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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? • • • • • 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- • • • • • • • 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, • • • • • • • • 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 • • • • 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 • • • • 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 • • • • & 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