Cardiac Review Content Answers PDF

Cardiac content review 1. If a patient complains of chest pain, what diagnostics can be performed? -electrolytes, lipids, troponin, CK-MB, EKG, exercise stress test, Holter monitor -cardiac cath – post procedure watch for bleeding, assess vital signs, pulses distal to the cath insert...

Cardiac content review 1. If a patient complains of chest pain, what diagnostics can be performed? -electrolytes, lipids, troponin, CK-MB, EKG, exercise stress test, Holter monitor -cardiac cath – post procedure watch for bleeding, assess vital signs, pulses distal to the cath insertion. 2. What is the below rhythm and what can we do?  Sinus bradycardia, give O2, stimulate the patient, give atropine, pacemaker 3. What is this rhythm and what can we do? Assess for SOA, weakness, calm patient- assess reason- maybe from pain or anxiety and treat accordingly 4. What is this rhythm and what do we do? Afib, give warfarin, diltiazem for rhythm, cardioversion. If on warfarin will need to check bleeding – PT/INR which should be between 2-3 if therapeutic 5. What rhythm is this and what do we do? First check the patient for a pulse, if no pulse then defib 6. Describe left sided heart failure- where is the blood coming from before it gets into the left atrium? Where is the  backup? What symptoms will be present? -blood coming from the lungs, backup happens in the lungs causing respiratory symptoms of dyspnea, confusion, crackles, orthopnea, cyanosis, fatigue, weak pulses 7. Describe right sided heart failure – where is the blood coming from before it gets into the right atrium? Where is the backup? What symptoms will be present? -blood is coming from the superior/inferior vena cava so the backup is in the body causing symptoms of edema in hands/feet, abdominal distention, ascites, JVD, enlarged liver and spleen 8. Regardless of the type of heart failure, treatment is the same. What do patients do to manage their heart failure? -daily weights, low sodium diet, oxygen -the meds students need to know are furosemide and valsartan for heart failure; so with furosemide need to watch for dehydration/hypokalemia (lethargy, decreased GI motility, heart irregularities), teach to take in the AM; valsartan- change positions slowly, report dizziness, lightheadedness, and cough, monitor electrolytes and renal function 9. What teaching is necessary for home management of patients with CHF? -tell students to look on page 680 in new book at: MAWDS  M- meds: take as prescribed A – activity, stay active, walk couple days a week, increase time W- weight, daily weights- same time everyday on same scale D- diet, low sodium, limit fluid intake 2L S- symptoms; note any new or worsening symptoms 10. Susie is seen for the third time in her PCP office for evaluation of blood pressure. It has been high: first reading – 182/88, second reading- 178/86, and now the reading is 180/82. She is diagnosed with hypertension. What will you teach Susie about how to manage hypertension? -DASH diet, weight loss, limit alcohol, exercise, stop smoking, relaxation techniques for stress, take meds- watch for side effects of HTN meds: orthostatic hypotension, electrolyte imbalances, monitor BP at home Susie had more lab work done and has atherosclerosis. Her total cholesterol was 300: LDL was 220, HDL 80. What could be underlying reasons for high cholesterol? -sedentary lifestyle, smoking, diabetes, obesity, high fat diet. What symptoms could Susie have of atherosclerosis? -HTN, chest pain, decreased pulses in extremities, cool extremities, bruit The doctor would prescribe ____statins________ class for atherosclerosis. Susie will need to watch for side effects of statins, which includes: _abd pain, constipation, muscle cramping, diarrhea  Susie was wondering why her legs had no hair growth anymore and asked if it was related to atherosclerosis. What do you tell her? -yes, it can cause PVD or PAD (interchangeable words meaning decreased blood flow to periphery) -symptoms besides hair loss include intermittent claudication, rubor (redness of lower legs), ulcers that don’t heal. The cardiologist recommends she have a stent placed in her lower leg to increase blood flow. What would you teach her regarding this surgery to watch out for? - Watch for decreased circulation, no pulse, extreme pain, cold lower extremity- means occlusion 11. Describe Buergers disease: -ischemia to feet, linked to smoking, intermittent claudication, sensitive to cold temps, can lead to ulcers. Stay out of cold, no smoking, take meds 12. Describe Raynauds disease: -vasospasms of hands, painful when exposed to cold, same treatment as Buergers 13. Your patient had hip replacement surgery 3 days ago. He is extremely weak and cannot get out of bed. He was complaining of calf pain. You notice it is hot, swollen, red, hard. What could this be? - DVT What treatment is necessary? -since in the hospital, he will be on heparin IV, which is  weight based. Nurses will need to monitor bleeding time – which is with the aPTT, and it should be between 60-80 seconds while on heparin. Will also need to discuss bleeding, bruising risks -he could be on enoxaparin injections which is SQ, and safer in regards to bleeding risks. -the antidote for heparin is protamine sulfate 14. A nurse is complaining that they are on their feet all day, and when they go home their feet ache and feel heavy. The nurse noticed varicose veins behind the knee. What should you teach the nurse about treatment? -wt loss, no smoking, compression stockings, exercise but not high impact, elevate, surgery if needed 15. Haley presents to the ER with chest pain, and a feeling of indigestion, weakness, SOA. She was diagnosed with CAD a few years ago, and she took 3 nitro pills before she arrived. She is sent to cardiac cath lab where she is diagnosed with a MI. What is MONA? -Morphine -oxygen -Nitro -aspirin