Cardiac Review Exam - May 2024 PDF

Review for Cardiac Exam May 2024 Findings that may indicate cardiovascular problems Chest pain Heart murmurs (valve disorders) Murmurs are whooshing sounds caused by turbulent blood flow through a valve Dyspnea on exertion Dizziness Poikilothermia (peripher...

Review for Cardiac Exam May 2024 Findings that may indicate cardiovascular problems Chest pain Heart murmurs (valve disorders) Murmurs are whooshing sounds caused by turbulent blood flow through a valve Dyspnea on exertion Dizziness Poikilothermia (peripheral arterial disease) Orthostatic hypotension Dependent rubor Edema Question The nurse is collecting data on a client who reports sleeping 8-10 hours a night, smoking a pack of cigarettes a day, drinking alcohol on the weekends and rarely exercising. The client presents with complaints of low back pain, dyspnea on exertion, chest discomfort, and a sour taste in the mouth. Which findings may indicate a cardiovascular disorder? Select all that apply. Rarely exercising Chest discomfort Back pain Sour taste in the mouth Dyspnea on exertion Smoking history Sleep pattern Alcohol use Diagnostic Tests Stress Test-NPO 2-4 hours, no smoking, no caffeine; wear comfortable clothes for walking EKG (ECG)-measures electrical activity of heart; lie still, normal breathing; ensure accurate lead placement. Skin clean and dry Holter monitor-24-72 hour continuous monitoring (for low risk, intermittent symptoms) Echocardiography-shows heart in motion Duplex ultrasound-shows blood flow through arteries, veins. Identifies blockages Diagnostic tests Cardiac catheterization/angioplasty: check for prior reactions to contrast dye. Invasive. Signed consent needed. NPO 6-8 hours Local anesthesia. Warm, flushed feeling. Post: Increase fluids. Maintain bedrest, pressure dressing Monitor neurovascular status, vital signs, heart rate, rhythm No flexion of extremity Neurovascular checks Circulation (color, temperature, capillary refill, pulse quality) Motion (ability to move digits) Sensation (paresthesia, ability to feel pain/pressure) Question The nurse is assisting in the care of a client following a cardiac catheterization. Which action should the nurse take to evaluate the neurovascular status of the extremity? A. Ask questions to determine orientation B. Check pedal pulses bilaterally C. Check pupil reactions to light D. Calculate a Glasgow coma score Electrocardiogram Lead Placement V1: 4th intercostal space, right sternal border V2: 4th intercostal space, left sternal border V4: 5th intercostal space, left mid-clavicular line V3: between V2 and V4 V5: 5th intercostal space, left anterior axillary line V6: 5th intercostal space, left mid-axillary line Limb leads: anywhere from shoulder to wrist and hip to ankle. Position the same on both limbs Labs Cardiac biomarkers: Troponin, CK-MB Elevations indicate cardiac muscle damage, possible myocardial infarction Troponin stays elevated for 7-10 days after injury Total cholesterol, LDL cholesterol Total cholesterol level above 200 mg/dL increases risk of heart disease Elevations in LDL increase heart disease risk Major food sources of cholesterol: red meat, eggs, cheese, full fat dairy products PT/INR: monitor warfarin levels. PT normal values can vary depending on equipment used to analyze. INR is consistent range of 0.8-1.2 (therapeutic 2-3) regardless of lab used Question A client who has a total cholesterol level of 240 mg/dL (normal less than 200 mg/dL) and other risk factors for heart disease is reluctant to start medications. The client asks about lifestyle modifications to lower cholesterol levels. Which foods should the nurse recommend eating only in limited amounts or avoiding entirely? A. Spinach, baked beans, corn B. Salmon, olive oil, potatoes C. Eggs, whole milk, red meat D. Pasta, chicken, whole wheat Signs of decreased cardiac output Dizziness Syncope Weak, rapid pulse Hypotension Weakness Fatigue Activity intolerance Dyspnea Hypertension Normal BP is less than 120/80 Check both arms; if one arm higher, check future BPs in that arm Accuracy: correct size cuff, no talking, back and feet supported Arm supported at heart level