Med-Surg 2 Exam 1 Cardiac

MI's and dysrhythmias: what is happening?

�A MI occurs as a result of sustained ischemia causing irreversible myocardial cell death. Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration is the hallmark of an MI. Persistent and unlike any other pain; it

What diagnostic tests are done and what do they tell you?

�ECG: Measures electrical activity of the heart. Can identify areas of necrosis and ischemia.
�Blood tests: After an MI, proteins are released into the blood from necrotic heart muscle. Indicates if cardiac damage has occurred.
oCK increased 3-12 hours af

Coronary angiography

Cardiac cath that locates blockage, assesses severity, evaluates function of left ventricle.

What is PCI?

Percutaneous Coronary Intervention (PCI) aka heart cath or balloon angioplasty, uses local anesthesia and has a faster recovery than CABG. This procedure is when a cath equipped with an inflatable balloon tip is inserted into the appropriate coronary arte

What are nursing interventions after a PCI?

�After procedure, assess circulation to extremity used for cath insertion.
�Check peripheral pulses, color, and sensation of extremity q15 min for 1hr with decreasing frequency.
�Observe puncture site for hematoma and bleeding.
�Place compression device o

What meds are given for MI and why?

�B Blockers
�ACE Inhibitors
�Stool softeners

What is appropriate activity post-MI?

�While the pt is in the hospital, activity level depends on severity of angina or MI. Pt may sit up in chair, perform ROM exercises and self-care, and progress to ambulation in the hallway and limited stair climbing.
�After discharge, weeks 2-12, activity

What complications would you monitor for?

�Dysrhythmias-damaged heart cells are more sensitive to nerve impulses.
� HF-damaged heart muscle can't work as well.
�Cardiogenic shock-left ventricle fails and can't get enough O2 to tissues.
� Mitral Valve regurgitation-if damage occurs near papillary

What is CABG?

Coronary Artery Bypass Graft is the use of vessels from the pts body placed into the heart to bypass occlusion and transport blood to the myocardium distal to the occlusion. The chest is opened (sternotomy) and the patient is placed on cardiopulmonary byp

What is nursing care post op?

�The pt will have numerous invasive lines for monitoring cardiac status and other vital organs including: pulmonary artery catheter, intra-arterial line, pleural and mediastinal chest tubes, continuous ECG, endotracheal tube, epicardial pacing, urinary ca

Teaching for CABG?

The pt activity must be increased slowly while being monitored. The HR should NOT increase more than 20bmp from baseline during activity. If it does, they're overdoing it.

What if pt develops bradycardia--what is the treatment and why?

�Bradycardia is usually caused by vagus nerve stimulation.
�If it is asymptomatic the patient is assessed and monitored.
�If it symptomatic the patient is given 1 mg of atropine IVP. Atropine stops the stimulation the vagus nerve. "Mechanical Scissors".

When might bradycardia be normal finding?

�The resting heart rate of an athlete may be bradycardic.

What treatments might be used for tachycardia?

�Adenosine-stops the heart momentarily before it restarts it with a lower heart rate.
�Vagal maneuvers.

What are PVC's?

�Premature Ventricular Complexes- early beat that originates in the ventricle.
�QRS will be wider than usual on the ECG strip.
�Dangerous when they are more frequent than every 6 minutes, coupled, multifocal or R-on-T (PVC following closely on T-wave of t

What are possible causes of PVC's?

Usually due to irritable area in the ventricles or electrolyte imbalances (potassium).

How would you treat PVCs?

�Treatment is lidocaine or amiodarone.

What is pericarditis? Most common cause?

Inflammation of the pericardium (outer layer of the heart). Usually caused by the Coxsackie virus.

What are symptoms of pericarditis?

Chest pain, dysphagia (diff swallowing), restlessness, irritability, anxiety,PERICARDIAL FRICTION RUB, and weakness.

What are causes of pericarditis?

Surgery, infection, connective tissue disease, radiation therapy, uremia (toxins not excreted by the kidneys), MI, TB.

What is the treatment for pericarditis?

�Relieve the symptoms, treat pain, rest, salicylates (aspirin), raise the head of the bed, and NSAIDS.
�Monitor for complications such as pericardial effusion and cardiac tamponade.
�Monitor for decreased CO
�Usually is self-limiting.

What is nursing care for pericarditis?

�Manage the pain and anxiety of the pt.
�Monitor for complications with I's and O's, and vital signs.
�Monitor for symptoms of decreased cardiac output (Vitals again, particularly pulse and circulation in extremities).

Regurgitation--what is it?

Insufficiency or incompetence of the valve leaflets or valve cusps. They fail to shut completely and allow blood flow to continue when it shouldn't.

What is important teaching for regurgitation?

�Since many patients are asymptomatic for years, it is important to teach them the S/S of pulmonary edema and shock for mitral valve regurgitation.
�For aortic valve regurgitation it is important to teach them the S/S of left ventricular failure, shock, a

Stenosis--what is it?

It is the narrowing or constriction of the valve by adhesions (scarring) or by thickening and shortening of the leaflets in the valve.

What is the nursing care for stenosis?

