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Hurst 05 - Cardiac.docx · version 1

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1. Describe preload and afterload.
Preload→ Amount of blood returning to the right side of the heart and the stretch it causes.
Afterload→ Pressure in aorta and peripheral arteries that the left ventricle has to pump against.
2. What is cardiac output?
amount of blood being pumped out of the left ventricle
3. If your cardiac output is decreased, do you perfuse as well as you normally do?
4. What conditions can affect your cardiac output?
HR, blood volume, decreased contractility
5. If you are taking care of a client with decreased cardiac output, what is going to happen to
their level of consciousness?
6. Could they start complaining of chest pain?
7. Why does a client’s (whose cardiac output is low) skin feel cool and clammy?
because there is no perfusion. Peripheral vasoconstriction in an effort to shunt blood to vital
8. When you are taking care of a client who has decreased cardiac output, why do they get
short of breath and have wet lung sounds?
heart is not pumping fluid out of the body so it backs up into the lungs
9. When you are taking care of a client who has decreased cardiac output, why do their
peripheral pulses diminish?
because the heart is not pumping out to the periphery
10. What is going to happen to urine output when you have a client who has decreased cardiac
decrease, decreased renal perfusion
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11. When you have a client with decreased cardiac output, why does their blood pressure drop?
because the heart is not pumping out as much volume. Less volume less pressure
12. How will bradycardia affect cardiac output?
decrease because heart is not pumping out much volume, heart is pumping slowly
13. How can tachycardia (i.e., heart rate> 150) affect cardiac output?
decrease, ventricles cant fill up, don’t have time to fill because the heart is beating so fast
14. When someone has had an MI, how can this affect cardiac output and why?
CO decreases, dead muscle doesn’t pump well
15. If my blood pressure is really high, how will this affect cardiac output and why?
decrease, heart cant pump as much blood out against the high pressure
16. Draw a picture of my square heart and include the lungs and the aorta and trace the normal
blood flow through the heart.
refer to hurst student book
17. What is chronic stable angina?
decreased blood flow to the myocardium leading to ischemia
18. Explain the pain a client has with angina.
blood flow decreases (decreased co2) and causes chest pain (pressure sensation)
19. Why is nitroglycerine given?
to relieve the pain- vasodilates which increases blood/o2 to heart
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20. When you give somebody nitroglycerine, more ________________ is going to get to the
heart muscle?
blood flow, o2
21. How do you teach a client to take their nitroglycerine?
1 every 5 mins x 15 mins (3 total doses max)
22. Why could nitroglycerine sublingual have a burning sensation?
some preparations of nitro burn and that’s normal
23. What is a common and expected side effect of nitroglycerine?
24. When you give somebody nitroglycerine, are they going to vasoconstrict or vasodilate?
Therefore, what is going to happen to their blood pressure?
vasodilate, decrease
25. Why do clients with angina need beta blockers? List several examples.
they decrease workload of heart and decrease contractility, decrease blood pressure. Inderallopressor
26. What is the purpose of aspirin for the angina client?
to prevent platelet aggregation and vasoconstriction which will decrease the likelihood of a
27. Why is it so important that the angina client avoid isometric exercise, overeating, caffeine,
or any drugs that increase the heart rate and avoid cold weather?
because these increase the workload of the hart
28. Why is it so important that the angina client rest frequently?
to decrease workload of heart
29. Is it okay for a client with angina to take their nitroglycerine prophylactically?
30. Before they take their nitroglycerine, should the client sit down or stand up? Explain.
sit down, nitro makes them dizzy and may faint
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31. Why is it so important that you ask the client if they are allergic to iodine before they go for
a heart catheterization?
because contrast dye is used and it contains iodine
32. Any time you have a client who is injected with iodine-based dye, what is the common
complaint the client will have?
33. In post-cardiac catheterization, you have to watch the puncture site closely. What are we
watching it for?
