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Module 7 (Critical Care) > Cardiac > Flashcards

Cardiac Flashcards

1
Q

How does the blood flow through the heart in order?

A

Superior/Inferior Vena Cava
R Atrium
Tricuspid Valve
R Ventricle
Pulmonic Valve
Pulmonary artery
Lungs
Pulmonary veins
L Atrium
Mitral Valve
L Ventricle
Aortic Valve
Aorta and Aortic Arch Arteries
To the body
Repeat

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2
Q

If a plaque happens in the coronary arteries, what could follow?

A

increase pressure can cause a break off and a clot can form causing an MI

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3
Q

A cardiac assessment includes what stethoscope points

A

Aortic
Pulmonic
Ereb’s Point
Tricuspid
Mitral (APICAL FOR 1 MINUTES)

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4
Q

The aortic valve is located at

A

R 2nd intercostal space

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5
Q

The pulmonic valve is located at

A

L 2nd intercostal space

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6
Q

Erb’s Point is located at

A

L 3rd intercostal space
heart murmurs can be heard best when auscultated

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7
Q

The tricuspid is located at

A

L 4-5th intercostal space

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8
Q

The mitral valve is located at

A

L 5th intercostal midclavicular

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9
Q

The lub sound is

A

Tricuspid and Mitral valve closing
start systole
Blood exits the ventricles and into the body

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10
Q

The dub sound is

A

Aortic and Pulmonic valve closing
start diastole
blood enters the ventricles

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11
Q

What are the different coronary arteries of the heart?

A

L coronary artery
R coronary artery
R (acute) marginal artery
circumflex artery
L (obtuse)marginal artery
L anterior descending artery
diagonal arteries

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12
Q

T/F: Auscultating a regular rhythm is hearing the same thing every time even if the extra beat is consistent.

A

True

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13
Q

What are the layers of the heart from out to in?

A

Fibrous pericardium (hard and why the wond gets knocked out of you)
pariental layer of serous pericardium
Pericardial cavity (lube for the heart)
Epicardium (visceral layer of serous pericardium)
Myocardium (pushes and muscles of the heart)
Endocardium

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14
Q

Right-sided Heart Failure s/s

A

generalized edema (swollen ankles)

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15
Q

Left-sided Heart Failure s/s

A

low perfusion
pulmonary congestion
low cardiac output

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16
Q

Preload

A

volume of blood in verticles at the end of diastole

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17
Q

Afterload

A

resistance left ventricle must overcome to circulate blood

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18
Q

Preload increased in

A

hypovolemia
regurgitation of cardiac valves

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19
Q

Afterload increased in

A

HTN
Vasoconstriction

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20
Q

If afterload is increased then

A

cardiac workload is increased

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21
Q

Stroke volume

A

amount of blood put out of the ventricles

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22
Q

Cardiac output

A

amount of blood into the body in 1 minute

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23
Q

Coronary Artery Disease is caused by

A

T2DM
HTN
Hyperlipidemia
High Cholesterol >100 (HDL = low) (LDL = high)
heart is working overtime

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24
Q

Coronary Artery Disease is

A

coronary arteries struggle to supply blood, oxygen, and nutrients to the heart muscle
- cholesterol plaques in the coronary arteries and inflammation

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25
Q

What is the nursing teaching for coronary artery disease?

A

Heart healthy diet
Exercise (working up to 20 minutes a day)
more fluids
Teach on what happens when you don’t stop eating bad
- Be realistic (cut down on the bad food, show them reality or MI will happen)

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26
Q

Heart Healthy Diet

A

Low salt, low fat, low cholesterol

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27
Q

What medications could be provided for Coronary Artery Disease?

A

Metformin - glucose
Beta-blockers - HTN
Statin - cholesterol

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28
Q

Statin drugs should be taken when

A

at night
- due to face flushing

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29
Q

What is Acute Coronary Syndrome?

A

condition occurs when blood flow is decreased or blocked in the heart
- unstable angina
- NSTEMI
- STEMI

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30
Q

What is the main difference between unstable angina and NSTEMI/STEMI?

A

Unstable angina does not cause necrosis
Both STEMI and NSTEMI can cause necrosis

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31
Q

What is the difference between NSTEMI and STEMI?

