Cardiac Alternations Flashcards
What is an abdominal aortic aneurysm?
An abdominal aortic aneurysm occurs when a lower part of the body’s main artery, called the aorta, becomes weakened and bulges. An abdominal aortic aneurysm is an enlarged area in the lower part of the body’s main artery, called the aorta
patient teaching+follow up info post cardiac cauterization?
No bending or lifting for 2 – 6 weeks
Careful with cleaning (they can have a shower - we don’t want direct soap or water scrubed into the site, not longer than 10min, water can run down) - can shower if there is no drainage coming out
What will beta-blockers do?
Beta Blockers: We give this because it can help control their HR, this is helpful because it can lower the HR to lower O2 demands – higher the oulse rate the more O2 demands we have
Why do we need to be catious with administering beta-blocker?(what can they cause)
Be cautious whenever using beta blockers as they can very quickly cause a dangerous drop in heart rate
What kind of symptoms do women often have with an MI?
-Women are often atypical and sometimes don’t present the same way men would (feeling unwell sleep disturbances are some of the most common symptoms)
Post procedure cardiac cath lab nursing interventions?
Post-procedure:
-Pull out catheter
-Monitor for signs of bleeding (putting pressure on the site of insertion)
-We could have a vaovgoresponse from putting pressure on the site and disrupting blood flow
Why do we give Aspirin?
Asprin: Give an antiplate medication to prevent the clot from getting bigger (they stop the platelets from sticking together) – we administer SL and get them to CHEW IT - we want quick absorption (do not swallow it!!)
Pre procedure cardiac cath lab nursing interventions?
Pre-procedure:
-Before the patient goes into surgery, we will:
-Give profloatic antibiotics
-Consent
-Med history (what have they already taken/that morning) -
-Vitals (height and weight)
-Baseline ECG (have this right before they go so we are able to compare)
-Goals of Care
-Allergy!!! ( this is important due to the dye)
S+S of venous peripheral vasc disease?
S+S if it is venous: we will notice skin colour changes, sloughing, swleein , edema, wet – we have pain and can be relieved when we put our feet up, aching pain –pain releved when we lift/rest the leg up – vericos vains
Why is there SOB+Diaphoresis with an MI?
Due to activation of the SNS?
What is peripheral vasc disease?
Peripheral Vascular Disease (PVD), also known as Peripheral Arterial Disease (PAD), is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. When you develop peripheral vascular disease, your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication).
PVD is typically caused by atherosclerosis, a condition where plaque builds up in the arterial walls and reduces the flow of blood.
What happens/is going on with an MI?
With an MI the unstable plaque ruptures (plaques are filled with lipids) when this happens this causes a narrowing of the blood vessels which causes perminant damage to the heart muscle it’s self
What kind of pateints might have issues with properly noticing symptoms of an MI?Why?
Those with diabetes due to a decrese in sensation
Complications of an open AAA Repair?
Complications (open):
-Infection
-Hypovolemia from bleeding
-Kidney damage (from clamping off blood flow)
-Will have staples
Why don’t we see ST elevation on an ECG with an NSTEMI?
-We don’t see ST elevation here because there is repolarization here (there is still electricity going through here)
What is unstable angina?
Unstable angia is plaque with stability
S+S of MI?
Anxiety
Chrushing chest pain
left arm pain(med)
Arm,back,jaw pain(women)
Diaphoresis
Nausea
SOB
Management of Heart/pump failure?(Non-pharmacolgic therapy)
O2: Number one thing we are going to make sure that our patient is on (not an order if a patient has chest pain the first thing we have to do is put them on O2)
Pacemaker/ICD (Implanted cardiac defibulator): We have somone on a pacemaker because we have an insufficant heart that is not pumping the way that it needs to be
ECMO: This I still circulating blood through the heart, this is taking over the beating of the heart and oxygenation (will have this in surgery)
VAD: LVAD (think of greys) – this is physically pumping for the heart – it is taking oxygenation blood and pumping it through the aortia – this is done for patients that are waiting for a heart transpant – the ventricle is no longer working – they can last days on it (depends on the person for how long they will have) – it is pumping the blood into the aortia
Heart Transplant: You getting a new heart
When do we tell patients to come back to the hospital following an AAA repair?
Tell the patient to come back to the hospital if:
-Wound dehyse occurs
-Stretching, swelling, redness around wound (infection) – fatigue, fever, redness, swelling
Nursing care post angiogram?
Nursing care: Patient can’t sit up and bend for a couple of hours
How do we diagnose PVD?
Diagnosis of PVD begins with a physical examination, during which a doctor will look for signs of poor circulation. The Ankle-Brachial Index (ABI) — a comparative blood pressure reading in your ankle and arm — is a common test used to diagnose PVD. Further assessments may include Doppler and ultrasound imaging, Magnetic Resonance Angiography (MRA), and angiography.
Why do we give nitrates?