34. When a client has had a heart cath, you have a pertinent nursing assessment you need to do
distal to the insertion site. Explain.
assess circulation. Pulses, skin temp, cap refill, skin color
35. With a MI (myocardial infarction), why does the client have necrosis?
because of decreased blood flow and oxygen to the myocardium
36. Will rest or nitroglycerine relieve MI pain?
37. Explain how MI pain feels.
severe, nonstop pain, chest pressure, radiation to left arm and jaw
38. Why does an MI client get cold, clammy, and their blood pressure drop?
decreased CO (dead tissue doesn’t pump well)
39. Which biomarker would be appropriate if the client has delayed treatment post MI?
40. Is a negative myoglobin a good thing or a bad thing?
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41. When a client is having a MI, what arrhythmia is a very high risk?
v fib
42. When a client goes into V-fib, what is the priority nursing action?
d fib
43. What antiarrhythmics are used when the V-Fib is resistant to defibrillation?
44. What drugs are used for chest pain when the MI client arrives to the ED?
oxygen, aspirin chewable, nitroglycerin, morphine
45. How do thrombolytics work? Give me three examples of common thrombolytics.
They dissolve the clot that is blocking blood flow to the heart muscle. They decrease size of the
infarction. Streptokinase, TPA, reteplase
46. What is the major complications of a thrombolytic?
47. Before you give a thrombolytic, you are supposed to get a good history. What did I tell you
to focus on (what type of disease or illness)?
any past bleeding problems, stroke, pregnancy, surgery, bleeding ulcer
48. After someone has received a thrombolytic, why is it so important that we decrease puncture
to prevent hemorrhage. They will bleed anywhere they have been stuck
49. What is angioplasty and what is the major complication of angioplasty?
balloon to open coronary arteries to enhance blood flow- MI
50. If you increase preload, what do you do to the workload of the heart?
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51. List some ways preload can be increased.
Trendelenburg position, hypervolemia, supine, elevate legs
52. List some ways preload can be decreased.
standing upright, hypovolemia, less volume, lower legs, raise HOB
53. Explain afterload in your own words.
amount of pressure in the aorta that the ventricle has to pump against
54. If you increase afterload, what do you do to the cardiac output?
55. If cardiac output is decreasing, that means the blood is not moving forward. If blood is not
moving forward, then it has got to go backwards, so therefore where is it going to wind up?
the lungs
56. What are the major symptoms of left-sided heart failure and explain why.
Dyspnea, cough, pulmonary congestion, blood tinged sputum; restlessness, tachycardia; blood
backs up into lungs.
57. Why does a client with left-sided failure have restlessness and tachycardia?
because they are hypoxic
58. Why does a client with left-sided failure have nocturnal dyspnea?
when they lie down more blood can go back up to heart and lungs
59. Why does the client with left-sided failure basically have pulmonary symptoms?
blood is backing up in the lungs
60. What are the major symptoms of right-sided failure?
Enlarged organs, edema, weight gain, distended neck veins, ascites; blood backs into venous
system engorging everything.
61. When a client is in right-sided failure, is the blood backing up into the arterial system or the
venous system?
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62. What does a Swan Ganz catheter measure inside the heart?
pressures inside the heart
63. What does this catheter measurement tell you?
helps determine the cause of decreased cardiac output
64. What is an A-line?
arterial line, continuous BP on monitor
65. Why is it so important that the distal circulation be checked when a client has an A-line?
Explain your checks that you are going to do (nursing assessment).
Skin temp, color, pulse, capillary refill: These need to be checked because the A-line could
decrease heart perfusion so the line is normally placed in the radial artery.
66. If an A-line is accidentally pulled out, what is the first thing that needs to be done?
apply pressure to the artery
67. When a client has an A-line, pressure has to be kept in the infusion bag. Why? What would
happen if you didn’t keep the pressure on the infusion bag?
To prevent backflow of arterial blood: If you did not place pressure on the flush bag, the high
pressure of the artery would force blood back up through the tubing and fill the flush bag with blood.
68. Why does the client in heart failure develop cardiomegaly?
because the heart muscle is pumping so hard, it hypertrophies
69. Which two medication groups are the standard for heart failure?
ACE inhibitors ARBS
Digoxin slows down the heart rate which gives the ventricles more time to fill with blood. Then
the heart can squeeze down with a stronger contraction and more blood; therefore, it increases cardiac
the elderly have decreased renal function and are at high risk for dig toxicity
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72. When you start a client on an ACE, ARB or digoxin expect their cardiac output to increase;
therefore, what should happen to their:
