CARDIO MUST KNOW BEST POINTS FOR NURSES TO PASS NCLEX-RN 2024

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Do you know what cardiac tamponade is, cardiac markers are. If no, then this post is especially for you.

  1. Pericardial effusion is a buildup of fluid in the pericardium.
  2. Cardiac Tamponade, a serious complication of pericardial effusion, develops as the effusion increases in volume and results in compression of the heart. The heart struggles to contract effectively against the fluid, and cardiac output can decrease drastically.
  3. Cardiac tamponade is a life-threatening complication requires an emergency pericardiocentesis (a needle inserted into the pericardial sac to remove fluid.)
  4. Signs and symptoms of cardiac tamponade are:
    • Hypotension with narrow pulse pressure
    • Muffles or distant heart tones
    • Jugular venous distension
    • Pulsus paradoxus
    • Dyspnea, tachypnea
    • Tachycardia
  5. The nurse should report above cardiac tamponade findings to the health care provider immediately and prepare for a pericardiocentesis.
  6. Bounding pulses may be present during fluid overload or hypertension.
  7. Decreased breath sounds could indicate conditions such as atelectasis, pleural effusion, or pneumothorax.
  8. Coronary arteriogram requires that the client have nothing by mouth for 6-12 hours prior to the procedure and have an IV line started for sedation medications. The client may feel warm and flushed while the dye is being injected. The client is required to lie flat for several hours following the procedure to achieve hemostasis at the access site (femoral access). The client typically goes home the same day unless other interventions have been performed.
  9. General anesthesia is not used during coronary angiography. SEDATION MEDICATIONs are given during the procedures.
  10. Heparin infusions require close monitoring to the nurse. The partial thromboplastin time is the laboratory value required to accurately monitored the therapeutic effects of heparin.
  11. Heparin is an anticoagulant that helps prevent further clot formation. It is titrated based on a partial thromboplastin time (PTT). The therapeutic PTT target is 1.5-2.0 times the normal reference range of 25-35 seconds.
  12. A PTT value >100 seconds would be considered critical and could result in life threatening side effects.
  13. A normal prothrombin time is 11-16 seconds.
  14. Clients with any form of prosthetic material in their heart valves or who have unrepaired cyanotic congenital heart defect or prior history of IE should take prophylactic antibiotics prior to dental procedures to prevent development of IE. IE means Infective Endocarditis.
  15. Following coronary artery bypass grafting, activity should be increased gradually under medical supervision. Clients should be encouraged to participate in a cardiac rehabilitation program and abstain from sexual activity until approved by health care provider. Bath should be avoided. Submerging the incisions or applying creams postoperatively can introduce microorganisms to the surgical sites and cause delayed healing. Wound care generally involves washing the incisions gently with the mild soap and water and patting dry.
  16. Electrolytes and mineral imbalances can cause cardiac electrical instability that can result in life life-threatening dysrhythmias.
    • Hypocalcemia can cause ventricular dysrhythmias, prolonged ST and QT intervals, and cardiac arrest.
    • Hypercalcemia can cause a shortened ST segment and widened T wave, atrioventricular block, tachycardia or bradycardia, digitalis hypersensitivity, and cardiac arrest.
    • Hypokalemia causes increased cardiac electrical instability, ventricular dysrhythmias, and increased risk of digoxin toxicity.
  17. Cardiac markers:
    • Troponin
      • Troponin I especially has a high affinity for myocardial injury.
      • It rises within 3 hours and persists for up to 7 to 10 days.
      • Normal range is less than 0.35ng/mL.
    • CK-MB (creatinine kinase, myocardial muscle)
      • An elevation indicates myocardial damage.
      • An elevation occurs within hours and peaks at 18 hours following an acute ischemic attaccks.
      • Normal values for CK-MB is 2 to 6 ng/mL.
    • Myoglobin
      • The level rises within 2 hours after cell death, with a rapid decline in the level after 7 hours.
      • It is not cardiac specific
  18. Pain relief increases oxygen supply to the myocardium, administer morphine as a priority in managing pain in the client having a Myocardial infarction.
  19. Signs of left ventricular failure are evident in the pulmonary system.
  20. Signs of right ventricular failure are evident in the systemic circulation.
  21. For venous insufficiency, leg elevation is usually prescribed to assist with the return of blood to the heart.
  22. The client who undergoes cardiac surgery is at risk for RENAL INJURY from poor perfusion, hemolysis, low cardiac output, or vasopressor medication therapy. Renal injury is signaled by decreased urine output and increased blood urea nitrogen (BUN) and creatinine levels.
  23. HOLTER MONITORING: 24 hours EKG monitoring. Client should record any moment that they have chest pain.
  24. CARDIOGENIC SHOCK: Heart is unable to maintain effective cardiac output.
    • Assessment:
      • Low BP
      • Low urine output
      • Assess CVP (pressure in superior vena cava representing right atrial pressure preload)
        • CVP: 2-8 mmHg (normal range)
        • Reading should be taken at the end expiration if ventilated
        • Zero transducer at the fourth intercoastal spacce along the mid axillary line (location of the right atrium)
  25. Cardiac dysrhythmias:
    • Sinus Bradycardia:
      • Atrial and ventricular rates are less than 60 minutes
      • Treatment may be necessary if client is symptomatic (signs of decreased cardiac output)
      • Nurse role:
        • Withhold medication suspected to causing the bradycardia
        • Administer oxygen as prescribed for symptomatic client.
        • Administer ATROPINE SULFATE (to increase heart rate)
        • Be prepared to apply a non-invasive transcutaneous pacemaker initially if atropine sulfate doesnot increase heart rate.
        • Avoid additional doses of atropine sulfate because it may induce tachycardia.
        • Monitor for hypotension
        • Administer Fluids IV if prescribed.
    • Sinus tachycardia:
      • Atrial and ventricular rates are more than 100-180 beats per minute
      • Nurse role is to identify the cause of tachycardia
    • Ventricular fibrillation:
      • Treatment: Defibrillation
      • Drugs used: LAP : Lidocaine, Amiodarone, Procainamide
      • Causes: Untreated V tach, Post MI, Electrolyte imbalances, Proarrhythmic meds.
    • Ventricular Tachycardia:
      • Tombstone Pattern
      • Causes: Post MI, Hypoxia, Low potassium, Low magnesium
      • Treatment:
        • Early defibrillation
        • Call out and look for everyone to be CLEAR
        • Shock and immediately continue chest compression
        • When to shock ?
          • V tach with no pulse: DEFIBRILLATION
          • V Tach with Pulse: CARDIOVERSION
    • ATRIAL FIBRILATION:
      • CAUSES: Valvular disease. heart failure. pulmonary hypertension, COPD, after heart surgery
      • Treatment:
        • Cardioversion
        • Digoxin
        • Check ATP Before giving digoxin:
          • A: Apical pulse
          • T: Toxicity (max 2.0 range) visual disturbances, nausea, vomiting, anorexia
          • P: Potassium below 3.5 ( higher risk for toxicity)
        • Anticoagulants:
          • Warfarin (monitor INR, Vitamin K antidote, moderate green vegetables)
    • Atrial Flutter:
      • Causes and treatment are same as A-fibrillation.
  26. Before defibrillating a client, be sure that the oxygen is shut off to avoid the hazard of fire and be sure that no one is touching the bed or the client.
  27. Vital signs are monitored, and cardiac monitoring is done continuously for the client with a temporary pacemaker.
  28. Acute cardiac tamponade can occur when small volumes (20-50mL) of fluid accumulate rapidly in the pericardium.
  29. Thromboembolism can be a problem following valve replacement with a mechanical prosthetic valve, and lifetime anticoagulant therapy is required.
  30. For venous sufficiency, leg elevation is usually prescribed to help with the return of blood to the heart.
  31. Instruct the client with an aortic aneurysm to report immediately the occurrence of chest or back pain, shortness of breath, difficulty swallowing, or hoarseness.

