Cardiac Study Guide:

1. What are the side effects of nitroglycerin? Ans. Class:Vasodilator,coronary . Adverse Reactions; Headache lightheadedness, hypotension, syncope 2. What are the reasons for use of a Holter Monitor? Ans.Provides ECG monitoring for a 24-48hrs. Detects occasional dysrhythmias that may be correlated with specific activities noted in the pts diary. To assess the effects of medications, and for research purposes. The pts records in a dairy all activity that occurs during the monitoring,such as walking, stair climbing, sleeping, and engaging in sexual activity ,symptoms of mild chest pain shortness of breath while resting and excerising. 3. What are some of the side effects of Coumadin Therapy? Ans.Bruising, hemorrhage, nausea, and anorexia. Hemorrhage is the main side effect and may occur from any tissue or organ. Symptoms of hemorrhage include headache, paralysis; pain in the joints, addomen, or chest; difficulty in breathing or swallowing; SOB, unexplained swelling or shock. Epistaxis which is a nose bleed. 4. What is the treatment regimen for myocardial infarction?

Ans. Medical treatment includes management of the underlying cause, drug therapy to improve cardiac output and eliminate excess fluid, and conservative measures to decrease demands on the heart. Sodium restriction is prescribed for most HF pts. Underlying problems may involve such interventions as correction of dysrhythmias, management of hypertension, and valve replacement or repair. Decreasing cardiac workload and increasing myocardial oxygenation. (Drugs used to treat HF, ACE inhibitors, diuretics, beta-adrenergic blockers, inotropic agents, cardiac glycoside agents, and nitrates) A person who has been diagnosed with having a heart attack will be given a stool softener to prevent straining with bowel movements. 5. What are the signs and symptoms of cardiogenic shock? Ans. Pain is the classic symptom of AMI. It is typically a heavy or constrictive pain located below or behind the sternum, as described with angina. It may radiate to the arms, back, neck, or jaw. Pain last for more than 20mins. The pt becomes diaphoretic (covered by sweat) and lightheaded and may experience nausea, vomiting, and dyspnea. The skin is frequently cold and clammy. The pt experiences great anxiety and often a feeling of IMPENDING DOOM. Cardiogenic shock is marked by hypotension; cool, moist skin; oliguria; and decreasing alertness.

6. What are the signs and symptoms of heart failure? How do the different symptoms relate to the part of the heart failing? Ans. HF is the inability of the heart to meet the metabolic demands of the body. The pumping ability of the heart is ineffective. Signs and symptoms of the pt with let-sided HF is typically very anxious, pale, weak, and tachycardic. Bp readings may show a downward trend. Auscultation of the lung fields may reveal crackles, wheezes, dyspnea, and cough.S3 and S4 sounds may be heard as a result of the backup of fluid and the hearts inability to handle the excess fluids. The exchange of 02 and CO2 in the lungs is impaired, and pts are often restless and confused. With rt. Sided HF, the pt. has increased central venous pressure, jugular venous distention, abdominal engorgement, and dependent edema. Anorexia, nausea, and vomiting may result from the abdominal engorgement. Fatigue, weight gain, and decreased urinary output are common complaints. The LV, RV, or both fail as pumps. Usually the left side of the heart fails first. In time, the right side fails as a result of the left-sided failure. HF can be classified as systolic HF resulting from ineffective pumping of the ventricles or as diastolic HF resulting from impaired filling of the ventricles. With either classification, cardiac output is decreased. HF can occur acutely, with onset over several hours or days, or it can be chronic, with onset over months to years. Dyspnea, pedal edema, and increased girth means that the rt. ventricle side of the heart is being affected. 7. How does insufficient blood supply to the heart muscle present as a symptom? Ans. An AMI is the death of myocardial tissue as a result of prolonged lack of blood and O2 supply. An AMI begins with the occlusion of a coronary artery. Over a period of 4 to 6 hours, a process of ischemia, injury, and infarction develops. Ischemia results from a lack of blood and O2 to a portion of the heart muscle. Initial signs and symptoms include dyspnea, restlessness, and increased heart rate. Cardiac output and blood pressure fall. Untreated HF progresses to cardiogenic shock and death. HF may become a chronic condition. Chest pain that increases with exertion means there is insufficient blood supply to the heart muscle. 8. What are the post-op requirements for cardiac catheterization? Ans. Check the puncture site; maintain pressure per protocol if a vascular sealing device is not used. Monitor vital signs and peripheral pulses on the affected extremity. Enforce bed rest as ordered. Physical therapy and ambulation, and monitoring intake and output. 9. What are examples of foods on a low-sodium diet? Ans. Beans, peas, rice, lentils, coffee, and fruits are some foods that are low in sodium. Milk does not contain salt, and meats do not contain salt until you add it while cooking or eating it. Can meats are high in sodium. Low sodium diet does not include corn beef sandwiches with canned broth. 10. What are the Signs and symptoms of Left- Sided Heart Failure? Ans. Pt with left-sided HF is typically very anxious, pale, weak, and tachycardic. Consecutive bp readings may show a downward trend. Auscultation of lung fields may reveal crackles, wheezes, dyspnea, and cough. S3 and S4 may be heard as a result of the backup of fluid. The exchange of O2 and CO2 in the lungs is impaired, and pts are often restless and confused.

