Editing Medical-Surgical Nursing – RN Flashcards (section)

== Cardiovascular ==

;Troponin timing after myocardial injury
:Begins to rise about 3 to 4 hours after injury, peaks around 12 to 24 hours, and stays elevated up to 10 to 14 days. A single early normal value does not rule out infarction, so serial levels are drawn.

;Why nitroglycerin is absolutely contraindicated with sildenafil or tadalafil
:Both are vasodilators. Combined within 24 to 48 hours they cause profound, refractory hypotension. Always ask about phosphodiesterase type 5 inhibitor use before giving nitrates.

;Earliest sign of decreased cardiac output the nurse can detect at the bedside
:Change in level of consciousness such as restlessness or confusion, with narrowing pulse pressure and urine output falling below about 30 mL per hour. Hypotension is a late finding.

;Distinguishing left-sided from right-sided heart failure
:Left-sided backs up into the lungs, producing crackles, orthopnea, paroxysmal nocturnal dyspnea, and an S3 gallop. Right-sided backs up systemically, producing jugular venous distention, peripheral and sacral edema, hepatomegaly, and ascites.

;Heart failure teaching point that most reduces readmission
:Daily morning weight after voiding, before breakfast, same scale and clothing, with a call to the provider for a gain of 2 to 3 pounds in a day or 5 pounds in a week.

;Signs of digoxin toxicity and the factor that potentiates it
:Anorexia, nausea, vomiting, yellow-green halos or blurred vision, confusion, bradycardia, and new dysrhythmias. Hypokalemia, often from loop diuretics, potentiates toxicity even at a therapeutic drug level of roughly 0.5 to 2.0 ng/mL.

;Why atrial fibrillation causes stroke and what that means for care
:Blood stagnates in the fibrillating atria and forms thrombi that embolize to the brain. Anticoagulation, not just rate control, is the priority intervention, and the nurse assesses apical and radial rates for a pulse deficit.