Nitrate: Vasodiolater – we want to administer this to increase blood flow back to the heart (widen the pathway so we can get more blood to the hear) – we need to monitor for hypotension – evaluate BP and pulse rate administration – we can administer this through spray, SL, or via IV (move to IV if we are not getting the response we need for SL) – We give every 5 min for up to 3 doses (follow MD order)
What do we do/put our patients on for continueus Ax?
For continuous assessment we want out patients on:
1.) Cardiac monitor
2.) Administer Nitro
3.) Manage pain
4.) Start 12 lead ECG/ cardiac monitoring
5.) Assess if they need O2
6.) Start IV
what do we monitor paitnets for with both an open and closed AAA repair?
*For both monitor for post op illius
*May or may not be able to have a shower depending on how much drainage there is
S+S of right sided HF?(What caused it?)
Right sided: Caused by left sided
Symptoms are all perpetually (Edema in legs, JVD, liver issues
Angioplsaty complications?
-Rupture
-Thrombus formation – due to us going in there and blocking
-Patient doesn’t feel this – they will feel pressure in other places
-Damage to endothelium (could be causing issues were trying to fix)
-Infection
Risk factors for peripheral vascular disease?
Risk: Diabetics, smokers, poor diet, sedearty lifestyle, stress, chronic hypertnetion
What will ACE inhibitors; Angiotensin II receptor blockers; Calcium channel blockers do?
ACE inhibitors; Angiotensin II receptor blockers; Calcium channel blockers: Given because they decrease workload of the heart
complications of a closed AAA repair?
Complications (closed/stint):
-Rupture
-Endothelial damage
-Might migrate (change positon)
-Bleeding
-Infection
-Still monitor kidneys
What does it mean If a person has an acute corninary syndrome?
If a person has an acute corninary syndrome it means that the patient has had an MI (heart attack), or Unsatable angina (can/will transition to a STEMI)
WHat do we need to be catious with when administering Morphine or Nitro?(What can they cause?)
Be cautious whenever using morphine or nitroglycerin as they can very quickly cause a dangerous drop in blood pressure
Complications of femoral-popiteal bypass?
Complications:
-Bleeding at site
-Increase edema due to striping the vein
-Bruising, bleeding, etc
-We can have a thromis that we can fire off somewhere else due to us dealing with the artery
Risk factors for heart surgery/CAGB?
Risk factors:
Pneumonia: From aspirations, from the patient not taking deep breaths and/or coughing (we need to clear out those secretions) and atelectasis
*Pain move up slightly higher because it is [ainful for you to take deep resirations
DVT: Patient is immobile for the surgery
Heart muscle dysfunction: We can have this due to too much damage to the heart, surgery didn’t work, heart isn’t waking up properly,
Arrhythmias: We have possible interfered with it due to potential scaring
Kidney failure: Major problem due to elecotrlyte impalances and we are stoping blood flow to the kidneys
Stroke: Can come from stopping and starting the heart
Treatment of periferal vasc disease?
Treatment for PVD focuses on symptom management and controlling the risk factors to slow the progression of the disease. This includes:
Lifestyle changes: Quitting smoking, exercising, and healthy eating.
Medications: To improve blood flow, manage symptoms like high blood pressure, cholesterol, and diabetes medications.
Surgical procedures: Angioplasty, stent placement, or bypass surgery may be necessary to restore proper blood flow in the affected arteries.
S+S of arterial vasc disease?
S+S Arterial: We don’t have oxygen going down – pale, cold, poor pulses because we cant get the bloos going down, leg is shiny and hairless, the ulcers will have round edges and be dry (can see exactly where the edges are) – we have pain with intermidtened (person is walking around) activity will cause pain, pain comes more quickly
S+S of left sided heart failure?(what caused it?)
Left-sided: Caused by a heart attack (MI) – failure of the left ventricle - damage that has been done thorugh cardiac arrest
-Symtpoms are all in the pulmonary system (SOB, fluid overlaod, pulmonary edema, etc)
Nursing prioirites for post CABG?
Nursing Priorities
Assessment and management
Dressing
Drain
Pacemaker
Medications
Hygiene
We need to make sure that we do get our patients moving
-Continuing to do our focused cardiac assesments
-We do restart the heart so we want to make sure that we have a good/stable Rhythm going on
How do we treat the underlying cause in patients with an MI?
Treat the underlying cause:
-We are going to figure this out through blood work (tells us if we had an MI), ECG (tells us what artery is affected), and administer anticouagulants (to help stop the clots form getting bigger or new ones forming)
WHat is the goal/how soon do we want to get cardiac catheritzation done?
-Goal is to due it within 12 hrs if it is a STEMI and if it is a NSTEMI24 – 48hrs if it is a minor one (Angio within 12 hours if a patient has had an MI)
Why are PCIs prefered as opposed to thrombolitics?
-PCI is preferred as opposed to thromoblitics due to better longterm outcomes
Which MI would we give a thromoboltic to? What do we need to do before administering this? What can it do if were wrong?