11. What should the nurse ask in a medical history for mitral insufficiency? Ans. Hypertension, kidney disease, pulmonary disease, diabetes mellitus, stroke, rheumatic fever as a child, streptococcal sore throat, scarlet fever, previous cardiac diseases or conditions, previous hospitalizations, recent and current medications allergies. 12. Which chamber of the heart removes deoxygenated blood from systemic circulation? Ans. Right ventricle 13. The main regulator of heart rate is? Ans. Sinoatrical node (pacemaker) 14. What part of the heart muscle is studied with an EKG? Ans. Sinoatrical node (pacemaker), and Myocardium 15. Which wave form follows a P wave? Ans.QRS complex 16. What is the patient teaching for a Holter Monitor? Ans. Tell the pt. to wear loose clothing, take only a sponge bath, avoid magnets and metal detectors and monitor placement of electrodes. Emphasize keeping an accurate diary of activities and to push event button if symptoms occur. 17. What pathologic change is responsible for CAD? Ans. CAD, also referred to as coronary heart disease, occurs when the major coronary arteries supplying the myocardium are partially or completely blocked. Blockage of the arteries is caused by coronary artery spasm, or atherosclerosis and may result in ischemia or infarction of myocardial tissue.( Arteriosclerosis is an abnormal thickening, hardening, and loss of elasticity of arterial walls.) (Atherosclerosis, is a form of arteriosclerosis, is an inflammatory disease that begins with endothelial injury and progresses to the complicated lesion seen in advanced stages of the disease process.) 18. What enzyme study is most effective in detecting myocardial infarction? Ans. Troponin I (cTnI); It is specific to cardiac muscle and are released into the circulation after an AMI. 19. Be able to recognize a potassium-sparing diuretic. Ans. Spironolactone (aldactone), aldosterone

