Cardiac/Respiratory Exam Review

Flashcards for Cardiac/Respiratory Exam

Side effects of Nitroglycerin

Headache, dizziness, lightheadedness, decreased blood pressure, can cause passing out. Advise patients to move and change positions slowly.

Goal for unstable MI

Profuse what isn't being profuse (open stuff up). Use MONA, Beta Blockers, EKG, Cath Lab

Stable Angina Presentation

Chest pain, exertional.

Treatment for Stable Angina

Sit down, relax, take nitroglycerin (vasodilator).

Patient at home, chest pain, after one nitro pain goes from 8-6

Give another nitro 5 minutes later, then call 911. If after 3 nitros pain is still present, suspect Unstable Angina or MI.

MONA protocol

Morphine (opioid - pain relief and decrease oxygen demand in heart), Oxygen (4L nasal cannula), Nitro (unless three not working), Aspirin (anti-aggregate). Also give 12 lead ECG.

Abnormal 12-lead ECG finding during acute MI

ST elevation (heart muscle is dying, needs oxygenated blood flow).

PQRST on EKG strip

P: Atrial depolarization; QRS: Ventricular depolarization; T: Ventricular repolarization.

Unstable Angina

Doesn't go away, increasing chest pain, vital signs shift, altered mental status, does not respond to nitro. Get an EKG.

Concerns with Atrial Fibrillation (AFib)

Tachycardia, blood clots. Place patient on blood thinners (Warfarin, Eloqua).

Atrial Flutter

Looks like a saw tooth pattern. Treat with blood thinners.

Signs of instability - A-fib/Flutter

Light-headedness, BP shift (hypotension), altered LOC. Requires cardioversion (zapping).

PVCs (Premature Ventricular Contractions)

Big, ugly, and early ventricular contractions. Caused by caffeine, stimulants, anxiety, stress. Symptoms include heart racing, anxiousness, SOB, lightheadedness, tingling.

Treatment for Ventricular Tachycardia

Shock or the patient can die.

Bigeminy

Every other beat is a PVC.

Trigeminy

Normal beat, normal beat, then PVC.

Medication treatment for Symptomatic Bradycardia

Atropine, Epi

Right-sided heart failure presentation

Peripheral edema.

Left-sided heart failure presentation

Lung issues (Crackles/Rales). Treat with diuretics.

Concern when giving diuretics for HF

Urine output (can back up).

Diuretic choices for good kidneys

Lasix (loop diuretic, losing potassium).

Potassium sparing diuretics

Bumex, Low K+ diet, monitor potassium intake.

Sources of Potassium (K+)

Supplements, potatoes, bananas. Changes in K+ can cause cardiac arrhythmias.

Troponin

Protein released when heart muscle is damaged.

First line treatment for Hypertension

Diet and exercise.

PVD (Peripheral Venous Disease) treatment

Inject them to bring pressure down, support hose (compression socks).

PAD (Peripheral Arterial Disease) presentation

Cool skin, loss of pulses in lower extremities, hair loss/thinning in those areas.

CAD (Coronary Artery Disease) cause

Fat, junk, plaque build up blocks adequate blood flow.

CAD prevention

Lifestyle changes.

High cholesterol treatment

Statins (rough on kidney and liver).

Upper airway issues

Obstruction, swelling, epiglottitis.

COPD (Chronic Obstructive Pulmonary Disease) presentation

Tripoding, breathing through a tiny straw, retaining CO2, barrel chest, elevated RR, anxious, low O2, dizzy, light headed, numbness and tingling.

COPD treatment

Start with 2L O2, work up slowly.

Risks for COPD patients regarding infection

Pneumonia, which can lead to respiratory failure and possible mechanical ventillation.

Concern about COPD cough

Foul smelling, more color changes.

Treatment for tenacious secretions (Copious amounts of sputum)

Drink fluids (2-3 L a day), coughing, deep breathing.

