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NUR 104
NCLEX- Type Block 2 Cardiac Concepts
Nora Martin Vetto, MSN, BSN
Cardiac Function
• A complete cardiac cycle is contraction of the myocardium
called_____& relaxation called______?
• What is the volume of blood ejected with ventricular contraction
called?
• Formula for: Cardiac Output= ?
• A healthy person pumps approximately how much blood into the
circulation each minute?
Autonomic Nervous System
• Innervation of the myocardium is initiated through ANS
• Sympathetic Stimulation: Does what to HR? And also
increases the force of contraction
• Parasympathetic: vagus nerve stimulation- does what to
HR
• Name 3 factors that increase myocardial oxygen
demands:
Myocardial Blood Supply & Conduction
• Coronary Arteries: Provide the only source of WHAT for
the myocardium?
• When are narrowing vessels and plaque formation called?
• Nursing Assessment & Medical Interventions if a patient
has chest pain?
• The myocardium has pathways for conduction of electrical
impulses that initiate the contraction of the heart- what are
the two nodes?
Coronary Arteries
Rhythm Strip
Hypertension Classifications
Classification
Normal
Pre-Hypertension
Stage 1 Hypertension
Stage 2 Hypertension
Isolated
Malignant
Measurement
SBP & or DBP?
BP
mm Hg?
Primary Hypertension
• RISK: Non-Modifiable: age, gender, ethnicity incidence, family history?
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What ethnicity high risk? What age group?
RISK: Modifiable:
Weight? BMI? What should BMI be?
Alcohol & Smoking: how much Etoh/day? (no more than 1 oz hard liquor/day
advised) w
Diet? What leads to atherosclerotic plaque? What milligrams per day is high
Na+?
Sedentary? How much exercise?
Secondary Hypertension
• Define?
• Examples?
• Can it resolve?
Medication Classifications
• Learn most by suffixes
• Learn stand-out info for nursing management
• Know patient teaching- example what may be a first dose
effect with an ACE? What about another/later symptom?
Diagnostics for Hypertension
• Psychosocial- ask what
• Assess for kidney disease how?
• Chest Xray- Why?
• EKG- why?
Blood Pressure Management
• REVIEW AGAIN: Essential or Primary Hypertension
• Pre-hypertension SBP 120-139 DBP 80-89? Lifestyle changes-what?
• Stage 1: SBP 140-159, DBP 90-99: diuretics, name a few? Doctor may order a diuretic and an ACE-
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name one? What do ACEs end in usually? What is an adverse effect that would make this med
discontinued? What is monitored with a diuretic? What is normal level of this lab? When should
patient take diuretics if possible? What info for gout patient?
Stage 2: SBP >160 or DBP >100: diuretics, may receive a beta blocker: name one? What do beta
blockers end in? What are you checking in a patient on this? When would you not give this med?
(VS) What is an example of an ARB?
What BP is Hypertensive Crisis? Symptoms?
What is a common antihypertensive side effect that makes patients quit their meds? How can you
teach patient how to cope with this?
Dietary: Reduce sodium & fat to what? Control diabetes normal Hgb A1-C?
What should lipid levels be? Total? LDL? Triglycerides?
HDL?
Amount of ETOH per day?
What other factor might make a hypertensive patient non-compliant with management? dt
Types of Medications Actions
• Inotropic ?
• Chronotropic ?
• Dromotropic ?
Digoxin
• This is not used as often anymore due to toxicity, having to monitor levels,
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and contraindications with other medications
HESI & NCLEX still ask questions about it though!
Digoxin is a glycoside, increases contractility (positive inotropic effect),
reduces heart rate (negative what???)
Used to treat heart failure & atrial fibrillation, but other newer & safer drugs
available
Up to 20% of people manifest toxicity- normal level is 0.5-2.0 ng/mL
Low potassium and magnesium levels can increase chance of toxicity
Renal disease may also cause digoxin toxicity
Symptoms of toxicity: bradycardia, headache, confusion BLURRED OR
YELLOW VISION
Critical Thinking: How is toxicity treated?
Critical Thinking Question
• A nurse is educating a patient about new antihypertensive
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medications furosemide and lisinopril. What should be
included in the teaching? Select All That Apply
a. change positions slowly to decrease any problem with
dizziness (nursing- what mm Hg define this?)
b. call the doctor if you develop a cough
c. Adjust the furesomide if urine output increases
d. Labs- which one?
Critical Thinking
• A patient is taking metoprolol for hypertension. The nurse
knows this medication: Select All That Apply
• may cause tachycardia
• may cause rebound hypertension if stopped
• may be stopped when the patient’s BP is normal
• may cause bradycardia
• is a beta-blocker
Critical Thinking
• A patient takes sub-lingual nitroglycerine prn for chronic
stable angina. The nurse knows to monitor the patient for
select all that apply:
• a. vasodilation which may cause postural hypotension
• b. headache
• c. vasoconstriction which may cause postural
hypotension
Critical Thinking
• A nurse is educating a patient taking a new prescription
for Lipitor and niacin.
• a. Muscle cramping is normal- T or F (which med?)
• b. Facial flushing is an emergency side-effect- T or F
(which med)
• c Liver enzymes must be monitored- which med?
Critical Thinking
• It is change of shift. Choose the order of med-surg patient care. Can
you delegate any care to unlicensed personnel?
• 1. A second day post-op wrist fracture repair patient with a BP of
140/90, pulse of 94, respirations 20, 02 sat 94% room air, after
ambulating 5 minutes ago from the restroom
• 2. A patient who has a history of chronic stable angina and had an
episode of chest pain after walking down the hall 5 minutes ago, and
was given sub-lingual nitroglycerine
• 3. A patient who is on furosemide and is screaming that no one is
helping him, and he needs to use urinate now
Critical Thinking
• A patient who has chest pain after exertion but the pain
resolves- experienced:
• Infarction- what does this mean?
• Ischemia-what does this mean?
• The primary factor in developing heart disease is:
• Ateriosclerosis- this .means?
• Atherosclerosis- this means
Critical Thinking
• The nurse is reading a patient’s chart. The patient is 85
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years old has a history of hypertension and is taking
hydrochlorothiazide and digoxin. She has been admitted
for extreme fatigue and weakness, and says she sees
“yellow halo lights.” The nurse is concerned about: Select
All That Apply
1. hyperkalemia
2. digoxin toxicity
3. hypokalemia
4. dehydration
Critical Thinking
• A nurse is caring for a patient with a blood pressure of 140/90 and
knows this is:
• 1. Hypertension
• 2. Pre-hypertension
• A nurse is taking care of a 60 year patient who arrived at a clinic appt
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& has a BP of 160/90 and states, “she never has a blood pressure
that high” What might this be?
1. Isolated hypertension
2. White coat syndrome
3. Primary Hypertension
4. Secondary Hypertension