20. What are the discharge instructions for pacemaker placement? Ans. Teach the pt. to take pulse for one full minute. Explain wound care and the healing process and advise the pt to notify the physician of symptoms of decreased cardiac output: dyspnea, dizziness, syncope(fainting), weakness, fatigue and chest pain. In addition, instruct the pt to carry an identification card describing the type of pacemaker implanted. 21. Define orthopnea. Ans. Labored breathing that occurs when lying flat and improves when standing or sitting up. (This is one of the classic symptoms of left ventricular heart failure. 22. What are the symptoms of right-sided heart failure? Ans. With rt. Sided HF, the pt has increased central venous pressure, jugular venous distention, abdominal engorgement, and dependent edema. Anorexia, nausea, and vomiting may result from the abdominal engorgement. Fatigue, weight gain, and decreased urinary output are common complaints. 23. What is the action of a cardiotonic medication? Ans. The cardiac glycosides are also called cardiotonics or digitalis glycosides. (eg.digoxin(Lanoxin) and digitoxin). They slow the heart rate (negative chronotropic effect) and increase the force of myocardial contraction (positive inotropic effect), causing increased stroke volume and cardiac output. 24. What must the nurse assess prior to digitalis therapy? Ans. Obtain baseline vital signs, ECG, and electrolytes before administering the first dose. Assess apical pulse for 1 minute ; hold the drug and notify the physician if the pts. Pulse is LESS THAN 60. 25. What are the signs and symptoms of Digitalis Toxicity? Ans. Toxic effects may be indicated by dysrhythmias, pulse less than 60 bpm, anorexia, nausea, syncope, visual disturbances, and abdominal pain. Therapeutic level; 0.8-2.0ng/ml; toxic level; greater than2.0 ng/ml 26. What is the major goal for managing heart failure? Ans.To reduce the work load of the heart. Bed rest and stress reduction decrease the cardiac workload. Spacing activities and providing rest periods, providing adequate ventilation and oxygenation, relieving pain, and maintaining a calm, quiet environment. 27. What interventions would be prescribed for a nursing diagnosis of impaired gas exchange? Ans. Asses sounds and respiratory status every four hours. Monitor his/her oxygen(o2) saturation. Elevate the head of the bed in a semi- or high- Fowler position( easier breathing) with arms supported on a padded over bed table. Administer O2 as ordered. Assist to cough and deep breathe every 2 hours. Administer diuretic agents and morphine sulfate as ordered.

28. What are the signs and symptoms of pulmonary edema? Ans. Dyspnea, moist of gurgling respirations, and bounding rapid pulse. 29. What are the primary interventions for a patient with Rheumatic Heart Disease? Ans. Administer antibiotic agents as prescribed. Throughout the course of the illness, it is important to continue to assess cardiac output and monitor for complications. Teach the pt about the medications prescribed and any restrictions imposed. Encourage him or her to get adequate rest, which is necessary during the healing process. Range of motion exercises may be necessary during the acute stage and until the pt is ambulatory. 30. Be able to recognize nursing diagnoses for heart failure. Ans. Patient with heart failure has altered tissue perfusion related to reduce cardiac output. 31. Define Cardiogenic Shock and its causes. Ans. Occurring in the heart. Cardiogenic shock occurs when the heart fails as a pump. A decrease in myocardial contractility results in decreased cardiac output and impaired tissue perfusion. Difficult to treat, usually results when diseased coronary arteries cannot meet the demand of the working myocardial cells. 32. What are the signs of fluid volume deficit? Ans. Decreasing urine output, heart rate increases in an effort to maintain blood flow to body tissues. The blood pressure may fall because of the reduced blood volume, dry skin. 33. Know normal values of Sodium and Potassium. Sodium; 135-145, Potassium ; 3.5- 5.5 34. Be able to identify changes in Arterial Blood Gasses. Ans. ABGs Ranges pH 7.35-7.45 PaCO2 35-45, HCO3 22-26 PaCO2 greater than 45 with an acidic pH is a respiratory acidosis. pH in excess of 7.45 and a PaCO2 of less than 35 a respiratory alkalosis. pH is less than 7.35 and the HCO3 is less than 22 its in metabolic acidosis. With pH greater than 7.45 and HCO3 greater than 26 it is metabolic alkalosis. 35. Where is the best place to check skin turgor on the elderly? Ans. Sternum (chest) 36. How does a nurse monitor fluid gain and fluid loss? Ans. Monitoring daily Wt. Input and output 37. What is the treatment for the complaint of chest pain if the patient presents to the ER? Ans. When a pt. comes to the hospital with chest pains you would administer oxygen, attach a monitor, take vital signs, and administer sublingual nitroglycerin.

