Transcript NUR 104
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) 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 monitors her BP at home & never has a blood pressure that high.” She has no other medical problems. What might this be? Select all that apply 1. Isolated hypertension 2. White coat syndrome 3. Primary Hypertension 4. Secondary Hypertension