INSTRUCTIONS FOR CLIENT WITH DEEP VEIN THROMBOPHLEBITIS:

  1. Avoid prolonged sitting or standing, constrictive clothing, or crossing legs when seated.
  2. Elevate legs for 10-20 minutes every few hours each day.
  3. Wear a MedicAlert bracelet.
  4. Avoid smoking
  5. Inspect the legs for edema, and measure the circumference of the legs.
  6. Wear Antiembolism stockings as prescribed
  7. Recognize the signs and symptoms of bleeding.
  8. Avoid any medications unless prescribed by HCP.
  9. Instruct the importance of follow-up.
  10. INSTRUCT THE CLIENT CONCERNING HAZARDS OF ANTI-COAGULATION THERAPY.

If a client taking metformin is scheduled to undergo a procedure requiring the administration of iodine dye, the metformin is withheld for 24 hours prior to the procedure because of the risk of lactic acidosis. The medicine is not resumed usually 48 hours after the procedure or after the renal function studies are done and the results are evaluated.

QUICK NCLEX CARDIAC FACTS:

  1. Assess Apical pulse for 1 min before administration of DIGOXIN.
  2. Bleeding precautions:
    • Use an electric razor
    • soft-bristled toothbrush
    • Avoid flossing.,
    • Avoid NSAIDS, ASPIRIN, ANTIBIOTICS,ALCOHOL
  3. Antihypertensive can cause orthostatic hypotension and rebound hypertension.
  4. Statins can cause RHABDOMYOLYSIS
  5. Mnemonic for Myocardial Infarction Symptoms: CRUSHING.
    • C: chest pain
    • R: radiates (neck, jaw, back)
    • U: unrelieved pain w/ nitro, rest
    • S: sweating (cold sweat)
    • H: hard to breathe
    • I: increased heart rate
    • N: nausea and vomiting
    • G: gloom and doom.

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