38. What are the signs and symptoms of potassium depletion? Ans. hypokalemia which can lead to dangerous dysrhythmias. Drowsiness, gynecomastia in men on long term therapy. 39. What are the foods suggested for a low potassium diet? Ans. Toast , eggs, and a cup of tea. 40. What are the side effects of Lasix therapy? Ans. , hypokalemia, hyponatremia Orthostatic hypotension 41. What are the signs and symptoms of pulmonary edema? Ans. Left sided HF and coughing up pink tinged foamy sputum. 42. What should the nurse monitor if her/his patient is on IV lasix therapy? Ans. Hourly urine output. 43. What is the patient teaching for sublingual nitroglycerin? Ans. Sit or lie down at onset of chest pain. Place the tablet under the tongue; the tablet causes tingling sensation if effective (older adults may not detect this). Burning means its working.. Repeat every 5mins for a total of three doses; if chest pains are not relieved, have someone else drive to the emergency dept. Keep the tablets in the containers in which they are supplied. 44. What is patient teaching for a low-sodium diet? Ans. A low sodium diet could be baked chicken and a potato. Only 2g of salt. 45. What is patient teaching for Coumadin therapy? Ans. Patient should be taught how to reduce the risk of bleeding, such as to use an electric razor and a soft bristle toothbrush. Pt needs to avoid foods high in vitamin K such as green leafy vegetables, broccoli, and spinach. ( vit K is the antidote) 46. What are the signs and symptoms of hypokalemia and hyperkalemia? Ans. Hypokaleima; anorexia, abdominal distention, vomiting, diarrhea, muscle cramps, weakness, dysrhythmias (abnormal cardiac rhythms), postural hypotension, dyspnea, shallow respirations, confusion, depression, polyuria(excessive urination), and nocturia. Hyperkalemia; is a serious imbalance because of the potential for life- threatening dysrhythmias, cardiac arrest is present, can cause explosive diarrhea and vomiting, muscle cramps and weakness and paresthesia (a tingling sensation), irritability, anxiety, abdominal cramps, and decreased urine output.

47. What is patient teaching for Captopril therapy? Ans. Report without delay unexplained fever, unusual fatigue, sore mouth or throat, easy bruising or bleeding. Report darkening or crumbling of nailbeds. Inform surgeon or dentist that captopril is being taken. Alert diabetic it may produce hypoglycemia. If pts is experiencing hypotension you should not give captopril. 48. What does the nurse do first when assessing an unresponsive patient? Ans. ABCs Airway breath circulation. Gently shake and shout are you ok. 49. What is the most sensitive indicator of fluid balance? Ans. Daily wt. input and output. 50. How would a nurse teach her patient to take his/her radial pulse? Ans. Use the 2 middle fingers to palpate the artery and count for a full minute. 51. How would a nurse teach her patient to decrease the risks of atherosclerosis/arteriosclerosis? Ans. Educate the pt on how to reduce risk factors that can be modified. (ex. Decrease serum lipids, high blood pressure, tobacco use, diabetes mellitus with elevated blood glucose,obesity, and sedentary lifestyle, stress, excessive alcohol intake. (Increase the level of activity.) 52. What are the signs and symptoms of aspirin toxicity? Ans. Tinnitus (ringing of the ear) 53. Define Stroke volume. Ans. Stroke volume is the amount of blood ejected with each ventricular contraction. The normal stroke volume is 60 to 100ml. Three factors affect stroke volume;(1) preload, (2)contractility, (3) afterload. 54. What is the patient teaching for valvular heart disease patients receiving dental care? Ans. Pt will verbalize information about her condition, treatment, self care measures, and resources. With valvular heart diease are prescribed antibiotics to prevent infective endocarditis. (IE) 55. What are the signs and symptoms of rejection of a heart transplant? Ans. Life long immunosuppression is administered to prevent the body from rejecting the donated heart, which is recognizes as foreign tissue. Initially, large doses of corticosteroid agents are administered, and the dose is decreased over time. At the first indication of rejection(increased temperature, infection, dyspnea, malaise, fatigue, dysrhythmia), the steroid dose usually is increased. Other drugs used to prevent and treat rejection are azathioprine(Imuran) and cyclosporine(Sandimmune). Rejection is monitored through endomyocardial biopsies and the Heartsbreath test. (Common complications noted after heart transplantation, are hypertension, elevated cholesterol, obesity, and malignancies).

