CARDIO FINAL/PHARM REVIEWS
Patient taking Cholestyramine resin(Questran) who has serum cholesterol level of 398 mg/dL. Patient statement indicate further instructions?
"I'll continue my nicotinic acid from the health food store".
nicotinic acid are contraindicated with all lipid lowering meds = liver abnormalities
Patient taking Gluconizol+Losartan for HTN. Risks of interaction
Patient with acute myocardial infarction receiving alteplase (tPA). What is NI priority?
Bleeding - a side effect of thrombolytics
Patient with history of mild heart failure receiving diltiazem(Cardizem - Calcium Channel blocker) for HTN. Nurse are to check for
Lung crackles, weight gain, peripheral edema = worsen by the medication
Antidote for Heparin
Patient taking diuretic for HTN - monitor for
When to withold Digoxin
Apical <60 or >100
Nitro lose potency if exposed to light, when to replace
smell like vinegar
Correct use of Nitro tab
Q 5 min . Max of 3 tabs
Consequence of increase BP in HTN patient with renal disease
Ejection Fraction rate for HTN
Normal: >60% Moderate HF: 40-60% Moderate-severe HF: 20-40% Severe HF: <20%
(prils) decrease aldesterone levels, decrease BP, decrease cardial work load decrease peripheral resistance
Nitro transdermal patch is good for
Side effects of Nitro SL
headache (expected) hypotention dizziness (geriatric cautions)
Pre administration of cholestipol
baseline serum total and LDL-C and triglyceride levels.
Nitro ointment teaching
Use gloves. Measured dose on applicator.
Patient pre op PTCA rationale for taking aspirin
prevent thrombus formation
When to hold milrirone
ncreased risk of bleeding due to hypoprothrombinemia from vitamin K deficiency
quinidine drug interaction causing increase serum level
clonidine patch good for
in gluteus maximus
Patient with CHF is taking digoxin + furosemide. What data collection would lead the nurse to suspect patient is hypokalemic?
Muscle weakness+leg cramps
Hydrochlorothiazide (HydroDIURIL) contraindicated with
lithium,digoxin, corticosteroids, hypoglycemic medications
What the nurse should avoid doing in administration of nitroglycerin ointment (Nitro Bid)
Using fingers to spread the ointment. Medication is absorbed through the skin.
Patient with heart disease+ HTN is taking atenolol, digoxin(Lanoxin) and chlorothiazide (Diuril). Diagnosis of digoxin toxicity is made. What is supports for this diagnosis
Double vision, nausea, loss of apetite- as well as bradycardia, visual alterations(green/yellow), seeing spots or halo, confusion, vomiting, diarrhea, decreased libido, impotence
Teaching for postoperative patient taking warfarin (Coumadin)
If patient has a serum potassium level of 3.0 mEq/L complaining of anorexia, therapeutic serum level for digoxin is
Normal range = 0.5-2 ng/mL
Data indicate an adverse reaction associate with propanolol(Inderal)
Audible expiratory wheezes indicate bronchospasm. Beta blocker induce this reaction in patient with COPD / asthma.
Lab to order to monitor for a therapeutic effect of patient taking Heparin
Activated partial thromboplastin time (aPTT)
Teaching for Nitroglycerin ointment
Remove previous dose from skin. Squeeze a ribbon of ointment on prescribed length onto applicator paper. Spread ointment over 6x6 area using chest, back, abdomen, upper arm, anterior thigh + cover with plastic wrap. Rotate sites + avoid touching ointment.
Procainamide injection precautions
Monitor respiratory, BP, Pulse will be watched closely via ECG.
Contraindiation: AV block, lupus,history of "Long QT syndrome, congestive heart failure, circulation problems, a history of heart attack or stroke (including "mini-stroke"), a weak immune system, kidney or liver disease, myasthenia gravis, asthma, allergic to aspirin, sulfites, or any type of numbing medicine.
When to hold off administering digoxin
hold dose if pulse < 60 in adult or < 90 in infant
NI for administering colestipol
Do not take other medications . Taking colestipol can make it harder for your body to absorb certain drugs, making them less effective. Take your other medications at least 1 hour before or 4 hours after you take colestipol. Avoid constipation by drinking 8 to 12 full glasses (8 ounces each) every day
When to hold milrinone
heart failure or low levels of potassium in your blood (hypokalemia, digoxin, diuretic
Side effective of nitroglycerin CR
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; dry mouth; fainting; flushing; heavy sweating; irregular heartbeat; new or worsening chest pain; pale skin; pounding in the chest; rapid heartbeat; severe dizziness or headache; severe or persistent nausea or vomiting; shortness of breath; slow heartbeat; swelling of the hands, ankles, or feet; unusual weakness.
Digitalization of patient with cardiotonics
Rapid : administering loading dose
Gradual: maintenance dose allowing therapeutic drug blood levels to accumulate gradually
Additional fractions of digitalis dose given 6-8 hr intervals. Vitals Q 2-4 hr
Elevated level of homocysteine
Amino acid plays an important role of platelet aggregation. Risk factor for ischemic heart disease, cerebrovascular disease, peripheral arterial disease,venous thrombosis. Normal range: 4-14 mol/L
10 yr old rheumatic fever patient will develop what complication if untreated
Rheumatic heart disease (childhoood pharyngeal or upper respiratory tract infection)
NI for patient with history of 3 times CHF is noncompliance taking his meds
Edema/JVD/Abdominal distention/weight gain
Right Ventricular Failure
Protein released in MI
cardiac serum enzymes and troponin I
HTN patient using salt complain she can not lose 30 lbs.
sodium restriction diet
NI for patient with chest pain preoperative to cardiac catheterzation
termination of ventricular fibrillation by delivering a direct electrical counter shock to patient's precordium
Dx for ventricular gallup in adult
rates of 100 beats per minute or more due to an abnormal third or fourth heart sound being heard in addition to the first and second sounds. Also called gallop rhythm.
