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 Measurement BP Normal SBP & or DBP? mm Hg? Pre-Hypertension Stage 1 Hypertension Stage 2 Hypertension Isolated Malignant

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 DBP 80-89? Lifestyle changes-what? Stage 1: SBP , 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 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