A

STEMI has an EKG ST elevation

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32
Q

What causes the chest pain in acute coronary syndrome?

A

ischemia

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33
Q

What is used to differentiate NSTEMI and STEMI?

A

EKG - ST elevations

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34
Q

What are the 2 goals if a patient comes in with chest pain?

A

decrease O2 demand
increase O2 supply

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35
Q

What is the priority intervention if a patient comes in with chest pain?

A

apply supplemental O2 (1st thing)
- 2L NC
decrease physical activity
administer medications

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36
Q

ACS medications should do what

A

decrease preload
decrease afterload
dilate coronary arteries
reduce contractility
reduce HR
prevent further thrombosis

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37
Q

What medications would you administer for ACS?

A

Beta-blockers
Anticoagulants
Calcium Channel Blockers
Nitrates - Nitroglycerin
Opioids - Morphine
Narcan
ACE/ARB

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38
Q

Beta Blockers

A

block epinephrine and adrenaline

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39
Q

Before you give a Beta Blocker, check

A

BP

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40
Q

Anticoagulants

A

prevent more clots

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41
Q

Calcium channel Blockers

A

decrease HR

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42
Q

Nitrates type

A

Nitroglycerin SUBLINGUAL

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43
Q

Nitroglycerin does what

A

dilates arteries and lowers BP absorption

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44
Q

What medications should you HOLD if HR is lower than 60?

A

Beta Blockers
Calcium Channel Blockers
- check the apical pulse

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45
Q

If the patient is sent home with topical Nitroglycerin, what should the nurse teach the patient?

A

Wear gloves
Sit down

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46
Q

What is contraindicated with Nitroglycerin?

A

Viagra
- ask males after clearing the room as it can be fatal if combined

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47
Q

81 mg Aspirin is absorbed by

A

chewing (sublingual) causing absorption quickly into the bloodstream

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48
Q

As people get older, they are at a higher risk of what cardiac critical care illness?

A

increased risk of plaques due to blood vessels stiffening and tough
increase resistance = high BP

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49
Q

Nitroglycerin should be given how

A

Sublingual
wait 5 minutes
repeat up to 3 times
Move to Morphine

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50
Q

With morphine, what do you need to watch?

A

RR and O2Sat
- possibly can give if less than 10 in a cardiac situation

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51
Q

ACE/ARBs do what

A

vasodilate preload and afterload

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52
Q

ACE/ARB side effect

A

dry mouth

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53
Q

ACE/ARB adverse effect and need to see HCP

A

coughing not going away

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54
Q

What is an MI

A

death/necrosis of myocardial cells caused by blood flow blockage
- STEMI / NSTEMI

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55
Q

How long does the medical team have to get a NSTEMI into the cath lab?

A

12-72 hours
= if not necrosis

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56
Q

How long does the medical team have to get a STEMI into the cath lab?

A

90 minutes

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57
Q

NSTEMI is a

A

partial occlusion at a 50% rate
- enzymes up and heart damage still

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58
Q

STEMI is a

A

total occlusion emergency and reopen within 90 minutes in the cath lab

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59
Q

STEMI has total necrosis within

A

4-6 hours of the myocardium
- Hypomyokinesis
- Akinesis

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60
Q

Hypomyokinesis

A
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61
Q

Akinesis

A
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62
Q

What is the ACS/MI?
The chest pain goes away after giving Nitro and lab levels are normal.

A

Unstable angina

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63
Q

What is the ACS/MI?
The chest pain is constant and labs show cardiac injury.

A

STEMI - ST elevation
NSTEMI - no ST elevation

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64
Q

Time =

A

Muscle
- when the cells have died they are gone
- replaces necrotic cells with scar tissue

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65
Q

Hypoxia begins in

A

10 seconds

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66
Q

O2 deprivation can cause damage to occur after

A

20 minutes

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67
Q

STEMI is an emergent situation! Intervention within

A

90 minutes

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68
Q

Typical s/s of MI

A

Chest pain /discomfort /pressure - ELEPHANT
Elevated blood glucose
N/V
Diaphoresis
Increased HR/BP
S3/S4 heart sounds
Peripheral vasoconstriction
Fever
SOB
Dizziness
AMS
Dysrhythmias
Pulmonary edema