Signs/Symptoms of Buerger's disease
instep claudication, extremities may be cold, pale, ulcers and gangerene present. Sensitivity to cold.
Left ventricular failure assessment
Decreased cardiac output+pulmonary congestion = PE, dyspnea, wheezing, pink frothy sputum, pulmonary crackles/wheezing
Rationale for pacemaker in patient with 3rd degree block
regulate cardiac rhythm
Status post of cardiac canulation patient NI
Teaching for AVU
Right ventricular failure
peripheral congestion. Peripheral edema.Distended jugular veins. Enlarge liver.Ascites.
NI for patient preoperative of heart transplant with anxiety
Positioning of left ventricle failure
sitting position with pillows or high fowler
Teaching of patient with coronary artery bypass graft (CABG)
Cardiac enzymes in MI episode
Troponin T: in the blood 3-5 hrs after an MI, remain elevated up to 21 days. Affected by muscle injury + renal disease
Troponin I: rises 3 hrs after MI, peaks at 14-18 hrs return to normal in 5-7 days
Myoglobin: present in muscle, may be non cardiac cause
CAD most risk factor
Common vessel use for CABG
saphenous veins in the leg, or internal mammary artery
Diet for patient taking Lasix
Avoid in low sodium diet
Processed can food. Ketchup. Soy sauce
Type of disorder treat with pacemaker
nausea, vomiting, anorexia, dysrhythmias, bradycardia, tachycardia, headache, fatigue, visual disturbances
Signs indicating renal perfussion in left ventricular failure
Valves preventing back flow to pulmonary artery
pulmonary semilunar valve
auscultate of patient's heart sound with pericarditis for
pericardial friction rub
Characteristic of normal sinus rhythm
Atrial + ventricular rhythms are at 60-100 bpm
Monitor patient taking Heparin
evaluates effectiveness of antidysrhythmics or pacemaker therapy
NI for angina pectoris
promote comfort. promote tissue perfusion. promote activity & rest. relief of anxiety and well being.
Geriatric caution for digoxin
risk for fall. abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrhythmias
Aortic stenosis manifestation
26 yrs old with cardiomyopathy due to
cocaine abuse = vasoconstriction hypertension=MI
NI for Clonergic antagonist
How heart contract
sympathetic nerve fibers releases the norepinephrine, increase heart rate, increase conduction speed through AV node, increased atrial +ventricular contractibility, and peripheral vasoconstriction, stimulation occurs when a decrease of pressure detected.
Rationale for giving propanalol for PTCA
block beta stimulation, decrease myocardial oxygen demand, decreasing myocardial damage
Pace maker teaching
Immobilized for first few hours. Not lift arm over head on he surgical side until given permission by MD. Monitor heart rate and rhythm by apical pulse.
Monitor vital signs +LOC
How to increase HDL
Diet and exercise. Low:<40 High:>60
NI Status post PTCA
monitor vital signs Q 30 min. monitor peripheral pulses, color, warmth, sensation. bleeding.extremity extended for 4-6 hr, keeping leg straight to prevent arterial occulsion. Fluid intake.
MRI side effects
claustraphobia while in the scanner
Sign/symptom of angina
substernal, squeezing pain, radiate to shoulder, arms, jaw, neck and back
NI status post patient with MI
bed rest first 24-36 hrs. ROM to prevent thrombus. Dangling legs at side of bed for 30/day. Ambulation 30 min 3X/Day
arterial occlusion disorder teaching
narrowing of artery in arthorslerosis, interupt blood flow to leg+feet=cramps
Cholesterol risk in cardiac disease factor
LDL Optimal: 100 High: 190
Hormone marker for CHF
BNP (Brain Natruetic peptide)
SDP > 250 DBP >130 bpm = renal failure, cerebral hemorrhage = life threatening
CAD modifying factors
Smoking. Blood pressure. Lipid level. Diabetes
Which BP reading is consider life threatening
>200/130 Diabetes: 130/80
Systolic vs Diastolic Pressure
Systole • Phase of contraction – systolic pressure(BP)– depolarization(EKG)
Diastole• Phase of relaxation – diastolic pressure(BP)–repolarization(EKG
rise 4 to 8 hours, peaking at 16 to 30 hours and returning to baseline within 4 days.
Creatine Kinase (male) 25 - 90 U/L
Creatine Kinase (female) 10 - 70 U/L
(LDH) Lactate dehydrogenase
Total LDH rise 2 to 5 days after an MI; last 10 days.
LDH, serum: 45 - 90 U/L
LDH-1 and LDH-2 LDH isoenzymes - Compare LDH 1 and LDH 2 levels. Normally, the LDH-1 value will be less than the LDH-2. In the acute MI, however, the LDH 2 remains constant, while LDH 1 rises
abnormal within 1 to 2 hours of necrosis, peaks in 4-8 hours, and drops to normal in about 12 hours.
(male): 10 - 95 ng/mL (female): 10 - 65 ng/mL
Peaks in 10-24 hours, begins to fall off after 1-2 weeks. Tropinin I: < 0.1 ng/mL Tropinin T: < 0.1 ng/mL
Cause by rheumatic fever. Breathlessness with activity. Chest pain, angina-type. Crushing, squeezing, pressure, tightness
Pain increases with exercise, relieved with rest
Under the chest bone, may move to other areas
Fainting, weakness, or dizziness with activity
• Family history
• Sex (gender)
• Race (heredity)