Cardiac Disease Treatments Flashcards
What are pacemakers?
Initiate heartbeat when heart’s intrinsic electrical activity is inadequate
Why would someone need temporary pacing?
Bradydysrhythmias d/t drug toxicities electrolyte imbalances ACS Prophylactic support
Tachydyshrhythmias
d/t overdrive pacing
What is demand pacing
MOST COMMON
Acts like an AV node. Will kick out a pulse if no beat is detected at a certain rate. Ensures HR does not drop below whatever rate is set to.
Pacer pads and EKG Leads on patient (to look for electrical activity)
What is sensing threshold?
What beat to look for and how much power to deliver.
What are bipolar pacemakers?
two electrodes located within the heart
What are unipolar pacemakers?
negative electrode in direct contact with myocardium
Where are pads placed on transcutaneous pacers?
Right chest
Left lower ribcage, left of sternum
What is a pacing artifact?
Spike seen on EKG as pacer delivers stimulus
Transcutaneous pacing only paces the___
ventricle
If you see a P wave and then a pacer spike, the ___ are being paced
atria
If you see no P wave, but a spike and then a QRS wave, the ___ are being paced.
ventricles
If you see two pacer spikes (one at P wave, one at QRS), we are pacing ____
both chambers
What is failure to pace?
Slow HR with no pacer spikes
common with transvenous pacers
What is failure to capture?
Pacer delivering spike, but not strong enough to capture control of heart.
Pacer spike with no immediate response
What is failure to sense?
Pacer brain not detecting underlying rhythm. Attempting to pace even though heart working right.
What is undersensing?
Pacer not turning off when heart returns back to intrinsic rhythm
Underlying heart rhythm AND pacer spikes on top of it.
What is the nursing management for pacemaker patient?
Ensuring the patient is getting adequate pacer spikes.
What is the biggest thing to avoid if you have a pacemaker?
magnets.
They can turn pacer on./off
What is an implantable cardioverter defibrillator?
Detects V-Tach and delivers shock to fix rhythm
Also worn by severe heart failure patients
What does an ICD do?
Delivers ‘shock’ to provide electrical energy for shocks
What is the goal of fibrinolytic therapy?
Dissolve clot and restore blood flow to area.
When can someone not receive fibrinolytic therapy?
< 12 hours of when chest pain started (tissue now dead)
Persistent ST elevation (muscle actively dying)
If had recent stroke, had operation, or trauma within last 6 weeks
What to watch for if someone is getting fibrinolytic therapy?
bleeding!
monitor vitals and neuro for next 24 hours
What is evidence of reperfusion?
CP quits
ST elevation goes back to baseline
dysrhythmias
CK-MB peaks and decreases faster
What is percutaneous coronary interventions?
Cath lab procedure of balloon angioplasty.
Percutaneous because they go in through femoral artery
It is important to watch liver labs on cath lab patients because ___ is nephrotoxic
dye
What is a stent?
Metal net that opens up the narrow vessel
What is arthrectomy?
Dissolve/break down the clot using a roto-rooter drill bit type thing
What labs are done prior to cath lab procedures?
Creatinine.
If > 1.6, they are ok to go. Premedicate with steroids and fluids to protect kidneys
If a patient has an iodine allergy, can they get a cath procedure done?
Yes, with lots of steroids prior to procedure
What are complications of PCI?
Coronary spasm Coronary thrombosis Coronary dissection Bledding Hematoma Retroperitoneal bleed
What is the nursing management for PCI?
Monitor for: Recurrent angina Bleeding @ site Hemostatic devices peripheral pulses EVERY 15 MINUTES
Protect kidney function by giving pushing IV fluids to rinse out dye
Promote ambulation after 6 hours
How long do legs need to remain straight after cath?
6 hours
What is CABG?
Vein is used for grafting
What things need to be monitored after CABG?
surgery site
graft sites
bleeding
What do we teach about sternal protection post CABG?
do nothing that applies force or stretch the sternum.
What is pericardial tamponade?
blood leaks into pericardium, limiting heart movement.
What is beck’s triad?
Signs of cardiac tamponade:
~narrow pulse pressure
~JVD
~muffled heart sounds
What do you monitor for in chest tube output after CABG?
sudden increase (something’s leaking)
OR
quick cessation of flow (something’s clogged)
What is treatment for cardiac tamponade?
bedside thoracotomy
What is valvular surgery?
replace broken/bad heart valves
What is the biggest concern after heart transplant?
rejection
What are signs of heart failure rejection?
Pain
High fever
Failure of organ
Biggest risk after valve surgery?
clotting
Will be on coumadin
Keep INR between 1.5 - 2
What is cardiopulmonary bypass?
Blood shunted away from heart so we can operate on it
What is nursing management for cardiac post surgery?
~Optimize cardiac output
~Monitor temp (they are chilled during surgery)
~Look for drastic increase or stoppage of drainage
What are the indications to use intraorticic balloon pump?
Left ventricular failure after cardiac surgery
Unstable angina not managed by medications
Recurrent angina after MI
Complications of acute MI
Unresolved ventricular dysrhythmias
What is cariogenic shock?
HTN that occurs when heart does not pump right
What does intraaortic balloon pump do?
Inflates in diastole when aortic valve closes. (Increases myocardial oxygen supply)
Deflates just prior to opening of aortic valve (decreases resistance of left ventricular ejection)
What do we measure closely with balloon pump?
Skin level measurement.
What is a trans thoracic echocardiogram?
ultrasound of heart done through chest
What is a trans thoracic echocardiography?
looks for clots in the heart before a cardioversion
