Podcast
Questions and Answers
Which of the following statements BEST describes the underlying mechanism of benefit when nitroglycerin is administered to a patient experiencing angina?
Which of the following statements BEST describes the underlying mechanism of benefit when nitroglycerin is administered to a patient experiencing angina?
- It directly inhibits platelet aggregation, preventing further thrombus formation in the coronary arteries.
- It increases myocardial contractility, thereby improving cardiac output and oxygen delivery to ischemic tissues.
- It selectively dilates the coronary arteries, increasing blood flow to the heart muscle without affecting systemic blood pressure.
- It causes vasodilation, which reduces preload and afterload, decreasing myocardial oxygen demand, and also improves blood flow to the heart. (correct)
A patient with a history of stable angina reports experiencing chest pain that is now more frequent, severe, occurs at rest, and is less responsive to nitroglycerin. What is the MOST appropriate next step in managing this patient?
A patient with a history of stable angina reports experiencing chest pain that is now more frequent, severe, occurs at rest, and is less responsive to nitroglycerin. What is the MOST appropriate next step in managing this patient?
- Administering a dose of oral aspirin and scheduling the patient for elective outpatient cardiac catheterization.
- Immediately transferring the patient to the emergency department for further evaluation and potential intervention. (correct)
- Increasing the dose of the patient's regular beta-blocker medication and scheduling a follow-up appointment in one week.
- Instructing the patient to take an extra dose of nitroglycerin and monitoring for improvement at home.
Which of the following risk factors for angina is MOST strongly modifiable through lifestyle interventions?
Which of the following risk factors for angina is MOST strongly modifiable through lifestyle interventions?
- Male gender
- Family history of coronary artery disease
- Tobacco use (correct)
- Advanced age
What is the MOST likely rationale for prescribing aspirin to a patient diagnosed with angina?
What is the MOST likely rationale for prescribing aspirin to a patient diagnosed with angina?
A patient is diagnosed with Prinzmetal's angina. Which of the following medications would be MOST appropriate for managing this specific type of angina?
A patient is diagnosed with Prinzmetal's angina. Which of the following medications would be MOST appropriate for managing this specific type of angina?
Which statement BEST differentiates between stable and unstable angina?
Which statement BEST differentiates between stable and unstable angina?
A patient reports experiencing chest pain that radiates to the jaw and left arm, accompanied by shortness of breath and nausea. Which of the following actions should be taken FIRST?
A patient reports experiencing chest pain that radiates to the jaw and left arm, accompanied by shortness of breath and nausea. Which of the following actions should be taken FIRST?
Which of the following lifestyle modifications is MOST effective in reducing the frequency and severity of angina episodes?
Which of the following lifestyle modifications is MOST effective in reducing the frequency and severity of angina episodes?
Following successful resuscitation with ROSC, a patient is started on lidocaine. What is the primary rationale for administering this medication in this clinical context?
Following successful resuscitation with ROSC, a patient is started on lidocaine. What is the primary rationale for administering this medication in this clinical context?
During a cardiac arrest, epinephrine is administered. Which of the following is the most critical reason for using epinephrine in this situation?
During a cardiac arrest, epinephrine is administered. Which of the following is the most critical reason for using epinephrine in this situation?
A patient is diagnosed with severe aortic stenosis. Which assessment finding is most indicative of this condition?
A patient is diagnosed with severe aortic stenosis. Which assessment finding is most indicative of this condition?
A patient with mitral regurgitation is assessed. What specific finding would suggest the severity of the regurgitation is increasing?
A patient with mitral regurgitation is assessed. What specific finding would suggest the severity of the regurgitation is increasing?
A patient has a murmur occurring between S1 and S2. What does this suggest about the timing and potential cause of the murmur?
A patient has a murmur occurring between S1 and S2. What does this suggest about the timing and potential cause of the murmur?
During an assessment, a nurse identifies a murmur occurring between S2 and S1. Which condition is most likely to cause this type of murmur?
During an assessment, a nurse identifies a murmur occurring between S2 and S1. Which condition is most likely to cause this type of murmur?
You are assessing a patient with a history of cardiac issues and auscultate a murmur. Which characteristic of the murmur is most important to document to aid in diagnosis and monitoring?
You are assessing a patient with a history of cardiac issues and auscultate a murmur. Which characteristic of the murmur is most important to document to aid in diagnosis and monitoring?
When evaluating the pulse of a patient post-cardiac arrest, what characteristic would most strongly indicate that the heart is achieving effective hemodynamic stability?
When evaluating the pulse of a patient post-cardiac arrest, what characteristic would most strongly indicate that the heart is achieving effective hemodynamic stability?
