1. NCLEX- Type Block 2 Cardiac Concepts Nora Martin Vetto, MSN, BSN
NUR 104
NCLEX- Type Block 2 Cardiac Concepts
Nora Martin Vetto, MSN, BSN
Concepts: cardiac cycle, blood flow, pre-load & afterload, innervation of ANS, cardiac blood supply, brief overview of conduction system, nursing assessment of cardiac patient, arteriosclerosis, atherosclerosis, hypertension, CAD, chronic stable angina

2. 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?
Students to answer

3. 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:
3 factors that increase myocardial oxygen demand: increased HR, increased force of contractions, increased afterload

4. 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?

5. Coronary Arteries

6. Rhythm Strip EKG shows relationship of conducting pathways to the EKG
P wave: indicative of the impulse generated from the sinoatrial node (SA node); initiates atrial depolarization.
PR interval: delay of the impulse at the atrioventricular node (AV node) and bundle of His to promote ventricular filling.
QRS complex: passage of the impulse through the bundle of His, down the bundle branches, through the Purkinje fibers; depolarization of the ventricle occurs.
T wave: ventricular repolarization and return to the resting state.
ST segment: above the baseline in cardiac injury (ST elevation) and below the baseline

7. Hypertension Classifications
Classification Measurement BP Normal SBP & or DBP? mm Hg? Pre-Hypertension Stage 1 Hypertension Stage 2 Hypertension Isolated Malignant
SBP , DBP 80-89
SBP & DBP <or =120 <or=80
SBP >or=160, DBP > or =100
SBP > or = , DBP > or = 90-99
SBP 140 or >, DBP 90
SBP > or = to 220, DBP or >

8. 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?
Students Answer

9. Secondary Hypertension
Define?
Examples?
Can it resolve?
Students

10. 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?
Meds meds meds they won’t go away
Example ca++ Channel Blockers- avoid grapefruit juice….

11. Diagnostics for Hypertension
Psychosocial- ask what
Assess for kidney disease how?
Chest Xray- Why?
EKG- why?
Students

12. 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
Student
3 types Diuretics- Thiazides inhibit sodium, chloride & h20 reabsorption, good for uncomplicated hypertension, Loop Types- inhibit sodium, chloride, and h20 reabsorption in ascending loop of Henle & promote potassium excretion, Potassium Sparing, distal end of renule tubule inhibit reabsorption of sodium ions in exchange for potassium, so retain the potassium

13. Types of Medications Actions
Inotropic ?
Chronotropic ?
Dromotropic ?
Block 2 Level
Inotropic- helps with force
Chronotropic helps with HR
Dromotropic- affects conduction

14. 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?
Students

15. 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?
Students answer

16. 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
Students

17. 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
Students

18. 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?

19. 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
Students

20. 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
Students

21. 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
Students

22. 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
Students