2 Cardiovascular Alterations Flashcards
Right vs left side heart issues
Right:
Low pressure system
Involves volume deficits
Left:
Pump issues
PSNS
What we see (6)
Decreased HR (-) chronotrope
Increased gastric secretion
Increased bladder/bowel emptying
Miosis (pupil constriction)
Bronchial smooth muscle constriction
SNS
What we see (6)
Increased HR (+) chronotrope
Increased BP
Bornchial smooth muscle dilation
Shunting of blood
Mydriasis (pupil dilation)
Mobilizations of stored energy
CAD to ACS
Coronary artery disease to acute coronary syndrome
CAD is an umbrella term
-something is wrong
ACS (actually bad something needs to be done)
ACS=atherosclerosis of CAD
ACS
What is it
Endstage CAD
Imbalance between supply and demand
STEMI or nonSTEMI
RF of CAD
5
—Age/gender:
Men greatest risk
Women 2 times more likely to die w/ early onset
—Heredity if diagnosed prior to 55 y/o
—blood cholesterol
—Smoking
(vasoconstriction from nicotine)
Increase LDL levels
—Physical inactivtiy
RF for CAD
-blood cholesterol
3 types which is good
LDL (worst one, we want it low)
HDL (GOOD)
-promoting cholesterol removal
VLDL
Diagnostic tests for CAD (5)
Normal ejection fraction
12-lead (locates specific parts of heart)
CXR (alterations in circulation/oxygenation)
Echocardiogram & Transesophageal echocardiography (TEE)
-ejection fraction (55-60%)
Stress testing
Angiography
Labs for CAD (4)
When they increase
Which is best for early detection bc it shows faster
—Electrolytes
—CPK (creatine phosphokinase)
-increases within 2-4hr
-peal 18-36hrs
-baseline return 3-6 days
—Troponin I & T
-more sensitive and useful for early detection
-elevated 1hr
—myoglobin
-all muscle damage (released 30-60min after injury)
Stable vs unstable angina
Stable: need tx but not urgent (prn)
Unstable: need tx urgently
-pain with rest
ACS (acute coronary syndrome)
Catch-all diagnosis for what 3 diagnosis
AMI (what is the definition)
Angina
STEMI/non-STEMI
Imbalance between:
-myocardial oxygen demand and supply
(Not getting oxygen needed to muscle)
Complications of ACS
HF
AMI reoccurance
Rupture of heart tissue
Thromboembolism
Pericarditis
Infarct extension
Cardiac dysrhythmias
Cardiogenic shock
Treatment of ACS
(Remember its a catch-all diagnosis for angina/STEMI/nonSTEMI)
MONA and Rest (sx within 60-90 mins)
—Morphine (other pain meds too)
—Oxygen (goal: >90%)
—Nitroglycerin (vasodilator)
—Antidysrhythmics/ASA(aspirin)
-platelet aggregation prevention
acute MI
Goal
Intervention (same as ACS)
Door to balloon in 90min for STEMI
MONA
t-PA (clot buster) -if you qualify
Nursing care post cardiac cath
-monitor what
-interventions
Assess:
-ABCs (vitals/rhythms)
-CP/back pain/extremity pain
-Puncture site
-Pulse/color/sensation of extremity site
-BUN/Creatinine/UOP (30ml/hr or 0.5ml/kg/hr)
Interventions:
-bed rest (lay flat)
-immobilize extremity to bed
Nursing care post cardiac cath
Monitor peripheral pulses, color, sensation of extremity distal to site
(How frequently)
Q 15min x 4
Q 30min x 4
Q 1hr x 2
Coronary artery bypass graft (CABG)
Definition
Procedure
Surgical procedure allowing a bypass of a known ischemic area of the myocardium
Heart is stopped, cardiopulmonary bypass to pump oxygenated blood
Post op CABG
Monitor what (tells us what)
Prevent what
Assess what (how?)
Monitor fluids
(worried about hypotension/hypovolemia)
Prevent hypotension:
-fluids or meds
Assess hypovolemia: outputs
-chest tube output
-UOP (30ml/hr or 0.5ml/kg/hr)
IABP (intra-aortic balloon pump)
Things it increases=2
Decreases=2
Improves=1
Increases:
Coronary artery blood flow and perfusion
Decreases:
Cardiac oxygen demand
Workload of left ventricle
Improves:
Oxygen supply to the heart
IABP (intra-aortic balloon pump)
Indications to need one (7)
-Pre/post CABG sx
-Cardiogenic shock
-Left ventricular failure
-Unstable angina
-Refractory dysrhythmias
-Septic shock
-Bridge to heart transplantion
IABP (intra-aortic balloon pump)
Insertion
-ballon (what the ml) where is it introduced through into where
-what is put in balloon
What happens during diastole vs systole
30-40ml
Introduced thru femoral artery into thoracic aorta
Helium
Inflates balloon during diastole
Deflates balloon during systole
IABP (intra-aortic balloon pump)
When times with EKG
-when does it inflate in rhythm with?
-when does it deflate in rhythm with?
Inflates on T wave (early diastole)
Deflates on R wave (systole)
IABP (intra-aortic balloon pump)
Art-line used to adjust cycle after insertion:
-inflates at what?
-deflates when?
Inflates at dicrotic notch
-closure of aortic valve and start of diastole
Deflates prior to systole
IABP (intra-aortic balloon pump)
Goal
How is placement verified
Goal:
Decrease afterload (left side)
Increase coronary artery perfusion
Xray
