Cardiac Flashcards
What is released when the heart is stretched
BNP
What is sterlings law
CO = HR X SV
What drugs affect preload
diuretics and nitrates
vasodilate or diurese to reduce preload (amount of stretch)
what drugs affect afterload
ACE inhibitors, ARBS, Hydralazine, Nitrates (vasodilate to reduce afterload)
what drugs improve contractility
Inotropes
dopamine, dobutamine, milrinone
What drugs are used for rate control
beta blockers, calcium channel blockers, digoxin
what is used for rhythm control
antiarrhythmics
What 3 arrhytmias are always a big deal
pulseless V tach, Vfib, asystole
CPR NOW NO CO
What is chronic stable angina
when there is intermittent decreased blood flow to the heard causing ischemia.
usually on exertion
when does stable angina cause pain
on exertion due to low O2 to heart
what relieves pain in stable angina
rest or nitro SL
what are the actions of nitoglycerin
venous and arterial dilation decreasing preload and afterload
dilates coronary arteries –> increase blood flow
what is the timing of administering nitro
1 every 5 min x 3 doses
how often should nitro SL be renewed? spray?
SL: 6 months
spray: 2 years
common side effect of nitro
HA
for pts taking nitro when should an ambulance be called
if still pain after 1 spray
what should happen to BP after nitro
decrease
what do BP do
block beta cells –> receptor sites for epi and NE
decrease BP, P and contractility –> decreases workload of heart
what happens with CO when taking beta blockers
decreases
what drugs are given for stable angina
nitro
beta blockers
calcium channel blockers
ASA
give examples of calcium channel blockers
nifedipine
verapamil
amlodopine
diltiazem
how do calcium channel blockers work
vasodilation of arterial system
dilate cornary arteries
what are two benefits of caclcium channel blcokers
decrease afterload and increase oxygen to the herat muscle
How does Aspirin work
prevents platelets from sticking together –> keeps blood flow
What is an important question to ask pre procedure regarding cardiac catheterization
are they allergic to iodine or shellfish
what is important to check prior to cardiac catheterization
renal function since you excrete the dye through your kidneys
what might the patient experience during dye injection for cardiac catherterization
warm and flush
palpitations
post cardiac catherization what it is important to do as a nurse
assess puncture site for bleeding
assess extremeity distal to puncture site for 5ps
bed rest, flat, extremeity striaghht
ask pt. to report pain asap
what are the 5 ps you must assess post cardiac catheterization
pulselessness pallor pain paresthesia paralysis
where do you assess the 5 ps and when
post cardiac catheterization and extreity distal to puncture site
what is the major complication we are worried about post cardiac catheterization
hemorrhage
what medication is held prior to cardiac catheterization and when is it given again. why?
metformin, 48 hours after; worried about kidneys
what is the number 1 sign of an MI in the elderly
SOB
what 3 components in lab work are we looking at regarding the heart
CPK-MB
Troponin
Mytoglobin
what is CPK-MB
cardiac specific
increased with damage to cardiac cells
elevates w/in 3-12 hours and eaks in 24 horus
What is troponin
cardiac biomarker with high specificity to myocardial damage
elevates within 3-4 hours and reminas elevated for up to 3 weeks
2 things about myoglobin
increases within 1 hour and peaks within 12 wnat a negative result
what cardiac biomarker is the most sensitive indicator for an MI
troponin
which enzymes or biomarkers are most helpful when the client delays seeking care?
troponin
If shocking a client doesnt’ work and the client remains in V-fib what is the first vasopressor we give
epinephrine
what common antiarrhythmic do we give for rapid heartrates and pulseless VT
amiodarone
what anti-arrhythmic drugs are given to preven a second episode of V fib
amiodarone and lidocaine
what sign is indicative of lidocaine toxicity
neuro changes
what is an important side effect of amiodarone
hypotension
what 4 things are given for P in emerg
oxygen
aspirin 160-325
nitro
morphine
what position do we keep an MI patient in and why
head up - decreases workload on the heart and increases CO
what is ideal door to drug time for thrombolytics
30 mins
how soon after the onset of myocardial pain should these drugs be administerd?
