case study key notes

Question 1

ejection fraction percentages (4)

Answer 1

NORMAL = 55-70%
heart failure= <40%
dysrhythmia = <35%
Class 4 HF= <20%

Question 2

symptoms of advanced heart failure (8)

Answer 2

PAIN
DYSPNEA
DEPRESSION/ANXIETY
FATIGUE
CARDIAC CACHEXIA
ANEMIA-
EDEMA
ASCITIES

Question 3

what meds do we NOT give with advanced heart failure and why-2

Answer 3

TCAS (long QT, arrythmia, orthostatic hypotension)

NSAIDs (↑fluid retention)

Question 4

what meds do we give for pain for advanced heart failure

Answer 4

nitrates and opioids

Question 5

what med for depression/anxiety

Answer 5

SNRI venlafaxine

Question 6

what causes Cardiorenal anemia Syndrome

Answer 6

↓kidney function
–>↓EPO –>↓RBC
–>anemia

Question 7

diagnostics for advanced heart failure

Answer 7

echo

Question 8

med if pt has sinus rhythm and HR>70 BPM

Answer 8

Ivabradine

Question 9

1st line treatment for advanced heart failure

Answer 9

ACE-I- ramipril
ARB - losartan
ARNI- Entresto
(NOT with hx of angioedema)

Beta blocker- metoprolol

MRA- spironolactone (help with edema)

SGLT2i - flozins (good with DM)

Question 10

if pt has pace maker what to do at death and why

Answer 10

turn off ICD/CRT, inform funeral home (shocks during death and explosive during embalming)

Question 11

when to use devices

Answer 11

if EF <35% and meds are not enough

Question 12

what is LVAD used for

Answer 12

bridge to transplant

Question 13

types of devices (5)

Answer 13

cabag -graft
PCI-stent
ICD
BVP
LVAD

Question 14

what are the 6 oncological emergencies

Answer 14

-spinal cord compression
-hypercalcemia
-pleural effusion
-bowel obstruction
-hemoptysis
-superior vena cava

Question 15

diagnostics for spinal cord compression (2)

Answer 15

MRI (without contrast)

CT scan for those who cannot have an MRI (pacemaker)

Question 16

diagnostics for pleural effusion

Answer 16

chest x-ray

Question 17

diagnostics for bowel obstruction

Answer 17

occult blood test

Question 18

diagnostics for hemoptysis

Answer 18

bronchoscopy

Question 19

diagnostics for superior vena cava (2)

Answer 19

CT scan
Pemberton’s Sign

Question 20

1st line treatment for spinal cord compression

Answer 20

corticosteroid (dexamethasone) STAT

Question 21

1st line treatment for hypercalcemia (2)

Answer 21

• IV hydration or hypodermoclysis
• bisphosphonates (pamidronate)

Question 22

risk of hypercalcemia

Answer 22

arrhythmia

Question 23

patho of hypercalcemia

Answer 23

tumor releases PTH
–>↑osteoclasts
–>↑bone calcium

Question 24

most common symptom of hypercalcemia

Answer 24

delirium

Question 25

most common symptom of pleural effusion

Answer 25

refractory dyspnea

Question 26

when to use pleurodesis

Answer 26

pleural effusion with a prognosis > 3 months

Question 27

1st line treatment for **partial** bowel obstruction (4)

Answer 27

Octreotide, Buscopan, dexamethasone, (Haldol- Nausea)

Question 28

what meds do we NOT give with bowel obstruction and why

Answer 28

prokinetics -perforation

Question 29

biggest risk with hemoptysis

Answer 29

asphyxiation

Question 30

how to control local bleeding

Answer 30

tranexamic acid

Question 31

how to help with anxiety with hemoptysis -3

Answer 31

bleed kits explain sedation

Question 32

signs of superior vena cava (4)

Answer 32

-Jugular/chest wall vein distension -Facial Edema, -edema of the arm -dilated veins on the hand

Question 33

Positive Pemberton’s Sign (3)

Answer 33

Raise arms above head--> red, flush, swollen

Question 34

treatment for pain/dyspnea with superior vena cava (2)

Answer 34

opioids and dexamethasone

Question 35

1st line treatment for superior vena cava (2)

Answer 35

Thrombosis- Tenecteplase, anticoagulation

Question 36

Pharm tx neuropathic pain in advanced heart failure (3)

Answer 36

gabapentin, venlafaxine, methadone

Question 37

what is methylnaltrexone given for

Answer 37

opioid induced constipation

Question 38

what meds are given for nausea (4)

Answer 38

metoclopramide, Nozinan/Haldol, ondansetron, Granisetron

Question 39

why manage constipation with heart failure (3)

Answer 39

↑cardiac workload--> exacerbate HF symp. med absorption prevent pain

Question 40

What position should a patient with **unstable spinal cord compression** be placed in?

Answer 40

Flat neutral supine, log roll

Question 41

Intervention for complete bowel obstruction (3)

Answer 41

NPO, hydrate IV, artificial saliva

Question 42

Non pharm for partial bowel obstruction (3)

Answer 42

Sips of fluid Ice chips Soft diet as tolerated

Question 43

Invasive Tx bowel obstruction (3)

Answer 43

GI decompression with NG tube Colonic stent Surgical resection