Rest for 5 minutes before checking Reasons to avoid checking BP in both arms: mastectomy, dialysis catheter Orthostatic hypotension-lying, sitting, standing; done as a single procedure. Drop in BP, increase in pulse with dizziness indicates orthostatic hypotension Hypertension risk factors Modifiable Non-modifiable Obesity Family history (biggest non- Sedentary lifestyle modifiable risk factor) Diets high in fats, sodium, Age calories Stress Gender Smoking Ethnicity Excessive alcohol intake (more Non-Hispanic blacks at than 1 drink a day for women, 2 highest risk for men) Less than 5 hours of sleep a night Diabetes Hypertension complications Stroke Vision loss Cardiac problems: heart failure, cardiomegaly, MI, peripheral arterial disease Renal damage: hypertension is the second most common cause of chronic renal failure Question The nurse is instructing the UAP on how to take orthostatic vital signs. Which action should the nurse recommend? A. Take the supine pressure when you wash the client, and the sitting and standing pressures when you get the client out of bed. B. Take the sitting blood pressure after breakfast, and the supine pressure after the client goes back to bed in the afternoon. C. Wait one to two minutes between measurements. Do the supine pressure first, then the seated, then the standing pressure. D. You can take the blood pressures in any order, but they should be done at the same time. Patient teaching for hypertension Take medications as directed Do not stop abruptly (rebound hypertension can occur) Take meds even if BP is normal and you are feeling well Decrease sodium Monitor blood pressure Check pulse, blood pressure before beta-blockers, calcium channel blockers Change positions slowly to prevent orthostatic hypotension Cardiac surgery Hold anticoagulants for up to a week before surgery Hold diuretics for 24-hours before surgery Diabetics generally should not take insulin or antidiabetic medication before surgery Post-op: monitor vital signs, rhythm, urine output, lung sounds Sternotomy dressing changes done under sterile technique Medicate for pain before ambulation Incentive spirometry Medications Beta blockers, calcium channel blockers-check pulse AND blood pressure before administration. Do not administer if either pulse or BP is below parameters (usually 100 mm Hg systolic, 60 beats per minute) ACE inhibitors, other antihypertensives-check BP before giving Digoxin-check pulse, hold if below parameter (usually 60 beats per minute) Diuretics-check potassium levels. Hydrochlorothiazide, furosemide, bumetanide can decrease levels. Spironolactone can increase. Hold if hypokalemic Give antihypertensives even if BP is normal. Medications (2) Warfarin- Monitor PT, INR Consume consistent amounts of vitamin K (mostly green leafy vegetables) Monitor for bleeding No over-the-counter medications without consulting healthcare provider (Aspirin, NSAIDS increase bleeding risk) Bleeding precautions: Use a soft toothbrush, electric razors. Don’t go barefoot. Carry medical alert identification.  Question The nurse is administering 9 AM medications. The blood pressure is 118/64. The pulse is 68. The morning’s potassium level was 3.2 mEq/L (range 3.5-5 mEq/L). Which action should the nurse take? A. Administer all medications as prescribed. B. Administer all medications except the amlodipine. C. Administer the medications with 4 ounces of orange juice. Amlodipine D. Hold10the mg byhydrochlorothiazide mouth. Hold if and consult Hydrochlorothiazide the 25 mg by registered mouth. nurse. systolic blood pressure is below 100 mg Hg or pulse is less than 60 Aspirin 325 mg by mouth. Ferrous sulfate 65 mg by mouth. Valve Disorders Etiology: congenital, aging, endocarditis, rheumatic fever General signs and symptoms: heart murmur, dysrhythmias, palpitations, chest pain. Complications: heart failure, stroke, endocarditis Interventions: medications to manage dysrhythmias and heart failure, prevent stroke; valve repair or replacement Valve replacement: Biologic last only 7-10 years; no anticoagulant required Mechanical - Durable but require lifelong anticoagulation NCLEX Question Which finding is common to