�Prevention of exacerbations of HF, pulmonary edema, thromboembolism, and recurrent endocarditis.
�Anticoagulant therapy is used as prevention and treatment for PE.
�Dysrhythmias are treated with meds or cardioversion.

What problems can stenosis of the aortic valve cause?

Aortic valve stenosis can cause the LEFT VENTRICLE HYPERTROPHY, heart failure, and pulmonary hypertension.

With mitral valve stenosis---what is complication (symptom) that a nurse should assess for?

�Fluid overload.
�Pulmonary hypertension is a concern since the pressure impacts the pulmonary vessels.
�Seizures or a stroke from emboli can result from blood stasis in the LEFT ATRIUM.

Valve replacement--what is important teaching?

�Mechanical or biological replacement of a damaged valve using a prosthetic valve.
�The most important teaching is anticoagulation therapy. They must realize that this surgery is NOT A CURE, and that regular follow up with their health care provider is ma

Rheumatic fever: What causes it?

Having an untreated strep infection for 2-3 weeks. (Group A hemolytic streptococcus)

What does Rheumatic fever cause?

�Causes scarring and deformation of cardiac structures or valves (Mitral valve most commonly affected)
�S/S: fever, lymphadenopathy, arthralgia, N/V, epistaxis, abdominal pain, tachycardia, carditis, polyarthritis, chorea (involuntary writhing), and eryth

How can you decrease incidence of Rheumatic fever?

Get a throat culture to test for strep A pharyngitis and treat with oral PCN or erythromycin.

What is important teaching for the patient with it?

To teach pt about recurrence. Once you have it, you are more susceptible to a second reoccurrence. These patients should be taught about the disease process, possible sequelae (a condition following a disease), and continual need for prophylactic antibiot

What are risk factors for Infective Endocarditis?

�Inflammation of the endocardium (inner lining of the heart).
� Risk Factors: acquired valvular heart disease, prosthetic heart valves, previous history, male gender, age, IV drug use(IVDA), long term catheter use(renal dialysis), or cardiac surgery. (Bac

What is important teaching for infective endocarditis?

�Teach on the symptoms of recurrence. Teach to stay away from people with infections especially upper respiratory infections (URI), and to report cold/flu/cough symptoms.
�Teach patient the S/S of emboli and dysrhythmias.
�Avoid excessive fatigue and plan

How do you calculate Cardiac Output?

�Cardiac output is the amount of blood pumped by the left ventricle in one minute. You calculate cardiac output by multiplying the stroke volume by the heart rate (in one minute).
�The normal cardiac output for the normal adult at rest is 4-8L/min.

What is preload?

the volume of blood in the ventricles at the END OF DIASTOLE. Could also be defined as the amount of stretch placed on the heart between each beat.
�Increases with exercise.

What is afterload?

the peripheral resistance against which the left ventricle must pump or the amount of pressure that the heart must pump against.
�Increases with HTN, and aortic stenosis.

How do preload and afterload affect cardiac output?

�Both preload and afterload increase the workload of the heart resulting in an increased oxygen demand.

What does peripheral vascular resistance have to do with any of it?

Peripheral vascular resistance increases afterload which in return decreases cardiac output.

What do the P wave, the PR-Interval, and the QRS complex on the ECG indicate is happening?

The P wave begins with the firing of the SA node and indicates depolarization of the atria (or contraction of the atria)
The PR-interval indicates the amount of time it takes for the electrical impulse to travel from the SA node to the AV node.
The QRS co

What is the pacemaker of the heart and its rate?

The pacemaker of the heart is the SA node and sustains a rate of 60-100 bpm

What about the SA node's backups?

�The first back-up is the AV node that sustains a rate of 40-60 bpm.
�The last back-up pacemaker the heart has is the Purkinje fibers. They can sustain a rate of 20-40 bpm.

What are symptoms of decreased cardiac output?

The symptoms of decreased cardiac output include decreased blood pressure, increased heart rate, decreased oxygen saturation, labored breathing, decreased capillary refill, cyanosis, decreased urine output, pale and diaphoretic.

How do you quickly determine the heart rate by looking at a rhythm strip?

To quickly assess the heart rate from an individual's rhythm strip count the beats in between 2 hash marks on the top of the strip and then multiply by ten.


clot busters" IV meds to dissolve clot and allow reperfusion (Give within 6hr of onset of pain/sx)


antiplatelet and analgesic


IV analgesic, vasodilator, decreases workload of the heart


may be sublingual, up to 3 tabs q5min or until pain relieved. Works to decrease preload and afterload, vasodilator, increases O2 to myocardium, decreases pain, increases blood flow. Immediate onset.

B Blockers

decrease hearts demand for O2, Decreases HR and BP

ACE Inhibitors

given post MI to decrease HF if left ventricular dysfunction

Stool softeners

prevent constipation and straining

Cardiogenic shock

left ventricle fails and can't get enough O2 to tissues

Mitral Valve regurgitation

if damage occurs near papillary muscle attached to valve, leads to increased blood volume in LEFT ATRIUM and decreased CO.

Ventricular Aneurysm

damaged heart wall is thinner and bulges with contractions


Stops vagus nerve stimulation