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69
Q

Atypical s/s of MI

A

ANY S/S NOT ACCOMPANIED BY CHEST PAIN
- “I just don’t feel good”
- if they have multiple dx

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70
Q

Nitroglycerin is sensitive to

A

light

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71
Q

Older adults are more common to have

A

MI without chest pain

72
Q

What gender is more common to have MI

A

women

73
Q

Description frequently used for MI

A

squeezing
band-like sensation
tightness
burning/heartburn
pressure
ache
crushing
knot in the center of chest
toothache
Elephant/heavy wt

74
Q

Description NOT frequently used for

A

SHARP
knife
changed with breathing
stabbing
pins and needles

75
Q

Can a NSTEMI turn into a STEMI

A

YES

76
Q

How do you know if a NSTEMI turns into a STEMI?

A

PULMONARY S/S
TACHYCARDIA
COOL, CLAMMY SKIN

77
Q

What do you do when the NSTEMI goes into a STEMI

A

Call doc immediately

78
Q

Diagnosis of an MI includes

A

elevated cardiac enzymes
typical s/s
ST Segment changes
Hx of cardiac intervention

79
Q

What can help guide to the dx of MI?

A

EKG - ST elevations
Cardiac Enzymes - cardiac injury
Stress Test - follow-ups
Echo
Coronary Angiogram

80
Q

Cardiac s/s in an MI is a sign of

A

late stage ischemia

81
Q

Cardiac Enzymes show what

A

cardiac injury

82
Q

Occlusion/Collateral Circulation

A

can be good with by helping the patient live because of plague build up blocking the path (makes an alternate detour around the plague with only slight higher pressure)

83
Q

When does a collateral circulation become known as the widow maker?

A

Left Anterior Descending gets plaque (the doctor can not make it through the tiny branches to get to the clot inside becoming inoperable

84
Q

Troponin is best known for letting the medical staff know they had an

A

MI

85
Q

Troponin elevates after how many hours of injury?

A

4-6 hours

86
Q

Troponin peaks at

A

10-24 hours

87
Q

Troponin level normals

A

<0.03 (I)
<0.1 (T)

88
Q

Troponin is found in

A

skeletal and cardiac muscles

89
Q

Creatine Kinase (CK) elevates how long after injury

A

6 hours

90
Q

CK peaks after

A

18 hours

91
Q

Normal level of CK

A

30-170

92
Q

CK returns to normal how long after injury

A

24-36 hours

93
Q

CK is found

A

muscle (not heart specific)

94
Q

CK shows

A

muscle damage
- workout to heart attack
DOES NOT MEAN MI

95
Q

CK-MB (Myoglobin) elevates within

A

2 hours

96
Q

CK-MB peaks at

A

3-15 hours

97
Q

CK-MB normal

A

<90

98
Q

CK-MB returns to normal after

A

12-24 hours after injury

99
Q

CK-MB is specific to

A

cardiac

100
Q

CK-MB is elevated due to to

A

shock and myocarditis

101
Q

CK-MB shows

A

heart damage

102
Q

What is the correct order of interventions if a person comes in with chest pain?

A

Rest
Apply supplemental O2 – NC to NRB
Place the patient on a cardiac monitor – ST Elevation
Vital signs -
EKG
Ensure adequate IV access – 2 large bore IVs for cath labs and get blood
Draw cardiac enzymes
Administer medication – Nitro to Morphine
Get patient ready for reperfusion therapy
Cath Lab

103
Q

What can the ER instruct a patient to do if they are waiting for the ambulance to come to their house when they have chest pain?

A

have high-dose aspirin

104
Q

MI Medications

A

Nitrates (IV/SL nitroglycerin)
Beta-blockers (Metoprolol)
Antiplatelet Agents (ASA/Clopidogrel/Eptifibatide)
Anticoagulants (Heparin/Enoxaparin)
Thrombolytic Therapy (Alteplase)

105
Q

Antiplatelet Agents types

A

(ASA/Clopidogrel/Eptifibatide)

106
Q

Thrombolytic Therapy

A

(Alteplase)

107
Q

Beta blockers do what

A

lowers pumping allows the heart to decrease the workload

108
Q

Anticoagulant labs therapeutic level for MI

A

2-3X NORMAL

109
Q

PT/INR normal

A

PT 11-13.5 secs
INR 0.8-1.1

110
Q

PT/INR normal for MI

A

PT 22-33 secs
INR 2.4-3.3 secs
2-3 x the therapeutic range

111
Q

Antiplatelet agents ASA or Heparin
- which half-life is longer

A

antiplatelet agents

112
Q

If the patient is going to the cath lab, what medication can be given?

