarseness, and/or dysphagia
H.C., a 67 year old woman comes into the ED with a burning sensation in her epigastric area extending to her sternum
health history includes T2DM, HTN, chronic smoker, takes albuterol for asthma
state whether the following actions are INDICATED, CONTRAINDICATED, NONESSENTIAL
- apply supplemental oxygen
-perform PQRST assessment
- perform a head to toe assessment
- obtain a 12 lead EKG
-administer NTG 0.4 mg SL
- administer a non-selective beta blocker
INDICATED : apply O2 (improves O2 demand), perform PQRST (provide information about pain), obtain 12 lead EKG (identifies the cardiac rhythm)
CONTRAINDICATED : administer nitro SL (patient does not have baseline vitals yet nitro causes hypotension never administer medication without getting bp first), administer a nonselective b-blocker (nonselective bblocker will make asthma worse),
NONESSENTIAL : perform head to toe (nurse should perform a cardiac specific assessment a head to toe is not necessary at this time
A 72-year-old patient with a history of chronic heart failure is admitted with acute shortness of breath, orthopnea, fatigue, and weight gain of 5 lbs in 2 days. Vital signs: BP 90/58 mmHg, HR 118 bpm, RR 30/min, SpO₂ 85% on room air. Lung auscultation reveals bilateral crackles. Jugular veins are distended, and 2+ pitting edema is noted.
BOWTIE
central problem ? acute decompensated HF with pulmonary congestion & hypotension, peripheral edema, urinary retention, left ventricular heart failure
Which 2 interventions should the nurse implement first to prevent life-threatening complications?
A. Initiate supplemental oxygen to maintain SpO₂ ≥ 92%
B. Elevate the head of the bed to reduce pulmonary congestion
C. Administer IV diuretics at full dose immediately without checking BP
D. Encourage bedrest and avoid any position change
E. Notify the provider to order a sedative for anxiety
2 parameters to monitor?
A. SpO₂ / oxygen saturation
B. I&O
C. Lung auscultation for crackles
D. cardiac auscultation for murmurs
problem - ADHF with congestion & hypotension
2 interventions - A oxygen & B elevate HOB
2 parameters to monitor - A O2 sats & C lung sounds
when a patient with PAD is admitted to the hospital the nurse is aware that maintaining their legs which position will provide the most comfort and relief ?
why?
keeping their feet hanging off the bed or dangling off
- this is because dangling their feet off the bed helps the blood flow all the way down to their extremities
In acute myocarditis, this finding is often elevated due to myocardial injury but does not necessarily indicate a blockage of coronary arteries, helping distinguish it from a myocardial infarction
elevated troponin
A patient in the emergency department presents with sudden, severe back pain and is showing signs of hypovolemic shock. The nurse suspects a ruptured aortic aneurysm.
1. what specific bruising sign may or may not be present?
2. what is the immediate management for patients who survive long enough to reach the hospital?
1. grey turners sign - flank bruising indicating hemorrhage
2. NS, LR, fluid expander, giving massive amounts of blood/blood products
If they survive → need simultaneous resuscitation & immediate surgery