56. What is priority for 6 hours post op cardiac cath? Ans. Ans.You would maintain a pressure dressing over the femoral(groin) site. Monitor vital signs peripheral pulses on the affected extremity. Enforce bed rest as ordered 57. What are late signs of hypoxemia? Ans. Diaphoresis 58. How would a nurse treat AV Heart Block? Ans. Pacemaker (Atropine) 59. How would the nurse treat Hypervolemia? Ans. Administer Diuretics as ordered. 60. How would the nurse treat Tachycardia with Hypertension? Ans. Propranol (inderol) beta-blocker 61. How would the nurse treat Tachycardia with Decreased Cardiac Output? Ans. Cardiac glycosides agent (digoxin, lanoxin) 62. What is the indication for Dopamine Therapy? Ans. Used to correct hemodynamic imbalance in shock syndrome due to MI(cardiogenic shock), open heart surgery and CHF. When using dopamine for shock you would monitor the pts. BP. 63. What is the most common side effect of antiarythmic drugs? Ans. Additional dysrhythmias 64. Be able to recognize modifiable risk factors for heart disease. Ans. Stop smoking, sedentary lifestyle, high blood pressure, obesity, diabetes mellitus with elevated blood glucose, stressm, excessive alcohol intake. 65. How can the nurse relieve chest pain after heart surgery? Ans. Give ordered morphine and change the pts position . 66. How would a nurse increase the effectiveness of coughing and deep breathing exercises? Ans. Elevate the head of the bed and use table. 67. What is patient teaching for cardioversion? Ans.Explain the procedure and obtain informed consent. Two electrodes will be placed on the chest one to the rt of the sternum just below the clavicle, the other is placed at the apex of the heart. The impulse given varies from 25 to 100J depending on the type of dysrhythmia. If the initial impulse does not convert the dysrhythmia to normal sinus rhythm, then the impulse energy is increased and the procedure is repeated.

68. Define Bradycardia. Ans. The normal heart rate is 60- 100 bpm. A rate less than 60 bpm is considered to be bradycardia. 69. What should the nurse do before a stress test? Ans. Tell the pt. what to expect. NPO for 2 hours before test. Have the pts wear loose clothing and comfortable shoes. Give a beta blocker if prescribed. Signed consent is needed. 70. What does the nurse monitor for a patient who is taking a drug to lower his/her cholesterol? Ans. Drug; Pravastatin , Monitor liver function tests. Teach the pt. to continue diet and excirse, report muscle tenderness, take as a single dose in the evening, have routine eye examinations. 71. How would the nurse decrease the workload on the heart for a patient with CHF? Ans. Bed rest and stress reduction decrease the cardiac workload. When the pt. is acutely ill, eliminate all unnecessary activity. Reduce sodium in diet will help control swelling and reduce the workload on the heart. Maintaining wt. Give meds as prescribed to improve heart function, gradually increase activity. Avoid activity that causes shortness of breath or severe fatigue. Weigh pt each mrn before breakfast, on the same scale and with the same amount of clothing. Contact physician if pt gain 3-5lb in 1 week develop a persistent cough, or have shortness of breath or chest pain. The pt may be limited to 2g of sodium/day. Reduced sodium intake decreases fluid retention, thereby reducing the cardiac workload advise the pt to avoid foods high in sodium ,not to add salt before or after cooking, and to use no more than 2 cups of milk products daily. 72. What is the patient teaching for Beta-Blocker Therapy? Ans. Drug; Nadolol (Corgard), Propranolol(Inderal); Take radial pulse for 1 min, Hold meds and notify the physician if the HR is less than 55bpm, Weigh yourself daily; report a gain of 3-4 lbs. Do not discontinue this drug abruptly; taper off over 1-2 weeks. Take the drug at the same time (or times) each day. 73. What are the usual dietary recommendations for a patient with cardiac problems? Ans.No more than 10%saturated fats. A low fat, high fiber diet. Well balanced diet that includes an emphasis on fruits, vegetables, grains, and proteins low in fat( fish, legumes, poultry, and lean meats). Cholesterol intake should be limited to 200mg/day. 74. What medication is used to dissolve clots? Ans.Fibrinolytic agents; also called thrombolytic agents. Streptokinase, reteplase, and tissue plasminogen activator(t-PA)are examples of thrombolytic agents.