A

anticoagulant heparin due to lower half-life

113
Q

Thrombolytic therapy does what

A

low platelets

114
Q

HIT stands for

A

Heparin-Induced Thrombocytopenia

115
Q

HIT is defined as

A

immune response to heparin by the body making antibodies

116
Q

HIT on platelets

A

platelets are activated
increase platelet plugs
increase R/O thrombosis
low circulating platelets

117
Q

HIT can typically occur how many days into tx

A

5-10 days
- possibly in 24 hours

118
Q

If you suspect HIT, what nursing intervention needs to happen?

A

DC immediately
bed rest (fall risk, bleed out and die)
Argatroban and Ivalirudin

119
Q

What are the s/s of HIT?

A

Plt. <150 or drop of 50% + from baseline
Arterial or venous thrombosis
Acute systemic reactions after administration

120
Q

What are continuous treatment of MI?

A

Percutaneous Coronary Intervention (PCI)
Cardiac Bypass
CABG

121
Q

What is the main goal of continued treatment of MIs?

A

reperfusion of cardiac muscle

122
Q

With continued treatment (PCI, Stents, and CABG), what does the nurse need to ask the patient before they continue?

A

allergy to shellfish or iodine

123
Q

What are s/s of post-op hemorrhage?

A

low BP
high HR
cold
no pulses in feet

124
Q

What should you do if the patient is bleeding from the femoral incision site?

A

notify HCP
put tons of pressure on the site

125
Q

If the incision for PCI is located on the right femoral artery site, what pulse should you check?

A

right sided popliteal and pedal pulses and check with the left side

126
Q

How long should the patient be on bedrest after going to the cath lab?

A

6 hours to clot and for the blood thinners to get out of the system

126
Q

Cardiogenic Shock occurs

A

inadequate tissue perfusion due to cardiac dysfunction
- low O2 to cardiac muscles = low cardiac function = low perfusion to the body

127
Q

Most common cause of cardiogenic shock

A

MI from ischemia and necrosis

128
Q

Cardiogenic is what type of problem

A

pump
- MI have all the volume needed

129
Q

Hypovolemic is what type of problem?

A

volume problem
- shark bite = volume, nutrient, and O2 all deplete

130
Q

With cardiogenic shock patient, do not give them what?

A

fluid bolus

131
Q

Treatment for cardiogenic shock

A

fix the pump do not bolus
- reperfusion of cardiac muscle
- find the cause and treat it
- ASA to PCI to clopidogrel
- symptom mgmt

132
Q

Cardiogenic shock mortality rate

A

50-70%
- life-threatening

133
Q

What are symptoms of cardiogenic shock?

A

dysrhythmias
Hypotension
Fluid overload

134
Q

S/S of Cardiogenic Shock Intervention
- dysrhythmias

A

antidysrhythmics
- Amiodarone

135
Q

S/S of Cardiogenic Shock Intervention
- Hypotension

A

positive inotropic and vasopressor agents
- Norepinephrine
- Dopamine
NO BETA BLOCKERS
Cautious fluid admin
- 250 mL fluid challenge

136
Q

S/S of Cardiogenic Shock Intervention
- Fluid Overload

A

Diuretics
Vasodilators

137
Q

What medication should the cardiogenic shock patient avoid?

A

Beta Blockers

138
Q

What do the vital signs of cardiogenic shock?

A

Hypotension = heart not being able to beat due to the fluid surrounding it
Tachycardia = trying to compensate

139
Q

How long does it take for a person to recover from a MI?

A

several weeks
- scar tissue replaces damaged heart muscles

140
Q

What life style changes are necessary for recovery of an MI?

A

New medications
Diet modifications
Activity modifications
Tobacco Cessation

141
Q

What is a good resource for MI recovery?