a. Level of consciousness? Lungs should be dry
b. Lung sounds? Lungs should be dry
c. Urine output? Urine output will increase
d. Skin? Skin should feel warmer
e. Peripheral pulses? Should improve
f. Blood pressure? Should go up
to decrease the circulating fluid
74. When a client goes on a low-sodium diet and bed rest, what might happen to them?
diuresis may occur
75. Why do we give diuretics in the morning?
so pt wont be up all night using the bathroom
76. What is your natural pacemaker?
SA node
77. What do artificial pacemakers do?
depolarize heart muscle- shoot electricity through muscle
78. Can the electrical part of your heart be working and the pumping mechanism not?
yes but not for long
79. Explain the difference between a demand and a fixed-rate pacemaker.
demand kicks in only when the client needs it. Fixed fires at a fixed rate constantly
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80. You really need to get worried about a pacemaker malfunctioning when the rate of the
pacemaker does what?
if the rate decreases
81. Why is it so important that we immobilize the arm on the affected side after pacemaker
the wires need time to embed in the heart, if the arm is moving too much the wires (leads)
could pull out
82. Why does the pacemaker client need to check their pulse every day?
make sure pacemaker stays within range its set on
83. Why does the pacemaker client have to avoid electromagnetic fields? Give some examples
can alter or damage the pacemaker. Old microwaves, MRI machine, airport security
84. If a HF client notices their weight increasing, what could that put them at risk for?
pulmonary edema
85. What is pulmonary edema?
sudden onset of fluid accumulation in the lungs leading to severe hypoxia
86. How does a client develop pulmonary edema?
The left ventricle is failing so the blood is not being pumped forward into the systemic
circulation; therefore, the blood backs up into the lungs.
87. What time of day does pulmonary edema usually occur and why?
At night-because when lying down preload increases so we are dumping more blood into the
right side of the heart and into the lungs
88. What are the major S/S of pulmonary edema?
severe hypoxia, sudden onset, breatless, restless/anxious, productive cough
89. Why is the client in pulmonary edema restless and anxious?
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90. Why is it so important that we hurry up and decrease the circulating volume in the
pulmonary edema client?
because they cannot handle the volume of blood in their lungs
91. When a client is in pulmonary edema, why do we give them oxygen? How much do we give
the fluid makes it hard to breathe and exchange o2. Administer at levels to keep o2 above 90%
92. What is Natrecor and what precautions do we use when administering?
Natrecor is the same as BNP. It vasodilates veins and arteries. It is short term therapy and IV
Natrecor must be turned off for 2 hours prior to drawing a BNP level
93. When a client is in pulmonary edema, why is it important that you sit them up with their
legs down?
to decrease venous return
94. What are the hallmark signs of cardiac tamponade?
increased CVP and decreased BP
95. Why are these hallmark signs occurring?
The heart is being squeezed so the heart pressures (CVP) are high but the output is low which
drops the BP.
96. What events put a client at risk for cardiac tamponade?
car accident, right ventricular biopsy, MI, pericarditis or hemorrhage post CAGB
97. What is intermittent claudication?
The pain that develops as a result of inadequate oxygenation in an extremity associated with
arterial problems.
98. When a client has an arterial problem, it means the oxygen/blood are having a hard time
getting to the tissue, so therefore different S/S develop. Explain the S/S.
Coldness, numbness, decreases pulses, atrophy of the extremity occur because oxygenated
blood is not getting to the extremity. You may even see ischemia and gangrene.
99. Could a client with an arterial problem develop ischemia and necrosis in the affected
extremity? Explain.
yes because oxygenated blood is not getting there
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100. How will angioplasty help an arterial problem?
angioplasty will restore oxygenated blood flow to an area (opens up artery)
101. When a client has a venous disorder, are they having trouble with oxygenation of the
affected extremity?
102. Do you elevate venous disorders or lower venous disorders (such as an affected extremity)?
103. Explain the pathophysiology behind a venous disorder.
The blood can get to the area. The problem is once it gets there it cannot get away. So you get
stagnation of blood flow in one area
104. Why does a client with a venous disorder need Heparin?
to decrease the chance of a new clot forming and to keep the present clot from getting larger
105. How do TED hose help venous disorders?
enhance venous return, decrease pooling
106. When taking care of a client with a venous disorder, do you use warm moist heat or cold
wet packs?
warm moist heat to decrease inflammation
107. With DVT prevention is the key. We _____________ and _______________ the client.
ambulate and hydrate