Cardiac Flashcards
this occurs when there is a blockage of the coronary arteries
myocardial infarction
does heparin dissolve clots already formed
no - it prevents cloth growth
signs and symptoms of MI
-pain in jaw, back, epigastric (feels like heartburn), shoulder
-SOB
-nausea
-sweating
-pale cool skin
-anxiety
what are the key words to listen for re MI when pt is describing the pain
sudden, crushing, radiating
what are the risk factors for MI
S-stress, smoking, simulants
O-obesity
D-diabetes, HTN
D-diet - high cholesterol (animal fats)
A-african american males & 50+ years old
if troponin is over what number, it means MI occured
0.4ng/ml
what medications are given to lower cholesterol
statins
what are the cautions for statins
no grapefruit
liver toxicity
muscle pain
what is antidote for heparin
protamine sulfate
signs of right sided heart failure
peripheral edema
weight gain
JVD - big neck veins
abdominal growth
signs of left sided heart failure
pulmonary edema (fluid in lungs)
crackles in lungs
pink frothy sputum
orthopnea (difficulty breathing when lying flat)
what causes right sided heart failure
HTN
pulmonary HTN
fibrotic lungs (stiff)
left sided HF
what causes left sided heart failure
weak heart (after heart attack)
CAD
ACS
patient with heart failure who is constipated. what would nurse recommend
a. walking
b. increase fiber
c. stool softeners
d. drink more water
a. walking
b. increase fiber
c. stool softeners
risk factors for heart failure
HTN - #1 risk factor
atrial fibrillation
mitral valve regurgitation
cardiomyopathy
which food item should the heart failure pt avoid
select all that apply
chips
fruits
veggies
grilled chicken and ff
canned beans
bread
canned beans
grilled chicken and ff
chips
all have sodium
a client with CHF took cold medicine for her flu. she presents with new productive cough with pink forthy sputum and worsening crackles
what action should the nurse do first
- assess lung sounds
- give bumetanide IV push
- notify HCP
- clock out for lunch
- give bumetanide IV push
new, sudden, worsening, rapid symptoms
#1 action is furosemide = body dried
priority interventions for pulmonary edema crisis
HOB 45 degrees
Oyxgen
Push furosemide + morphine, positive inotropes
End sodium & fluids — stop IV fluids
what to watch for if pt is on digoxin
take apical 1 min before
look for toxicity - 2.0+ = vision changes & N/V
watch potassium. 3.5 -5.0 is normal
if pt is on furosemide, what do you need to watch for
potassium. K+ wasting
what do beta blockers do for heart
blocks both BP and HR
LOL = LOW
cautions for beta blockers (LOL)
bradycardia
wheezing (asthma & COPD)
bad for HF pts
hides S/S of blood sugar for diabetics
calcium channel blockers do what for heart
calms BP & HR
nitroglycerin is what kind of medication
vasodilator
lisinopril & losartan do what
lowers BP
nursing interventions for heart failure pts - 7
diet - low sodium & fluid
risk for falls - change position slowly
BP & BNP should not increase
elevate legs with pillows
daily weights
sex - only if can do 2 flight of stairs with no SOB
stockings
do you massage pt’s legs if they have CHF
never
what OTC meds can a pt have with HF
none. no NSAIDS, no cough or flu meds, no Antacids
-this is comprised of lipid deposition in intimal layer of artery
-narrows vessel and impairs blood flow
-smooth muscle proliferates, fibrous cap with lipid center
atherosclerosis
what can create chronic endothelial injury which can lead to atherosclerosis
HTN
tobacco use
hyperlipidemia
diabetes
toxins
hyperhomocysteinemia
this is the break down of aminoacids. it can be from diet, lifestyle or hereditary
hyperhomocysteinemia
when the plaque ruptures in artery.
thrombus formation
total occlusion or narrowing of vessel.
what can occur
myocardial infarction
this is the pain that occurs if you have chronic endothelial injury and then you exercise
angina
nonmodifiable risk factors of artherlosclerosis
age
gender - men younger - 55- , men and women- 55+
race - african, native, asian and mexican americans
hereditary - 40-60% genetic disposition
modifable risk factors of atherosclerosis
HTN
tobacco use
sedentary lifestyle
high serum lipids
obese
metabolic syndrome
stress
diabetes
homocysteine
substance abuse
what is metabolic syndrome
high blood pressure,
high blood sugar,
excess body fat around the waist,
and abnormal cholesterol levels.
is LDL or HDL the bad cholesterol
LDL
this occurs when there is complete blockage and damage to vessel, but blockage starts to dissolve
non ST segment elevation MI
why does angina occur
no oxygen to heart but not long enough to cause damage
this is a complete blockage, and blockage does not dissolve
ST segment elevation MI
the cells die in heart and there is muscle damage
ST segment elevation MI
what are the diagnostic tests for angina
12 lead EKG
echocardiogram
cardiac cath
stress test
troponin
this bloodwork is essential to find out if person had MI.