w/in 6-8 hours
what is the major complication associated with thrombolytics?
bleeding
what are 4 medications that require bleeding precautions
anti coags
anti platelets
anti thrombotics
acetaminophen
should you do ABGs on someone on bleeding precaution meds
hellz no; arteries bleed more
what is PCI what are some examples
percutaneous coronary intervention
include all angioplasty and stents –> can be any artery including renal
what is a major complicatoin of angioplasty
MI
what happens if there is any problem with PCI
pt. goes straight to sx
What is CABG? when is it used?
coronary artery bypass graft
used for multiple vessel disease or left main coronary artery
what coronary artery if occluded resuts in immediate death
LCA or widowmaker
what types of exercises should cardiac patients avoid?
isometric (weights)
when can sex be resumed for cardiac patients
when they can walk around the block or up a flight of stairs w/o discomfort
what is the safest time in the day for sex
morning time
what is the best exercise for an MI patient
walking
how is heart failure diagnosed
BNP (sensiive indicator; secreted b ventricle V and P is increased)
CXR (enlarged heart)
echo (look at pumping action and ejection fraction; also gives inromation on backflow and valve diseaes)
What do ACE inhibitors do
suppress RAS
prevent conversion of angio I –> II
dilation and increased stroke volume
what do ARBS do
block angiotension II receptors and cause a decrease in arterial resistance and BP
What do ACE and ARBs block? what does this do?
block aldosterone –> lose water and sodium and retain potassium
what needs to be monitored when taking digoxin
toxicity
what does digoxin do
slows HR and increases strength of contractions, thus improving CO and kidney perfusion
what is normal digoxin level
0.5-2
what are the early signs and symptoms of digoxin toxicty
anorexia
N/V
what are the late signs and symptoms of digoxin toxicitiy
arrhytmias and vision changes
where is the apical HR found
5yh intercostal space mid clavicular
what electrolyte imbalance are we worried about with digoxin? why
hypokalemia + digoxin = toxicity
ANY ELECTROLYTE IMBALANCE CAN CAUSE DIG TOXICITY
what do diuretics do
decrease preload
why should salt substitutes not be used in cardiac patients
contain excessive potassium
what amount of weight gain needs to be reported
1-2 kg
what should you think with fluid retention problems
HEART PROBLEMS
when are pacemakers used
with symptomatic bradycardia
what are the 3 types of pacemakers
temporary (invasive or non-invasive)
permanent
whats the difference between demand and permanent pacemakers
fixed - constant rate
demand - kicks in when HR goes below set rate
what is the most ommno complication post-op
electrode displacement
what exercises should be done with permanent pacemaker clients? WHy?
assisted passive range of motion exercises –> prevent frozen shoulder
why do you want to prevent pacemaker clients from raising their arms
could cause wires to fall out
what is it called if no contraction will follow the stimulus
loss of capture
wht is it called if the pacemaker fires at inappropriate times
failure to sense
what can cause loss of capture, failure to sense or other malfunctions
not programmed properly
electrodes dislodge
battery may be depleted
what client teaching needs to be done regarding pacemakers
check pulse daily
ID card and bracelet
avoid electromagnetic fileds (use cellphone on other side)
AVoid MRIS
who is at risk for pulmonary edema
reeiving IV fluids really fast
the very young and very old
any person who has a histroy of heart or kidney disease
when does pulmonary edema ussually occr
at night –> increased venous return lying down
what cough is associated with pulmonary edema
pink frothy sputum
how is pulmonary edema treated
oxygen furosemide (push slow to prevent hypotension and ototoxicity) nitroglycerin morphine --> vasodilation nesiritide --> vasodilation sit upwright
what drug infusion needs to be turned off 2 hours prio to drawing a BNP lvl
nesiritide
what is cardiac tamponade
blood, fluid or exudate leaks into the pericardial sac resluting in compression of the heart
what are the two hallmark signs of tamponade
increaseing CVP (heart is being squeezed) decreasing BP
what should you think with narrowed pulse pressure
cardiac tamponade
what should you think with widened pulse pressure
increased ICP
what is the pulse pressure
difference between systolic and the diastolic
we ______ veins and we ______arteries
elevate veins
dangle arteries