A patient with a history of atrial fibrillation is prescribed warfarin. Which laboratory finding would indicate that the patient is within the desired therapeutic range?
A patient with a history of atrial fibrillation is prescribed warfarin. Which laboratory finding would indicate that the patient is within the desired therapeutic range?
Following a myocardial infarction (MI), a patient develops cardiac tamponade. Which assessment finding is most indicative of this complication?
Following a myocardial infarction (MI), a patient develops cardiac tamponade. Which assessment finding is most indicative of this complication?
A patient is diagnosed with Prinzmetal's angina. Which of the following factors differentiates this condition from stable angina?
A patient is diagnosed with Prinzmetal's angina. Which of the following factors differentiates this condition from stable angina?
A patient presents with acute shortness of breath, frothy pink-tinged sputum, and crackles throughout both lung fields. Which condition is the most likely cause of these findings?
A patient presents with acute shortness of breath, frothy pink-tinged sputum, and crackles throughout both lung fields. Which condition is the most likely cause of these findings?
A patient is receiving heparin therapy for a deep vein thrombosis. Which laboratory value requires immediate intervention by the nurse?
A patient is receiving heparin therapy for a deep vein thrombosis. Which laboratory value requires immediate intervention by the nurse?
Which of the following EKG changes is most indicative of myocardial ischemia?
Which of the following EKG changes is most indicative of myocardial ischemia?
A patient with heart failure is prescribed furosemide. The nurse should carefully monitor for which electrolyte imbalance?
A patient with heart failure is prescribed furosemide. The nurse should carefully monitor for which electrolyte imbalance?
A patient with pericarditis reports that the chest pain is worse when lying flat. Which nursing intervention is most appropriate to provide immediate relief?
A patient with pericarditis reports that the chest pain is worse when lying flat. Which nursing intervention is most appropriate to provide immediate relief?
A patient is started is started on apixaban. Which statement indicates the patient understands the education about this medication?
A patient is started is started on apixaban. Which statement indicates the patient understands the education about this medication?
A patient is diagnosed with right-sided heart failure. Which of the following clinical manifestations would the nurse expect to find?
A patient is diagnosed with right-sided heart failure. Which of the following clinical manifestations would the nurse expect to find?
A patient experiencing supraventricular tachycardia (SVT) is unresponsive to vagal maneuvers. Which medication should the nurse prepare to administer?
A patient experiencing supraventricular tachycardia (SVT) is unresponsive to vagal maneuvers. Which medication should the nurse prepare to administer?
What is the significance of the PR interval on an EKG tracing, and what does a prolonged PR interval indicate?
What is the significance of the PR interval on an EKG tracing, and what does a prolonged PR interval indicate?
What is the most immediate nursing intervention for a patient experiencing acute cardiac tamponade that can rapidly progress to hemodynamic collapse?
What is the most immediate nursing intervention for a patient experiencing acute cardiac tamponade that can rapidly progress to hemodynamic collapse?
In the management of a patient with unstable angina, what is the primary goal of administering nitroglycerin, and how does it achieve this effect?
In the management of a patient with unstable angina, what is the primary goal of administering nitroglycerin, and how does it achieve this effect?
A patient is admitted with acute decompensated heart failure. Following initial interventions, which assessment finding would indicate the most significant improvement in the patient's condition?
A patient is admitted with acute decompensated heart failure. Following initial interventions, which assessment finding would indicate the most significant improvement in the patient's condition?
Flashcards
Lidocaine (post-ROSC)
Lidocaine (post-ROSC)
Medication used post-cardiac arrest to prevent dysrhythmias by slowing conduction and reducing automaticity in heart tissue.
Epinephrine (post-ROSC)
Epinephrine (post-ROSC)
Medication used post-cardiac arrest to increase coronary and cerebral blood flow during CPR, aiding in achieving ROSC.
Amiodarone (post-ROSC)
Amiodarone (post-ROSC)
Medication used to treat VF and VT, particularly when other treatments have failed. It helps manage arrhythmias during and post-cardiac arrest.
