28 Questions
What is an early sign of congestive heart failure (CHF) that a nurse should assess for during a cardiovascular assessment?
Peripheral edema
Which intervention is aimed at relieving pain and symptoms of ischemia in a patient presenting with a myocardial infarction (MI)?
Elevating the head of the bed
What does the acronym 'MONA' stand for in the context of initial treatment for myocardial infarction?
Morphine, Oxygen, Nitroglycerin, Aspirin
What is the purpose of administering nitroglycerin to a patient experiencing a myocardial infarction?
To reduce pain and vasodilate
Which symptom is more commonly associated with a female presentation of myocardial infarction?
Shortness of breath and nausea
Why is it important to monitor capillary refill in a patient with myocardial infarction?
To evaluate tissue perfusion
What is the recommended interval for administering Epinephrine IV bolus during CPR?
Q3-5min
When treating a patient with asystole, what is the final rhythm indicating?
Complete cessation of heart's electrical and mechanical activity
What action should be taken if a heart rhythm is shockable during resuscitation?
Deliver shock followed by 2 minutes of CPR
Which electrolyte imbalance should be monitored closely when administering loop diuretics?
Potassium (K)
In case of PEA, what is the potential outcome if not treated quickly?
Sudden cardiac death within minutes
What should a patient feel under their tongue when taking sublingual nitroglycerin?
Tingling sensation
Why should a patient replace their nitroglycerin after 6 months?
To maintain potency and effectiveness
What is the purpose of administering TPA in thrombolytic therapy for MI?
To dissolve blood clots
When does ischemia occur in the context of cardiac death progression?
Within 20 minutes
Why is it important to assess the patient for signs of bleeding when administering TPA?
Because TPA is a 'clot buster'
What should a patient do if chest pain is unrelieved after taking nitroglycerin?
Take another dose immediately
What is the function of a Calcium Channel Blocker like Lopressor in the medical management of myocardial infarction?
It slows down the heart rate, reducing heart workload and oxygen demand
What does a high PTT (Partial Thromboplastin Time) level indicate in a patient suspected of having a myocardial infarction?
Blood is taking longer to clot
What is the significance of abnormal troponin levels in the diagnosis of a myocardial infarction?
It confirms the presence of a myocardial infarction
What is the primary goal of thrombolytic therapy in a patient experiencing a myocardial infarction?
To limit the size of the infarct
In a patient with pulseless electrical activity (PEA), what is the most immediate concern?
Establishing a pulse
What are the normal reference ranges for Potassium (K+) levels in the blood?
3.5 to 5.2 mEq/L
What does the ST segment represent in an EKG?
Ventricular repolarization
What is the significance of the U wave in an EKG?
It is rarely observed, but is normal
Which zone of infarction is associated with Q waves on an EKG?
Zone of infarction
What is the underlying cause of cardiogenic shock?
Decreased tissue perfusion
How can cardiogenic shock caused by myocardial infarction be managed?
Placing a stent via cardiac catheterization
Study Notes
Cardiovascular Assessment
- Cardiovascular assessment includes physical examination, skin color, peripheral edema, and capillary refill
- 1L H2O = 1kg, so if a patient retains 1L of fluid, they will gain 1kg (2.2lb)
Signs and Symptoms of Myocardial Infarction (MI)
- Male presentation: chest pain, radiating pain to left arm, and jaw pain
- Female presentation: shortness of breath, nausea, and vague epigastric symptoms
- Other symptoms: dizziness, syncope, changes in level of consciousness, palpitations
Interventions for Myocardial Infarction (MI)
- Relieve pain and symptoms of ischemia
- Elevate head of bed (HOB) to improve respiratory function
- Treat anxiety with a calm voice
- Administer MONA+ (Morphine, Oxygen, Nitroglycerin, Aspirin, and Calcium Channel Blocker)
- Monitor intake and output (I&O) and tissue perfusion
- Educate patient and family on MI
MONA+ Initial Treatment
- Morphine: reduces anxiety and vasodilation, increasing oxygen supply
- Oxygen: provides supplemental oxygen to increase oxygen supply
- Nitroglycerin: vasodilation increases oxygen supply, may cause headache
- Aspirin: anticoagulant and platelet inhibitor, increases oxygen supply
- Calcium Channel Blocker: slows down heart rate, reducing heart workload and oxygen demand
Medical Management of MI
- Thrombolytic therapy: destroys thrombus and restores blood flow to myocardium
- Emergent PCI (Percutaneous Coronary Intervention): catheterization
- Goals of treatment: limit infarct size, pain relief, prevent and manage complications, preserve myocardial function
Lab Values
- Troponin: gold standard test for MI, normal value is 0-0.04 ng/mL, repeat every 6-8 hours x3
- Potassium: normal value is 3.5-5.2 mEq/L
- PTT: normal value is 25-35 seconds, may be affected by blood thinners
Treatment of Pulseless Cardiac Arrest
- Interventions: CPR for 2 minutes, administer Epinephrine 1mg IV bolus, identify and treat the cause
- Analyze heart rhythm, determine need to deliver shock, and administer amiodarone or lidocaine
Med Calc Conversions
- 1kg = 1000g, 1g = 1000mg, 1mg = 1000mcg, 1kg = 2.2lb, 1oz = 30ml, 1 cup = 8oz, 1 tsp = 5ml, 1 tbsp = 15ml, 1 tbsp = 3 tsp, 1L = 1000ml, 1 gallon = 4qt
Electrolyte Imbalances and Diuretic Administration
- Diuretics decrease fluid volume, monitor serum electrolytes
- Loop diuretics increase excretion of Na, Cl, and K, ensure patient receives K+ supplements
EKG Changes in MI
- 12-lead EKG changes: Q waves, ST elevation or depression, diagnose NSTEMI or STEMI
- Normal EKG: P wave, QRS complex, ST segment, U wave
- Pathophysiology: ischemia occurs within 20 minutes, necrosis occurs within 6 hours
Cardiogenic Shock
- Failure of the heart to pump enough blood, resulting in shock
- Caused by: MI, CHF, arrhythmias, pulmonary embolism
- Nursing assessment: low tissue perfusion, restlessness, agitation, confusion, low BP, tachypnea, oliguria/anuria, dysrhythmias
Patient Education for Sublingual Nitroglycerin
- Take prophylactic NTG prior to exertion
- Replace NTG every 6 months
- Keep in the original bottle
- Should feel tingling under the tongue
- If chest pain is unrelieved, repeat NTG every 5 minutes and call 911
Thrombolytic Therapy
- Goal: destroy thrombus and restore blood flow to the myocardium
- Nursing care: administer ASAP, assess for signs of bleeding, minimize punctures and invasive procedures
- Steps involved in cardiac death: ischemia, infarction, troponin release, and cardiac death
Learn about the sequence of actions to be taken during a cardiac arrest situation according to ACLS guidelines. Topics include CPR, epinephrine administration, capnography, identifying and treating causes of arrest, analyzing heart rhythm, and delivering shocks if needed.
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