Term
| What is the AntiPlatelet dosing for ASA? |
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Definition
| 40-150 mg QD (this is why we use baby aspirin at 81 mg) |
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Term
| What is the Antipyretic; analgestic dosing for ASA? |
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Definition
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Term
| What is the anti-inflammatory dosing for ASA? |
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Definition
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Term
| Which of the types of endocarditis are IVDAs most supceptable to? |
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Definition
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Term
True or False 33% of pts with MVP get endocarditis. |
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Definition
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Term
| What are some s/s of endocarditis? |
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Definition
Strep infection usually w/i 2w. fever, chills, nightsweats valve regurg. emboli abscess septic emboli 85% have murmurs 66% have CHF
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Term
| What exam findings are characteristic of endocarditis? |
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Definition
Janeway's legions: palms & soles Osler's Nodes: pads of fingers, toes. Splinter Hemorrhages: nail beds Petechiae: conjunctiva, buccal mucosa.
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Term
True or False Left untreated, endocarditis in fatal 100 % of the time. |
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Definition
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Term
| How does the clinical picture of endocarditis differ in the IVDA? |
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Definition
Rt. sided involvement cavitary lesions on xray fever, chills, pleuritic pain septic emboli-lungs cocaine users have left sided endocarditis.
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Term
| What are some s/s of systemic involvement of endocarditis? |
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Definition
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Term
| When BC return with a + result, what is ordered next for the pt? |
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Definition
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Term
| About 1/3 of pts with endocarditis have Neuro manifestations, what might you see? |
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Definition
H/A, seizures brain abscesses purulent meningitis younger pts present with h/a, stroke, meningitis. older pts present with confusion, malaise, fatigue, and no fever.
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Term
| What are the odds that BCs will be negative in the presence of infective endocarditis. |
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Definition
5-10% draw 3 sets of BC in first 24h if on previous ABs-get more cultures. Order UA for proteinuria/hematuria
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Term
| What diagnostics are ordered for the pt with endocarditis? |
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Definition
CBC Sed rate-usually increased retic count-usually low RPR RA/ANA
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Term
| What is seen on an echo for a pt that has endocarditis? |
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Definition
| 95% have veggitation which could take months to clear up after the regimen of ABs. |
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Term
| If the echo is negative for endocarditis & you stronglly susspect the pt has IE, what diagnostic should be ordered? |
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Definition
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Term
| What are some differential dx for endocarditis? |
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Definition
If 3 BCs are neg consider: Rheumatic fever atrial myxoma PE, systemic LE Non bacterial endocarditis occurs in pts with wasting (resolves on its own).
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Term
| What is the management for the pt with endocarditis? |
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Definition
strep: PCN Staph: vanco If prostetic valve: vanco, rif., genta. initially on day 1: broad spectrum.
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Term
| What are the different types of BCs that can be ordered on a pt with endocarditis? |
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Definition
Hacek: tx with rocephin fungal: amphoterecin TREAT ALL FOR 4-6W DO DAILY BCs UNIL NEGATIVE 10% can have fever for >2w
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Term
| What are some indications that the pt with endocarditis may require Sx? |
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Definition
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Term
| What are some s/s of Pericarditis? |
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Definition
pericardial friction rub-diagnostic Pain: worsened by coughing or laying down, relieved by sitting up & leaning forward. cyanosis anorexia hypotension substernal pain radiating to shoulder.
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Term
| What EKG changes could be seen in the pt with Pericarditis? |
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Definition
ST up or down Sinus Tach Flipped Ts SVT & A-fib.
