medsurge Cardiovascular disorders

What are the six clinical judgement functions?

Recognize cues, Analyze cues, Prioritize hypothesis, Generate solutions, Evaluate outcomes

What is atherosclerosis? What is CAD?

Lipid deposit accumulation within arterial walls – Deposits in coronary artery walls and can cause MIs

What is angina? What are the three types?

Chest pain due to cardia ischemia (low blood flow), stable goes away at rest, unstable is pain at rest (impending MI), variant has spasms often during rest

What is acute coronary syndrome?

An MI and unstable angina (artery not all the way occluded vs CAD where it is)

Explain STEMI vs NSTEMI

T inversion/ST depression and diagnosed w/ 12 lead ECG vs non

What are the 4 medications used to treat an MI?

MONA: Morphine if for persistent pain, oxygen, Nitroglycerin – every 3-5 minutes 3 times and then call 911/physician, Aspirin: chew for quicker absorption

What are concerns with nitroglycerin?

It is a vasodilator – meds like Viagra are contraindicated

What are patient complaints of MI?

Anxiety, chest pain, referred pain that radiates, arm weakness, indigestion/nausea, dizziness

What are female complaints that are more atypical?

Atypical angina between shoulders, jaw, or sensation of choking

What are assessment findings of an MI?

Cool clammy skin, diaphoresis (sweating), vomiting, lower LOC, tachycardia w/ heart palpitations, tachypnea (fast breathing)

What are lab findings to monitor with an MI?

Myoglobin, creatine kinase, troponin (standard for diagnosing an MI, measured every 6-8 hours x 3 even if first one was negative

What are the three main surgical interventions for MIs?

Stents (a wire mesh tube that holds a blockage open), Atherectomy (removal of plaque) or CABG (coronary artery bypass graft)

How do you prep a patient for contrast media (3 main things)?

Hold metformin for 48 hours/monitor blood sugar for hypoglycemia, assess renal function (because of iodine), assess shellfish allergy

Post op nursing care – what are your important neurovascular checks? (6)

Pain, pallor, pulse, sensation, movement, and temperature

What is important for post op nursing care for cardiac catheterization?

ABCs, vital signs, chest tube management, pain management, walk within 24 hours, incentive spirometer, monitor fluids/incision/infection signs and symptoms

What is important for post op client education for cardiac catheterization (five things)?

Leave dressing on for 24 hours, antiplatelet therapy for up to a year if stents placed, Femoral access: <10lbs lifting, no waist bending or straining on the toilet for 24 hours, Radial Access: <5lbs lifting, for 48 hours

What are complications of a PCI (percutaneous coronary intervention)?

Embolisms, retroperitoneal bleeding (abdominal cavity bleeding behind perineum), restenosis (clot formation) of treated vessel, and contrast die complications

What is a CABG?

Coronary artery bypass graft

What are complications of a CABG procedure?

Pneumonia, pulmonary edema, atelectasis (collapsed lung), hypothermia, cardiac tamponade, hypovolemia, LVHF, electrolyte imbalances, blood clots/CVA (stoke)

What is atelectasis?

A condition where part of or all the lung collapses

What is important for patient education after a CABG procedure?

Splint chest when coughing and deep breathing, 5lbs max for 3 weeks then 15lb max for 6 weeks, watch for signs of infection, quit smoking, heart healthy lifestyle

What are signs of left sided heart failure? (lungs)

Hypertension, valve disease, cardiomyopathy – lung crackles, dyspnea, nocturia (peeing at night because heart perfuses better lying down), displaced apical pulse

What are signs of right sided heart failure? (the body)

Left sided heart failure, right ventricular MI, pulmonary diseases – jugular vein distention, weight gain, lower edema, etc.

What is an S3 heart sound?

A lub dub dub with an extra dub there at the end

How do you diagnosis heart failure?

A echocardiogram (heart ultrasound), >400 pg/ml BNP is heart failure, hemodynamic monitoring

What is important for nursing care for heart failure?

Fluid restriction (less than 2L), low fat/sodium, rest in high fowler, no overexertion, I/Os (want more out than in – diuretics), oxygenate, assess for SOB, vitals

What are interventions for heart failure?

Meds, ventricular assist device (mechanical heart pump) w/ huge stroke risk and infection, or heart transplant (immunosuppressive therapy for life)

What is the main sign of HF leading to pulmonary edema? What is a caution for nursing care with this?

Pink frothy sputum – don’t lay heart failure patients flat

What are factors of a hypertensive crisis?

SBP>180, DBP>120, severe headache, blurred vision, disorientation, epistaxis (bloody nose)

How fast can you lower blood pressure in a hypertensive crisis?

20

What is valve stenosis vs regurgitation?

Not opening all the way vs not closing all the way

What are the two main surgical valve disease treatments?

Tissue valves: need to be replaced every 7-10 years, mechanical valves: need lifelong anticoagulation

What does ABX stand for?

Antibiotic administration

What is peripheral artery disease (PAD)?

Impairment of blood in peripheral arteries – toenail / leg hair abnormalities, low/absent pedal pulses, muscle atrophy, lower leg burning/cramping/pain during exercise

What’s important for PAD nursing care?

Peripheral artery disease – encourage exercise, increase vasodilation/decrease vasoconstriction, elevate legs but not above the heart, avoid crossing legs/restrictive clothing

What is a venous thromboembolism VTE?

Clots in the lower legs/damage to vein valves that lead to deep tissue damage

What is important for VTE nursing care?

Treat HTN, elevate legs above heart, avoid crossed legs and compression

What do you elevate feet below the heart for PAD but above the heart for VTE?

PAD needs help circulating through through the legs but VTE needs help getting blood BACK to the heart

What are nursing care notes for aneurysms?

S/S of rupture: brewery in stethoscope, abdominal pain, chest/back pain, SOB, cough, difficulty swallowing, hypovolemic shock REPORT ASAP – no lifting more than 15lbs, stop smoking

What is important to deal with / prevent cardiac issues?

Cholesterol/BP checks, weight, stress management, exercise, avoid/control diabetes