Post-ROSC Pulse Check
Post-ROSC Pulse Check
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Valvular Stenosis
Valvular Stenosis
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Stenosis Murmur
Stenosis Murmur
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Valvular Regurgitation
Valvular Regurgitation
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Heart Murmurs
Heart Murmurs
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Angina
Angina
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Stable Angina
Stable Angina
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Unstable Angina
Unstable Angina
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Coronary Artery Disease (CAD)
Coronary Artery Disease (CAD)
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Nitroglycerin
Nitroglycerin
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Angina Pain Location
Angina Pain Location
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Angina Character
Angina Character
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Angina Lifestyle changes
Angina Lifestyle changes
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EKG: P Wave
EKG: P Wave
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EKG: PR Interval
EKG: PR Interval
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EKG: QRS Complex
EKG: QRS Complex
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Warfarin INR Goal
Warfarin INR Goal
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Warfarin Reversal Agent
Warfarin Reversal Agent
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Heparin Reversal Agent
Heparin Reversal Agent
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Right-Sided Heart Failure Signs
Right-Sided Heart Failure Signs
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Left-Sided Heart Failure Signs
Left-Sided Heart Failure Signs
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Cardiac Tamponade Nursing Actions
Cardiac Tamponade Nursing Actions
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Cardiac Tamponade
Cardiac Tamponade
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Cardiac Tamponade Symptoms
Cardiac Tamponade Symptoms
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Pericarditis
Pericarditis
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Pericarditis Symptoms
Pericarditis Symptoms
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Pericarditis Assessment Findings
Pericarditis Assessment Findings
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Study Notes
- Cardiac medications used Post-ROSC manage heart rhythm and function.
Medications Post-ROSC
- Lidocaine prevents dysrhythmias by delaying conduction and reducing automaticity.
- Epinephrine increases coronary and cerebral perfusion during CPR to help achieve ROSC.
- Amiodarone treats VF and VT, especially when other treatments fail, managing arrhythmias during and after cardiac arrest.
Pulse Checks
- Pulse checks confirm heart has resumed pumping effectively.
- Pulse quality indicates hemodynamic status, where a weak pulse suggests inadequate cardiac output.
Valvular Stenosis and Regurgitation:
- Valvular stenosis is the narrowing of the heart valve, restricting blood flow.
Valvular Stenosis Assessment Findings:
- Murmurs: Loud or harsh murmurs are typically heard with valvular stenosis.
- Symptoms include fatigue, shortness of breath, and chest pain, especially during exertion.
- Other signs include heart failure due to increased workload on the heart.
- Valvular regurgitation occurs when the heart valve does not close properly, causing backward blood flow.
Valvular Regurgitation Assessment Findings:
- Murmurs: Soft or blowing systolic or diastolic murmurs can be detected with valvular regurgitation.
- Symptoms include palpitations, fatigue, and shortness of breath.
- Other signs include possible heart failure due to volume overload.
Heart Murmurs
- Murmurs are abnormal heart sounds due to turbulent blood flow.
- Systolic murmurs occur between S1 and S2 (e.g., aortic stenosis).
- Diastolic murmurs occur between S2 and S1 (e.g., mitral regurgitation).
EKG Components and Meaning:
- P Wave represents atrial depolarization (0.06-0.12 seconds).
- PR Interval is the time from P wave onset to QRS complex start (0.12-0.20 seconds).
- QRS Complex shows ventricular depolarization (0.06-0.10 seconds).
- ST Segment is the period between ventricular depolarization and repolarization.
- T Wave represents ventricular repolarization.
- QT Interval measures total time for ventricular depolarization and repolarization.
Sinus Tachycardia:
- Sinus tachycardia is a heart rate greater than 100 bpm.
- Causes include physical/psychological stressors, hypotension, hyperthermia, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial infarction, heart failure, hyperthyroidism.
- Interventions include beta-blockers (metoprolol), calcium channel blockers (diltiazem), adenosine (for SVT), and synchronized cardioversion (if unstable).
- Symptoms encompass dizziness, dyspnea, hypotension due to reduced cardiac output, increased work of the heart, and possible angina.
Anticoagulant Medications:
- Anticoagulant medications include Warfarin, Heparin, and Direct Oral Anticoagulants (DOACs) like apixaban, rivaroxaban, and dabigatran.
- Problems include bleeding, thrombosis, and drug interactions.
- Blood tests include Prothrombin Time (PT) / International Normalized Ratio (INR) for warfarin (INR 2-3), Activated Partial Thromboplastin Time (aPTT) for heparin (therapeutic range 1.5-2.5 times normal), and Complete Blood Count (CBC) for detecting bleeding or clotting issues.
Anticoagulant Reversals:
- Warfarin is reversed with Vitamin K; prothrombin complex concentrates (PCC) or fresh frozen plasma (FFP) may be used in significant bleeds.
- DOACs are reversed with andexanet alfa (for rivaroxaban and apixaban).
- Heparin is reversed with protamine sulfate.
Left vs. Right Sided Heart Failure Signs
- Decreased perfusion signs include hypotension, decreased urine output, cool extremities, altered mentation, heart murmur, dysrhythmias, and worsening renal/liver function.
- Right-sided heart failure signs include increased HR, murmur, jugular vein distention, edema, weight gain, ascites, and hepatomegaly.