Thrombolytics: Only administered to patients with a STEMI!!!! – we need to confim the diagnosis of a STEMI before admin – These are clot busters – they only go to patients that have a STEMI due to the risk of bleeding – If we give a patient that is having a NSTEMI we can worsen the MI that the patient is experiencing (makes the damage worse)
Common causes of peripheral vasc disease?(from ChatGPT)
Atherosclerosis: The most common cause, leading to narrowing and hardening of the arteries.
Inflammation: Inflammatory conditions, such as arteritis, can damage blood vessels.
Injury to limbs: Accidents, surgeries, or injuries can lead to vessel damage.
Blood clotting disorders: Hypercoagulable states or conditions like deep vein thrombosis (DVT) can also affect peripheral arteries.
What is a femoral popiteal bypass?
Definition:
-They are going to take a graft (vein), flip it and bypass the popliteal artery
-The atcholriss has gotten to bad
-Can be done open or closed
A femoral-popliteal bypass, often simply referred to as a “fem-pop” bypass, is a surgical procedure used to treat peripheral arterial disease (PAD), specifically in the leg arteries. This disease causes the arteries that carry blood to the limbs to become narrowed or blocked due to atherosclerosis, where plaque builds up inside the artery walls. This can lead to pain, sores, or even severe limb issues due to reduced blood flow.
What meds might pre prescibed for post cardiac catheritzation?
Post-procedure meds:
*Maybe antibiotics (profolaticly)
*Anticoagulants (depending on what we need – Aspin maybe?)
*For fluids, they should be drinking a normal amount (1 – 2L) - don’t want to overload them
Complications of cardiac cath lab?
Complications:
Bleeding/Hematoma-Can develop psudoanurum (leakage of blood between the vessel layers – not a true anurythm but there is bleeding)
Arterial thrombus
Pseudoaneurysm or AV fistula-Formation of fistula from the damage and minpuation that we have done
Retroperitoneal bleed-Retropertioneal bleed (bleeding that is into the back – not visible until its quiate severe)
Complications of Angiogram?
Complications: Infections, vessel damage, vessel rupture – done in cath lab (patient is awake)
Difference between an open and closed AAA repair
The primary difference between open and closed (endovascular) AAA repair lies in the approach and invasiveness of the procedure. Open AAA repair involves a large abdominal incision to directly access and replace the diseased section of the aorta with a synthetic graft, typically resulting in a longer recovery and higher immediate risk of complications. Conversely, the closed or endovascular approach uses a minimally invasive technique, where a stent graft is inserted through small incisions in the groin and guided into place via imaging, reinforcing the weakened aorta from within. This method generally allows for a quicker recovery, less pain, and a shorter hospital stay, although it may require ongoing monitoring for potential long-term complications.
Why do we administer morphine?
Morphine: We give this to manage pain – we want to treat their pain because pain increases out O2 demands and increases the sympathetic system so it will help relax them as well – we need to be carful for resp depression, sedation, and vasodilation (we don’t want this)
Open Vs Closed femoral poplital bypass?
(Closed)Surgical Technique: The surgery involves using a graft to create a new pathway for blood flow from the femoral artery in the thigh to the popliteal artery, which is located behind the knee. The graft used can either be a section of one of the patient’s own veins (often the greater saphenous vein), which is considered the best option due to compatibility and durability, or a synthetic tube made from materials like Dacron or polytetrafluoroethylene (PTFE) if the patient’s veins are not suitable.
(Open)Procedure Details: The surgeon makes an incision at the site of the femoral artery in the groin and another near the popliteal artery. The chosen graft is then sewn into place, bypassing the blocked section of the artery. Blood flow is rerouted through the graft, bypassing the obstructed or narrowed artery segment.
Complications of heart surgery/CABG?
Infection
Pneumonia
Deep vein thrombosis
Heart muscle dysfunction
Arrhythmias
Kidney failure
Stroke
Myocardial infarction
Decreased cardiac output
When do we need to do a 15 lead ECG?
If patient is having a right side infarct we wont see as well with a 12 lead ECG (if we suspect a right side MI we will do a 15 lead)
How long does it take for myoglbin to retrun to normal?
CK-MB
Myoglobun: Takes about 24hrs to return to normal, elevates faster
Why do we need to be catious when administering thrombolytics?(What can they cause?)
Be cautious whenever using anti-clotting medications (particularly thrombolytics / fibrinolytics) due to the risk of bleeding
What are we going to do as the bedisde nurse if our patient is having a STEMI?
As the bedside nurse we are going to:
-Change position (sit them up, but we need to be cautious when doing so due to orthostatic hypotension)
-Administer O2 (only recommended if the patient is symptomatic – low stats or experiencing SOB)
-If we need to bring HR up we are going to but on external pacing
What must there be on an ECG in order for us to fully diagnose a STEMI?
In order for an STEMI to be diagnosed, it needs to be seen in 2 continuous leads
* We need to have a minimum of 3 areas in the heart with changes in order to be able to diagnose a STEMI