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Term
| The friction rub in pericarditis is diagnostic. What are some of its characteristics. |
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Definition
it has 3 components: at times only 1 or 2 maybe heard. It is intermittant & variable in intensity. occurs in atrial/ventricular systole
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Term
True or False The echocardiogram is the study of choice in pericarditis to show effusion. |
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Definition
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Term
| What are the diagnostics that should be ordered in the pt with pericarditis? |
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Definition
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Term
True or False Most courses of pericarditis are self limiting & resolve in a few weeks. |
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Definition
| True, most have complete resolution in 2w. |
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Term
| What are some clinical indicators of pericardial effusion? |
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Definition
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Term
| What complications can be expected in the pt with Pericardial effusion? |
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Definition
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Term
What is the emergency tx for pericardial effusion? |
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Definition
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Term
Your 45 y.o. male pt is c/o: SOB, CP x 1h unrelieved by NTG x 3,and back pain and is diaphoretic & very anxious. WBCs are elevated & T1 is pending any minute. EKG shows sinus tach at 111. What are your thoughts? |
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Definition
Normal EKGs can never exclude an infarct. Only 50-60% show acute MI & 20% never show it. |
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Term
| How long does it take Troponin I to rise? |
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Definition
It will begin to rise in 2-6h. Note to self: Most deaths r/t MIs occur w/i the 1st 2h of infarct. |
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Term
| 30% of MIs fall into the "atypical" category. What types of pts are included in this group? |
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Definition
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Term
| How long does it take for CK-MB to rise in the case of an AMI? |
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Definition
| 4-6h, consider this when Troponin I only takes 2-6h (and most MI deaths occur in first 2h) |
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Term
| What does the acronym MONA stand for when treating the MI pt? |
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Definition
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Term
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Definition
| The MUGA scan (MUltiple Gated Acquisition scan) is an extremely useful noninvasive tool for assessing the function of the heart. The MUGA scan produces a moving image of the beating heart, and from this image several important features can be determined about the health of the cardiac ventricles |
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Term
True or False The higher the HR on an echocardiogram the more inaccurate it will be. |
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Definition
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Term
Myth or Fact: 20% of pts having an MI will NOT experience chest discomfort. |
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Definition
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Term
Myth or Fact Elderly pts (>85y) that have MIs, the most common symptom is SOB |
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Definition
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Term
What is Levine's sign? (hint: r/t MI) |
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Definition
| A clutched fist or open hand on the left chest when a pt is asked where their chest discomfort is. 80% of pts having an MI will demonstrate Levine's sign. |
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Term
| What are some less freqent locations of discomfort during an MI? |
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Definition
intrascapular region of the back (>common in females) Rt side of chest Rt shoulder, jaw, or ulnar aspect of rt arm.
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Term
| Why do we give B-bs to the pt with an MI? |
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Definition
lower risk of ventricular arrhythmias decrease myocardial O2 demand |
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Term
| Name a few ABSOULUTE contraindications to fibrinolytic therapy. |
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Definition
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Term
| What is the definition of heart failure? |
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Definition
| occurs when the heart can no longer produce sufficient CO at normal filling pressures to meet metabolic demand. This usually occurs when the left ventricular ejection fraction falls below 40% |
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Term
The NP suspects that tx of pericarditis has been effective if which of the following parameters are noted: sed rate rises ST segs return to baseline pt denies CP in the upright position pts mean arterial pressure decreases from 94 to 84 mm Hg
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Definition
| ST segs return to baseline. |
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Term
The NP knows that a pt with an MI may experience pain in the jaw or shoulder because of which of the following factors: ischemic heart tissue can irritate adjacent tissue causing diffuse pain. areas such as the shoulder and jaw share a nerve pathway with the heart resulting in referred pain. mediators relaeased from damaged heart tissue can cause increased capillary permiability, resulting in pressure on tissues adjacent to the heart.
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Definition
| shoulder and jaw share nerve pathways with the heart resulting in referred pain. |
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Term
| Which of the cardiac enzymes elevate first? |
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Definition
| Troponin I in 2-6h, but remember that death from most MIs occur in the first 2h of infarct. |
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Term
| What is the 2y mortality rate difference between Q wave MI % Non Q wave MI? |
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Definition
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Term
| What class of antihypertensives is most preferred in the pt with AMI and why? |
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Definition
| Bb, because they reduce myocardial oxygen demand, decrease HR & decrease BP. |
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Term
Exactly what does an echocardiogram evaluate? |
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Definition
valvular heart disease caridac chambers congenital heart disease cardiac masses wall motion pericardial disease
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Term
| What is the rule of Rosner when evaluating the results of and echo? |
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Definition
| The higher the HR, the less accurate the echo results are. |
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Term
| What classification of cardiac disease are alcoholics prone to? |
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Definition
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Term
| What is systolic failure? |
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Definition
| abnormal ejections fraction: LVF is decreased. |
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Term
| What is diastolic failure? |
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Definition
| Increased left ventricular end diastolic pressure, but have Normal systolic function & ejection fraction. The pressure in diastole increases, almost a normal part of aging. |
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Term
| Whatis the earliest s/s of CHF? |
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Definition
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Term
| What s/e of Bb must the NP make the pt aware of? |
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Definition
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Term
| what are some special considerations for the pt with CHF? |
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Definition
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