enzymes are released when there is muscle damage to heart
troponin 0-0.04ng/ml normal range
clinical manifestations of angina
chest pain - severe, crushing
skin clammy/cool
sob
anxiety
n/v
dysrhythmias
what medications are used to treat angina
nitroglycerine - vasodilator
beta blockers - dialates blood vessels, lowers HR
calcium channel blockers - lowers HR
aspirin or clopidogrel
heparin
what medications are used to treat MI
aspirin, nitroglycerine, morphine, beta blocker, oxygen
when do you use ACE inhibitors
when there is damage to the heart you use ACE inhibitors to prevent necrosis from getting worse
nursing considerations for acute coronary syndrome
-relieve pain and symptoms of ishcemia
-monitor cardiac output
-monitor respiratory status
-monitor fluid volume status
-reduce anxiety
-monitor and manage complications
what are the complications of acute coronary syndrome
dysrhythmias
cardiogenic shock
pericarditis
valve dysfunction
how does left sided heart failure work
backs up into left ventricle
then backs up into lungs
fluid in lungs — so you’ll hear crackles at base
pt eventually drowns to death
how does right sided heart failure work
right ventricle can’t pump as strong so the blood backs up into the body.
this causes welling in the body, edema and abdominal fullness
s/s of left sided hf
dyspnea, orthopnea
cough
pulmonary crackles
decrease O2 levels
oliguria
nocturia
decreased perfusion to systemic organs
s/s of right sided hf
lower extremity edema
ascites (acc. of fluid in peritoneal cavity)
hepatomegaly (enlargement of liver)
anorexia
nausea
weight gain due to fluid retention
decreased perfusion
weakness/fatigue, impaired cognition
this is the contraction of LV
contractivity
LV stretches beyond normal and it doesn’t contract back. this leads to decrease CO. like a rubberband without the snap
fluid overload
this medication works on contractility
2 examples
inotrope
digoxin, dobutamin
amount of blood pump out of LV in one heartbeat
stroke volume
how do you calculate the ejection fraction
it is the % of blood pumped out each heartbeat
normal is 50-70%
this is when the heart muscle is huge. but has good ejection fraction.
diastolic HF
the heart is big and boggy but can’t pump it, ejection fraction is abnormal.
-poor pumping action
-boggy LV taht can’t pump
systolic hf
this is the volume or pressure exerted on LV right before contraction
preload
amount of pressure that LV exerts to pump out blood
afterload
does the afterload increase or decrease with tight vessels
increase afterload
does the afterload increase or decrease with open vessels
decrease afterload
if there is a lot of blood in the preload this is called
hypervolemia
diastole is when the heart is what
at rest
systole is when the heart is
pumping
pt has clinical manifestations of coronary ischemia but ECG or cardiac biomarkers show no evidence of acute MI
this is called what
unstable angina
the patient has elevated cardiac biomarkers but no definite ECG evidence of acute MI
non stemi
the patient has ECG evidence of acute MI with characteristics changes in two ECG leads. Significant damage occurs
STEMI
what is the cardiac specific isoenzyme
CK-MB = creatine kinase myocardial band
this medication blocks sympathetic response. affects the afterload
beta blocker
what is an example of a beta blocker
metoprolol
what do you monitor for when taking beta blocker
orthostatic hypotension
this reduces preload and afterload
nitroglycerine
how often do you replace nitroglycerine medication
every 6 mos
this dilates the arteries (reduced afterload) resulting in decreased BP and decreased work of heart
nitroglycerine
this is used to treat angina, htn, tachycardia
calcium channel blockersq
do calcium channel blockers affect preload or afterload
afterload
decreases HR, BP, decreases myocardial contractility, slows conduction
if pt has HF the pt will be on which type of medication
ACE or ARB
this is used to prevent remodeling after MI
used dto treat systolic HF
ACE and ARBs
this creates vasodilation to decrease afterload to improve CO in HF
ACE/ARB
patient teaching for ARB and ACE
monitor BP
avoid salt substitutes bc contain K+
pt teaching for calcium channel blockers
-report weight gain or swelling in lower extremities
peripheral edema
waht do statins do
decrease LDL
increase HDL
decrease triglycerides
when do you take your statin
in the evening when cholesterol is highest
pt teaching for statins
grapefuit juice - no go
report muscle soreness
what medications lower cholesterol
statins
which medication decreases triglyerides
fibrates
this is used to treat HF to increase myocardial contractility
digoxin
inotropes
nursing consideration for inotrope
-drug level that’s safe 0.5-2
-listen to apical before giving
-monitor HR
-monitor serum K+
this creates a loss of K+, Na and Mg
diuretics
medication is used to treat HF and HTN by reducing fluid volume
furosemide
this is K+ sparing diuretic
spironolactonw
this is used to prevent MI and stroke
taken when ACS is suspected
decreases platelet aggregation
aspirin
antiplatelet medication - name two
prasugrel
clopidogrel
what do you assess for after pt has PCI
- vital signs
- look for bleeding
- avoid affected arm for bp and draws for 24 hours
- leave band on for min two hours
- neurovascular checks
- leave pulse ox on
waht changes do you report to HCP after PCI
chance in pts vital signs
any change in pt’s extremity - sensation, pain, bleeding, hematoma, lack of pulse, etc
