Emergency Management
This medication is administered to a patient experiencing chest pain from an MI to reduce clot formation
What is Aspirin
*along with its anti-inflammatory and pain reducing qualities, it is also an antiplatelet medication, meaning it keeps the blood thin and prevents clots from forming. Can be taken daily as well for preventative measures (81 mg)
A BNP greater than 100 may be an indication of this.
What is Heart Failure?
*an increase of this neurohormone in the blood is in response to expansion of the ventricles and increased pressure, making this a beneficial diagnostic tool for HF
This cardiac medication is often used to treat bradycardia by increasing heart rate and is commonly administered in emergency settings.
What is atropine?
*Atropine works by blocking the action of the parasympathetic nervous system, which normally slows down the heart rate through the vagus nerve. Specifically, it acts as an antagonist to muscarinic acetylcholine receptors. By inhibiting these receptors, atropine reduces vagal stimulation on the heart, allowing the sinoatrial (SA) node to increase its firing rate, which raises the heart rate.
This wave on an EKG represents atrial depolarization, which triggers atrial contraction.
What is The P wave.
*The P wave is the first wave seen on an EKG. Typically a smaller wave, indicating electrical activation of the atria (upper chambers of the heart)
The patient should be placed in this position if experiencing SOB due to HF.
What is high Fowler's position?
*This is when the patient is placed sitting upright with the head of the bed elevated significantly. This position helps maximize lung expansion and improve breathing.
This medication class is often administered to improve contractility in patients with cardiogenic shock.
What are inotropes? (dobutamine, dopamine)
*inotropes help the heart pump better, improving adequate perfusion to vital organs
This cardiac biomarker is released into the bloodstream after myocardial injury and is considered the gold standard for diagnosing a heart attack.
What is troponin?
*Cardiac troponin is a protein specific to the heart muscle that controls muscular force production (regulates muscle contractions).
Which medication class is commonly prescribed to treat arrhythmias and help slow HR in patients with a-fib?
Beta-Blockers
*Beta-blockers are a class of medications often prescribed to manage arrhythmias, including atrial fibrillation (a-fib), and to help slow the heart rate (HR).
Beta-blockers work by blocking the beta-adrenergic receptors in the heart, which are part of the sympathetic nervous system. This system typically increases heart rate and contractility in response to stress or exercise.*
Your new admission on the tele unit is an 80 y/o female. An EKG was done and shows no regularities, a discernible P wave, and heart rate at 50 beats. You know that the patient is in this rhythm.
What is sinus bradycardia?
*An impulse that originates in the sinoatrial (SA) node and at a slow rate is sinus bradycardia.
This cardiovascular assessment finding is characterized by swelling in the lower extremities. The nurse assesses the patient by using the thumb to place firm pressure over the extremity.
What is peripheral edema?
*Common finding in patients with HF and peripheral vascular diseases such as DVT or chronic venous insufficiency
This medication is commonly used in hypertensive emergencies to lower blood pressure quickly by causing vasodilation.
What is Nitroglycerin or Nitroprusside
*In hypertensive emergencies (SBP>180 or DBP> 120 with new or worsening target organ damage), we want medications that can be administered intravenously so there is an immediate onset. Other IV antihypertensives are nicardipine, clevidipine and labetalol. The goal for patients in HTN emergency is to lower SBP by no more than 25% within the first hour of tx, then BP back to normal within 24-48 hr.
This test measures the electrical activity of the heart and is commonly used to diagnose arrhythmias, ischemia, and myocardial infarction.
What is an electrocardiogram (ECG or EKG)?
*Small electrodes are placed on the chest, arms, and legs, which pick up the electrical signals from the heart and resulted as a wave pattern.
This medication may be used to treat high blood pressure and ease the swelling and water buildup caused by heart failure.
What is Diuretics?
*helps reduce fluid retention and swelling by promoting urine output, thus relieving HF symptoms like edema and SOB.
You are looking at your asymptomatic patients' EKG strip and see they are bradycardic with PR intervals greater than 0.20 seconds. This patient is likely experiencing this conduction disorder.
What is first-degree heart block?
*Occurs when all the atrial impulses are delayed (slower than normal rate) through the AV node into the ventricles.
A patient is admitted to the med surg floor following a total hip arthroplasty. After receiving a dose of Heparin the patient began showing signs of excessive nose bleeds, formation of petechiae, and blood in urine and stool. Using your amazing assessment skills, the RN knows that this has occurred and this medication will be given.
what has potentially occurred and what is the antidote?
Heparin overdose - administer protamine sulfate as prescribed.