all valve disorders? A. Nausea B. Dyspnea C. Heart failure D. Heart murmur Endocarditis Risk Factors Valve disorders IV drug use Gum disease Prior endocarditis Rheumatic fever Endocarditis Signs and Symptoms Heart murmur Fever Malaise Petechiae Janeway lesions Osler’s nodes Splinter hemorrhages Endocarditis Treatment and Complications Treatment: Antibiotics for several weeks (intravenous penicillin most often) High risk patients require prophylactic antibiotics before invasive procedures (tooth extractions, root canals, implants) Complications Heart failure (dyspnea, cough, crackles, edema, JVD) Valve dysfunction requiring repair or replacement Stroke (sudden difficulty with language, unilateral weakness) Pericarditis Inflammation of pericardial lining Signs and symptoms: Pleuritic chest pain (sharp, heavy, worse when coughing, deep breathing, or lying flat, better when sitting up and leaning forward) Friction rub Dyspnea Complications Heart failure Cardiac tamponade (jugular venous distention, tachycardia, hypotension, muffled heart sounds) Cardiomegaly Enlargement of the heart Dilated – most common type. Heart becomes stretched and less contractile Common etiologies: hypertension, pregnancy, alcoholism Restrictive: heart walls are rigid, don’t expand or contract normally Hypertrophic: heart muscle is enlarged, decreasing volume of heart chambers All types of cardiomyopathy can cause heart failure Deep Vein Thrombosis Clot in a vein Risk factors: venous stasis (immobility), oral contraceptives, smoking, vessel injury (surgery, crush injuries, IV catheters), hyper-coagulability (dehydration) Signs & symptoms: redness, warmth, edema, pain, hard (indurated) distended vein Treatment: anticoagulants, compression/antiembolism stockings, elevation of leg above heart, warm compresses Monitor PTT for heparin, INR for warfarin Complications: Pulmonary embolism, recurrent DVTs, venous insufficiency Question A client presents to the urgent care clinic reporting aching pain in the right calf and swelling of the leg. The right calf is 3 cm larger than the left and the calf is warm to touch. Which condition should the nurse suspect? A. Peripheral arterial disease B. Deep vein thrombosis C. Venous insufficiency D. Hyperlipidemia Math Cardiac output Stroke volume X heart rate; convert to liters per minute and round to the nearest 10th Drop factors (drops per minute) Volume in mL X drop factor/time in minutes Hourly rate when infusion runs less than an hour Volume in mL* 60/time in minutes Hourly rate for infusions running one or more hours Volume in mL/number of hours Duration of infusions Volume in mL to infuse/hourly rate Cardiac Output Math A client has a stroke volume of 45 mL and a heart rate of 85 beats per minute. What is the cardiac output? Record your answer in liters per minute. Round to the nearest 10th of a liter if necessary (one digit to the right of the decimal point.) Answer: 3.8 Liters per minute 45 * 85 = 3,825 mL. Convert to liters: 3.825. Round to the nearest 10th: 3.8 Math Drop Factors The healthcare provider prescribes 0.9% sodium chloride 1 liter to infuse at 75 mL per hour. The tubing drop factor is 15 gtt/mL. How many drops per minute will infuse? Round to the nearest whole number. Ans: 19 75 mL* 15 gtt per mL/60 minutes = 1125 gtt/60 minutes = 18.75. Round up to 19 gtt/min Hourly rate when infusion is less than an hour Furosemide 80 mg is prescribed intravenously. The pharmacy sends furosemide 80 mg in 50 mL to infuse over 20 minutes. What is the hourly rate of infusion? Identify the numbers you need. The answer will always be greater than the starting volume. Answer: 50 mL *60 minutes per hour/20 minutes 3,000/20 = 150 mL per hour. Math infusion rates when the volume infuses over an hour or more The healthcare provider prescribes 1 liter of 0.9 % sodium chloride to infuse over 8 hours. What is the hourly rate of infusion? Answer: 1,000 mL/8 hours = 125 mL per hour Math – determining how long an IV will run The healthcare provider prescribes 0.9% sodium chloride 1 liter to infuse at 125 mL per hour. How long will it take the infusion to complete? Answer: 1,000 mL / 125 mL per hour = 8 hours