NUR 312 EXAM 2 Questions & Answers
Cardiac injury: pathophysiology
Myocyte injury -> impaired contraction and possible electrical instability -> reduced cardiac
output
Cardiac injury: risk factors
Ischemia/infarction
Inflammation
Trauma
Oxygen supply-demand mismatch
cardiac injury: symptoms
Chest discomfort
Dyspnea
Diaphoresis
Nausea
Dysrhythmias
Presentations may be atypical
cardiac injury: diagnostics
12-lead ECG
Serial troponins
cardiac injury: treatment/medications
Antiplatelet/reperfusion treatment when indicated
,cardiac injury: nursing priorities
ABCs
Vital sins
IV access
Telemetry
Pain/perfusion assessment
Oxygen for hypoxemia
cardiac injury: red flags
-Troponin shows myocardial injury, not necessarily MI
-Acute MI also requires evidence of ischemia
aortic valve replacement: what is it
The damaged aortic valves between the left ventricle and aorta is replaced, commonly for severe
aortic stenosis and sometimes severe aortic regurgitation
AVR: pathophysiology
Damaged aortic valve -> impaired forward flow or backward leak -> LV pressure/volume
burden -> valves replacement restores a more effective one way outflow
AVR: procedures
Surgical aortic valve replacement (SAVR): the native valve is removed and a mechanical or
bioprosthetic valve is implanted.
Often requires sternostomy and cardiopulmonary bypass
AVR: post-op nursing care
,-Monitor BP, heart rhythm, mental status, pulses, cap refill, and urine output for low cardiac
output or stroke
-After TAVR, inspect the vascular access site and distal pulses, monitor for heart block, which
may require a pacemaker
-Assess breath sounds, oxygenation and fluid balance for pulmonary edema or HF
-Teach med adherence, follow-up ECG, dental hygiene and when to seek are for fever or new
neuro symptoms
AVR: valve types and anticoagulation
Mechanical: durable; requires lifelong warfarin and regular INR monitoring
Tissue: may deteriorate over time; anticoagulation depends on procedure, post op period and
other indications
AVR helpful tips
Aortic = OUT
TAVR = Through a vessel
Post Op: BRAIN = Bleeding, Rhythm, Access site, Ischemia stroke, New perfusion changes
mitral valve replacement: what is it
A damaged mitral valve between the left atrium and left ventricle is replaced when severe
mitral stenosis or regurgitation cannot be adequately managed with repair or another intervention
MVR: pathophysiology
, Diseased mitral valve leads to obstructed filling or backward leakage -> elevated atrial pressure
& pulmonary congestion -> replacement restores more effect one way flow
MVR: procedure
-Usually surgical replacement with a mechanical or tissue prosthesis
-Repair of often preferred when feasible for mitral regurgitation
-Replacement is used when repair is unsuitable
MVR: nursing care
-Monitor ECG for A-fib, heart block, and other dysrhythmias
-Assess BP for signs of decreased cardiac output
-Assess lung sounds, oxygenation, WOB, and fluid balance for pulmonary edema or HF
-Monitor for stroke, systemic embolism and prosthetic valve thrombosis., follow prescribed
anticoagulation and INR monitoring
-Teach bleeding precautions, consistent dietary vitamin K with warfarin, dental hygiene, follow-
up and infection warning signs
aortic stenosis: what is it
Remember: Stenosis = STIFF
-Narrowing of the heart's aortic valve. The valve which separates the left ventricle (pumping
chamber of the heart) and the aorta (the biggest blood vessel which carries blood to the rest of
the body).
-Harsh, mid-systolic ejection murmur
-Heard at 2nd intercostal space and radiates into the neck
Cardiac injury: pathophysiology
Myocyte injury -> impaired contraction and possible electrical instability -> reduced cardiac
output
Cardiac injury: risk factors
Ischemia/infarction
Inflammation
Trauma
Oxygen supply-demand mismatch
cardiac injury: symptoms
Chest discomfort
Dyspnea
Diaphoresis
Nausea
Dysrhythmias
Presentations may be atypical
cardiac injury: diagnostics
12-lead ECG
Serial troponins
cardiac injury: treatment/medications
Antiplatelet/reperfusion treatment when indicated
,cardiac injury: nursing priorities
ABCs
Vital sins
IV access
Telemetry
Pain/perfusion assessment
Oxygen for hypoxemia
cardiac injury: red flags
-Troponin shows myocardial injury, not necessarily MI
-Acute MI also requires evidence of ischemia
aortic valve replacement: what is it
The damaged aortic valves between the left ventricle and aorta is replaced, commonly for severe
aortic stenosis and sometimes severe aortic regurgitation
AVR: pathophysiology
Damaged aortic valve -> impaired forward flow or backward leak -> LV pressure/volume
burden -> valves replacement restores a more effective one way outflow
AVR: procedures
Surgical aortic valve replacement (SAVR): the native valve is removed and a mechanical or
bioprosthetic valve is implanted.
Often requires sternostomy and cardiopulmonary bypass
AVR: post-op nursing care
,-Monitor BP, heart rhythm, mental status, pulses, cap refill, and urine output for low cardiac
output or stroke
-After TAVR, inspect the vascular access site and distal pulses, monitor for heart block, which
may require a pacemaker
-Assess breath sounds, oxygenation and fluid balance for pulmonary edema or HF
-Teach med adherence, follow-up ECG, dental hygiene and when to seek are for fever or new
neuro symptoms
AVR: valve types and anticoagulation
Mechanical: durable; requires lifelong warfarin and regular INR monitoring
Tissue: may deteriorate over time; anticoagulation depends on procedure, post op period and
other indications
AVR helpful tips
Aortic = OUT
TAVR = Through a vessel
Post Op: BRAIN = Bleeding, Rhythm, Access site, Ischemia stroke, New perfusion changes
mitral valve replacement: what is it
A damaged mitral valve between the left atrium and left ventricle is replaced when severe
mitral stenosis or regurgitation cannot be adequately managed with repair or another intervention
MVR: pathophysiology
, Diseased mitral valve leads to obstructed filling or backward leakage -> elevated atrial pressure
& pulmonary congestion -> replacement restores more effect one way flow
MVR: procedure
-Usually surgical replacement with a mechanical or tissue prosthesis
-Repair of often preferred when feasible for mitral regurgitation
-Replacement is used when repair is unsuitable
MVR: nursing care
-Monitor ECG for A-fib, heart block, and other dysrhythmias
-Assess BP for signs of decreased cardiac output
-Assess lung sounds, oxygenation, WOB, and fluid balance for pulmonary edema or HF
-Monitor for stroke, systemic embolism and prosthetic valve thrombosis., follow prescribed
anticoagulation and INR monitoring
-Teach bleeding precautions, consistent dietary vitamin K with warfarin, dental hygiene, follow-
up and infection warning signs
aortic stenosis: what is it
Remember: Stenosis = STIFF
-Narrowing of the heart's aortic valve. The valve which separates the left ventricle (pumping
chamber of the heart) and the aorta (the biggest blood vessel which carries blood to the rest of
the body).
-Harsh, mid-systolic ejection murmur
-Heard at 2nd intercostal space and radiates into the neck