A

Cardiac rehab
- restoration of a person to an optimal state of function

142
Q

What are the expected physiological recovery for an MI?

A

weight reduction
smoking cessation
physical exercise
healthy eating
rest and comfort

143
Q

What are the expected psychological recovery for an MI?

A

dealing with fear, anger, and depression

144
Q

What are the expected mental recovery for an MI?

A

mgmt of stress
relaxation techniques

145
Q

What are the expected spiritual recovery for an MI?

A

support to deal with guilt
feeling of hopelessness

146
Q

What are the expected economic recovery for an MI?

A

dealing with loss of income
restrictions on work

147
Q

What are the expected vocational recovery for an MI?

A

assistance with new skills

148
Q

What are some non-modifiable risk factors?

A

age
race
ethnicity
gender????

149
Q

What can happen if the blockage can not be fixed with PCI?

A

Cardiac Bypass (CABG)

150
Q

T/F: The CABG patient should not cough as it can disturb the heart

A

False, the CABG patient should cough so they can take a deep breath and prevent pneumonia

151
Q

Why would a CABG patient need insulin?

A

due to stress from epinephrine
only for the acute phase of recovery
impair wound healing if high glucose

152
Q

Chest Tubes are always present after a bypass to

A

drain excess blood

153
Q

When does the most amount of drainage come from a chest tube?

A

immediately post-op upon insertion

154
Q

Chest tube drainage post-op > 1 hour

A

serosanguinous
- if still fresh than hemorrhage

155
Q

Chest Tibe drainage should not be more than ______ mL/hr

A

100

156
Q

What should never be done to a chest tube?

A

milk or clamp the line
below the chest always

157
Q

If the chest tube is disconnected from the setup or the setup breaks, what should the nurse do?

A

place the tip in sterile water

158
Q

What should the nurse do if the chest tube is pulled out?

A

notify
3-sided bandage
pull and replace

159
Q

What does AAA mean?

A

Aortic Abdominal Aneurysms

160
Q

Aneurysm

A

artery wall weakens causing it to widen abnormally or “balloon out”

161
Q

S/S of an unruptured AAA

A

Abdominal, back or flank pain
Pulsating abdomen
high HR
low BP
Pain or discoloration in the feet

162
Q

S/S of a ruptured AAA

A

Severe pain
Hypotension
Pulsatile abdominal mass
MEDICAL EMERGENCY!!

163
Q

What is the priority for AAA pt?

A
164
Q

AAA can be described in simple terms as a

A

water hose on full blast bleeding out into the abdominal cavity

165
Q

If the AAA patient is stable, what would nurses do?

A

imaging CT
consent for surgery
T&C

166
Q

If the patient has a unstable unruptured AAA, then what should the nurse do?

A

do not touch if the abdomen is pulsating
- get to the OR as quickly as possible

167
Q

If the AAA patient has ruptured, then

A

straight to the OR

168
Q

When the AAA has been repaired, then you can give the patient

A

blood and fluids with large bore IVs
VS Baseline
Peripheral Pulses

169
Q

Tx of AAA

A

open repair
endovascular aneurysm repair (EVAR)
Fluids and Blood

170
Q

EVAR does what

A

replaces diseased part of the aorta

171
Q

AAA Post-Op Complications

A

MI
Bleeding
Renal Failure
Bowel/Ureteral injury
GI complications
Leg ischemia
Graft infection (mortality of 90% with this)

172
Q

Cardiac Tamponade is a

A

pericardial effusion (build-up of fluid, blood, air) extends the sac beyond its limits
- heart unable to function properly (compressing)

173
Q

S/S of Cardiac Tamponade

A

Beck’s Triad
- Hypotension
- Distension of Jugular Veins
- Muffled Heart Sounds (SQUISHY S1 AND S2)
Bruising of the Sternum sometimes
Tachycardia
SOB
not everyone will show all 3 signs

174
Q

Tx of Cardiac Tamponade
- if has hemodynamic changes

A

Pericardiocentesis
- percutaneous fine needle (pierce and suck out the fluid)
- surgical is more unstable

175
Q

Tx of Cardiac Tamponade
- if has NO hemodynamic changes

A

conservative mgmt with continuous hemodynamic assessment

Module 7 (Critical Care) (22 decks)

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