O2 target for COPD patients

88-90%

Bronchodilators (Albuterol)

Dilate everything, open up airway, but cause tachycardia.

Side effect of Albuterol

Tremors

Inhaler with spacers steps

Grab inhaler and shake, put on spacer, put mouth on thing, spray prescribed amount of puffs, inhale for 2-3 seconds, hold breath as long as possible, breath normally. Rinse mouth after if corticosteroid.

Hoping for this after inhaler use

Coughing episodes are calmed down.

Status asthmaticus

Extreme asthma attack, life threatening.

Pulmonary Edema

Alveoli fills up with fluid. SOB, stats will drop, can go into respiratory failure.

Obstructive Sleep Apnea

Tongue causes obstruction. Treat with CPAP or BiPAP.

Symptoms of Hypoxia

Cyanosis, restlessness, anxiety, confusion.

Coronary Artery Disease (CAD)

Build up of fat and plaque in the coronary arteries of the heart. Leads to MI .

CAD Teaching/Treatment

Low fat, low carb diet, quit smoking, exercise daily, take statins (monitor kidney and liver function).

Peripheral Artery Disease (PAD) - What alters blood flow

Altered blood flow due to blood clots, plaque, injuries.

PAD symptoms

Cool skin, loss of pulses in lower extremities, hair loss/thinning or no growth in those areas (shin is common area for this), intermittent Claudication.

S/S of Peripheral Venous Disease (PVD)

big thick veins in legs, high pressure in those veins.

Where does Atrial Fibrillation (AFib) originate?

From Atria. Risk of blood clots!!

Risk Factors for Afib

Hyperthyroidism, diabetes.

S/S of Afib

Tachycardia, Irregular HR, Heart palpitations, Chest discomfort, SOB, Dizziness, Lightheadedness.

S/S of Myocardial Infarction (MI)

Substernal or precordial chest pain that can radiate to neck, shoulder, arm, present as jaw pain. Nausea, epigastric distress, dyspnea, anxiety, diaphoresis.

Priority Interventions for MI

Morphine, Oxygen, Nitro, Aspirin, ECG.

Layman's Explanation of COPD

Lungs are full of thick liquid that can make it hard to cough up/get rid of, so your body is not exchanging O2 and CO2 properly.

Interventions for COPD

Stay hydrated (1–2L per day), Coughing and deep breathing exercises, Smoking cessation.

Asthma Physiological Changes

Bronchial tube is becoming smaller (constriction).

Anaphylaxis Respiratory Effects

Wheezing lung sounds, Tachycardia, Hypotension, Tachypnea, Hypoxia, Altered mental status.

Anaphylaxis Respiratory Effects

Drop in blood pressure in respiratory conditions = impending shock.

Hypoxia What is it?

Too much CO₂, not enough O₂.

Left-Sided Congestive Heart Failure (CHF)

SOB, Wheezing/crackles/rales.

Right-Sided Congestive Heart Failure (CHF)

JVD, Edema.

Digoxin (CHF Medication) Monitor

HR, BP.

S/S of Digoxin Toxicity

Ringing of ears, Fatigue, Irregular HR, Vision changes, N/V/D.

Loop Diuretics (Furosemide)

Take out potassium, Need to put potassium back in, Eat more potassium, Possible potassium supplement.

Potassium Sparing Diuretics (Spironolactone, Bumetanide)

Eat less potassium.

Risk Factors for Immobile/Bed-Bound Patients

Pressure injuries, HF, PVD, PAD, Blood clots, CAD, etc.

STEMI

ST elevation.

STEMI Symptoms

diaphoretic, anxious, chest pain, dizzy

Cardiovascular Assessment - Palpate

carotid pulse, brachial pulse, radial pulse, ulnar pulse, femoral pulse, popiteal pulse, posterior tibial pulse, and dorsalis pedis pulses

Cardiovascular Assessment

If radial pulse is irregular, auscultate apical for one full minute.