75. Define- Palpitation Ans. The heartbeat is rapid , strong , or irregular enough that the person is aware of it. 76. Define-Afterload

Ans. The amount of resistance the ventricles must overcome to eject the blood volume. Afterload is decreased by vasodilation and increased by vasoconstriction. 77. Define-Arteriosclerosis Ans. Abnormal thickening, hardening, and loss of elasticity of the arterial walls. 78. Define-Dysrhythmia Ans. The disturbance in rhythm; arrhythmia. 79. Define- Cardiac Output Ans. Cardiac output is the amount of blood (in liters) ejected by the heart per minute. The normal cardiac output is 4- 8 L/ min. 80. Be able to distinguish between right and left sided heart failure. Ans. Right sided heart failure is jugular vein distention. Left sided heart failure is pulmonary edema. 81. Define- Bradycardia Ans. The normal heart rate is 60-100bpm. A rate less than 60 is considered to be bradycardia. 82. Define- Perfussion Ans. Perfussion is the passing of blood through the vessel of an organ. 83. Define- Preload Ans. Preload is the amount of blood remaining in a ventricle at the end of diastole. Increased preload results in increased stroke volume and thus increased cardiac output. 84. Define- Infarct Ans.Infract is an area of ischemic necrosis caused by disruption of circulation. 85. Define- Tachycardia Ans. Tachycardia is the rapid heart rate greater than 100. 86. Define- Normal Sinus Rhythm Ans.Normal sinus rhythm is 60-100 87. Be able to interpret the following EKGs and their treatment: a. 1st degree heart block Ans. Rate; Normal Symptoms; usually none, may be bradycardic. Treatment ; correction of underlying cause. Asymptomatic we treat it first. b. Sinus tachycardia Ans. Rate greater than 100; usually less than 150 beats per min. causes; fever, dehydration, hypovolemia, Symptoms; palpitations most common. Angina and decreased cardiac output from the decreased ventricular filling time may also occur . Treatment; correction of

underlying causes. Elimination of caffeine, nicotine , and alcohol. Vagal stimulation may vdecrease the rate but does not treat the cause. Treatment Beta blockers c. Sinus bradycardia Ans. rate less than 60 beats per min. Frequently seen in athletes as a result of conditioning. Symptoms; Dizziness, syncope, chest pain, hypotension, sweating, nausea, dyspnea, and disorientation; sometimes no symptoms. Treatment; Not treated unless the pt. is symptomatic. The underlying cause is treated. Atropine may be given to increase the heart rate . Isoproterenol is used with extreme caution. d. V-Tach (ventricular tachycardia) Rx Lidocaine, Bretyluim Ans. 100-250 bpm. No relationship exist between the atrial and the ventricular contractions. Symptoms: Initially palpitations, dizziness, and chest pain progressing to decreased cardiac otput and loss of consciousness. Treatment: Assess for pulse, signs and symptoms. If ventricular tachycardia without pulse, then defibrillate and follow advanced cardiac life-support algorithm. With pulse but unstable: synchronized cardioversion. If stable, with pulse: amiodarone; then synchronized cardioversion. e. V-Fib (ventricular fibrillation) Defibrillation, CPR Characteristics: Rate undeterminable. Treatment: Cardipulmonary resuscitation (CPR), defibrillation, and advanced cardiac life-support measures are used to treat ventricular fibrillation. 10 mins pg passes f. Infrequent PVCs No RX No treatment necessary for infrequent PVCs, which probably occur undetected in most people; g. Frequent PVCs (Premature ventricular contractions) Antidysrhymic medications Characteristics: RateNormal; Symptoms: The patient may or may not note a skipped beat. The PVCs are not palpable at peripheral pulse sites, but a pause may be observed. Cardiac output diminishes with frequent PVCs. Treat the cause and administer antidysrhythmic agents for symptomatic or frequent PVCs.