Right Sided Heart Failure Symptoms
- Fatigue, anxiety/depression, right upper quadrant pain, anorexia & GI symptoms, nausea.
- Left-sided heart failure signs include increased HR, poor O2 exchange (low PaO2 and elevated PaCO2), crackles in the lungs, S3 & S4 heart sounds, pleural effusion, and changes in mental status.
- Left Sided Heart Failure Symptoms: restlessness/confusion, dizziness, crackles, shallow rapid respiration, dry/hacking cough, frothy/pink sputum in pulmonary edema, weakness, fatigue, anxiety/depression, dyspnea, paroxysmal nocturnal dyspnea, and orthopnea.
Heart Failure Complications
- Heart Failure Complications: pleural effusion, dysrhythmias, hepatomegaly, cardiorenal syndrome, and anemia.
Heart Failure Goals of Therapy
- Symptom relief
- Optimizing volume status
- Supporting oxygenation, ventilation, CO, and end-organ perfusion
- Identify the cause
- Avoiding complications
- Provide teaching for discharge (diet, exercise, medication adherence).
Myocardial Infarction
- MI interventions, medications & their adverse effects.
- MI prioritization is ABC (Airway, Breathing, Circulation).
Cardiac Tamponade
- Cardiac Tamponade Fluid accumulates in the pericardial sac, preventing complete filling.
- Cardiac Tamponande Fluid can be pus or blood.
- Cardiac Tamponade Symptoms: dyspnea, dizziness, “tightness” in the chest, increasing restlessness, pulsus paradoxus (>10mmHg drop in systolic BP during inspiration), tachycardia, muffled heart sounds, and jugular vein distention.
- Nursing actions include administering fluids for hypotension and preparing for pericardiocentesis.
Pericarditis:(Inflammation of the pericardium)
- Pericarditis Symptoms include chest pain, increased pain with laying flat or deep breathing, and sharp/stabbing pain.
- Pain is often relieved by sitting up and leaning forward.
- Muffled Heart Sounds!
- Pericarditis is often due to viral, bacterial, or fungal infections, cancer, immune disorders, HIV/AIDS, underactive thyroid, kidney failure, rheumatic fever, or tuberculosis (TB).
- Additional symptoms: fever, chills, swelling in lower extremities, difficulty breathing, dry cough, and fatigue.
- Assessment: auscultate have muffled or distant heart sounds, pericardial rub.
Pericarditis Treatment
- Pericarditis Draining the fluid from the sac (pericardiocentesis) or cutting a small hole in the pericardium (subxiphoid pericardiotomy) to allow the infected fluid to drain into the abdominal cavity.
Angina and Myocardial Infarction (MI)
- Angina is a type of chest pain.
Angina Types:
- Stable angina occurs predictably, often triggered by exertion or stress, relieved by rest or nitroglycerin.
- Unstable angina is more serious, unpredictable, can occur at rest, and indicates a medical emergency. Variant Angina (Prinzmetal's Angina): This type of angina is less common and is caused by a temporary spasm in the coronary arteries, leading to reduced blood flow to the heart. It can occur at rest and may not be associated with traditional angina triggers. Unlike stable angina, which is often triggered by physical exertion or stress, Prinzmetal angina is caused by a temporary narrowing or constriction (spasm) of the coronary arteries, leading to a temporary reduction in blood flow to the heart muscle. In rare cases, severe and prolonged coronary artery spasms can lead to serious complications, including life-threatening arrhythmias, heart attack, or sudden cardiac death.
Angina Features:
- Location: Typically felt in the chest, behind the breastbone, or in the arms, neck, jaw, shoulder, or back.
- Character: Described as pressure, squeezing, burning, or tightness.
- Duration: Usually temporary, lasting a few minutes.
- Relief: Rest or nitroglycerin provides relief.
Angina Risk Factors:
- Risks include coronary artery disease (CAD), age, gender, smoking, high blood pressure, high cholesterol, diabetes, and family history.
Angina Management:
- Management includes lifestyle modifications, medications (nitroglycerin, beta-blockers, calcium channel blockers, antiplatelet agents; aspirin), and revascularization procedures (angioplasty or CABG).
- Angina patients typically do not require immediate catheterization. Non-invasive tests (EKG, stress test) are usually done first.
- Nitroglycerin causes vasodilation, improving blood flow. It lowers blood pressure and often causes headaches.
- Stable angina is consistent and relieved with nitroglycerin, while unstable angina is a new episode of increasing severity and constitutes an emergency.
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Description
Assess your knowledge of angina pectoris, including stable and unstable angina, Prinzmetal's angina, and risk factors. Review the mechanisms of nitroglycerin, aspirin, and other medications used in managing angina. Evaluate your understanding of appropriate next steps in patient management.