*Bleeding is the first sign of this overdose. Protamine sulphate stabilizes/blocks the anticoagulant effect of heparin.
Your full code patient suddenly collapses and is unresponsive. You check their pulse and they are pulseless. What is the first step in the management of this patient?
What is initiating high quality chest compressions / CPR
*cardiopulmonary resuscitation provides blood flow to vital organs until adequate perfusion can be reestablished. The aim for CPR is 2 in. chest compressions at 100 compressions/min with complete recoil of the chest in between to allow for cardiac filling.
This test measures the time it takes for blood to clot and is often used to monitor patients on anticoagulant therapy, particularly those taking warfarin.
What is the prothrombin time (PT) or international normalized ratio (INR)?
*INR levels are increased with the use of warfarin. A higher INR increases the risk of bleeding, while a lower INR increases the risk of clotting.
*Therapeutic INR range for patients taking warfarin is 2.0 to 3.0
This anticoagulant is commonly used to prevent clot formation in patients with atrial fibrillation, deep vein thrombosis, or pulmonary embolism and requires monitoring of INR levels.
What is warfarin?
*Warfarin is an anticoagulant medication that helps prevent blood clot formation. It is commonly prescribed for patients with conditions such as atrial fibrillation (a-fib), deep vein thrombosis (DVT), or pulmonary embolism (PE), where the risk of developing harmful blood clots is high. Warfarin works by inhibiting the activity of vitamin K, which is essential for the production of certain clotting factors (II, VII, IX, and X) in the liver.*
This EKG rhythm is characterized by rapid, irregular waves with no identifiable P waves or QRS complexes, often associated with a high risk of stroke.
What is atrial fibrillation?
*AFib results from abnormal impulse formation that occurs when structural or electrophysiologic abnormalities alter the atrial tissue causing the arrhythmia.
A-Fib causes myocardial damage - what do we do? Protect and support their cardiac efforts. Since the atria is quivering and not producing a strong contraction and ejection of blood into the ventricles, blood is pooling in atria. This can create micro clots that can travel and can cause MI.
TX of A-fib: anticoagulant like heparin, warfarin, enoxaparin, rivaroxaban (Xarelto); give antidysrhythmic like amiodarone, beta blocker (metoprolol)
For a patient with hypertension, these non-pharmacological interventions can help reduce blood pressure over time and are considered modifiable lifestyle changes.
What is patient education for encouraging weight loss, DASH diet, reducing salt intake, lowering alcohol consumption, smoking cessation, and promoting physical activity.
*DASH diet: fruits, vegetables, low-fat dairy products, low saturated fats, low total fat
*sodium restriction less than 2 g/day
Your patient on the tele unit suddenly has a regular heart rate of 190 beats with wide QRS complexes resembling tomb stones. You run to the room and check pulses. They have a pulse. The nurse understands that the next immediate step to ensure the patients survival is what?
What is administering amiodarone
*with a pulse, give pt antidysrhythmic and correct underlying
*w/o a pulse: defib, CPR, Epi, tx underlying
Produced by the liver in response to inflammation, this test can be used to assess the risk of infection, cardiovascular disease or an acute cardiac event.
What is a C-reactive protein (CRP) test?
*Elevated levels in a blood test can indicate increased risk for various health conditions.
*CRP levels of 1.0 to 10.0 mg/dL are considered moderately elevated.
This medication, used to treat heart failure and atrial fibrillation, increases the force of myocardial contraction and requires monitoring for toxicity, with symptoms like nausea, vision changes, and arrhythmias.
What is digoxin?
*Digoxin increases the force of myocardial (heart muscle) contraction, a property known as positive inotropy. It achieves this by inhibiting the sodium-potassium ATPase pump in heart cells. This inhibition increases intracellular calcium levels, which enhances the heart's ability to pump blood more effectively. In atrial fibrillation, digoxin also slows the conduction of electrical signals through the atrioventricular (AV) node, helping to control the heart rate.*
This life-threatening arrhythmia appears as a rapid, chaotic electrical activity with no discernible QRS complexes, P waves, or T waves, and requires immediate defibrillation.
What is ventricular fibrillation?
*Most common arrhythmia in patients with cardiac arrest. The most common cause of VFib is coronary artery disease and resulting acute MI.
A patient with an acute MI is experiencing hypoxemia. This nursing intervention is appropriate to improve oxygenation.
What is supplemental oxygen?
*This can be done via nasal cannula or face mask, titrating the flow rate to maintain an adequate oxygen saturation level.
*Monitor patient vital signs and O2 levels.