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module 7 > Cardiac Lecture > Flashcards

Cardiac Lecture Flashcards

1
Q

a condition that occurs when blood blow is decreased or blocked in the heart

A

acute coronary syndrome

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2
Q

what is the objective for acute coronary syndrome

A

decrease O2 demand and increase O2 supply

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3
Q

death or necrosis of myocardial cells caused by blood flow blockage

A

myocardial infarction

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4
Q

what are the 2 problems that occur in an MI

A

STEMI or NSTEMI

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5
Q

non occlusive blockage, is a block but not 100% blocked

A

non STEMI

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6
Q

100% occlusion of an artery

A

STEMI

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7
Q

which pt should be seen first a STEMI or NSTEMI

A

STEMI

*emergent and intervention with in 90 minutes or mortality goes up

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8
Q

damage in the heart starts from ______ to the ______ and after ___ minutes you have to many cells that have died

A

inside; outside; 90

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9
Q

what happens to the necrotic tissue of the heart once it has died

A

replaced with scar tissue

*hypoxia begins in 10 seconds and damage occurs 20 minutes of O2 deprivation

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10
Q

what are cardinal symptoms of an MI

A 
chest pain
elevated blood glucose
N/V
diaphoresis
increased HR/BP
S3/S4 heart sounds
peripheral vasoconstriction
fever
SOB
dizziness
altered mental status
dysrhythmias
pulmonary edema
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11
Q

how is an MI diagnosed

A

elevated cardiac enzymes PLUS
typical symptoms
ST segment changes
HX of cardiac intervention

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12
Q

alternate circulation around a blocked artery or vein via another route

A

collateral circulation
*develops in response to prolonged coronary artery disease or even with old age because as we age new routes are created and build new arteries

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13
Q

what lab is SPECIFIC to cardiac

A

troponin T or I

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14
Q

what level do you WANT to see on a troponin

A

non existent. 0 will make us happy

anything above that is a red flag

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15
Q

why is troponin lab preferred

A

it tells me that there is a CARDIAC injury or ischemia

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16
Q

what does the lab creatine kinase tell me

A

there is muscle injury somewhere just not sure where

*it is NOT cardiac specific

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17
Q

what does the lab myoglobin tell me

A

tells us there is cardiac injury but will NOT tell me if there is ischemia

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18
Q

what is the treatment for an MI

A

REPERFUSION
*give meds that dissolve the clot (thrombolytic therapy)
then if that doesn’t work they will go to cath lab then if that doesn’t work then they will go for cardiac bypass (most invasive)

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19
Q

if your pt complains of chest pain what do you do

A 
assess and figure out whats wrong
get an EKG 
IV access
draw labs
most important initiate MONA
*if there is an ST elevation send to cathlab
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20
Q

if pt is getting sent to cath lab what should we do to prepare pt

A

portable cardiac monitor, O2, ambu bag

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21
Q

result of pump failure

A

cardiogenic shock
*decrease cardiac output leads to decreased oxygenated nutrients to the tissues leads to initiation of the shock syndrome

22
Q

what is the most common cause of cardiogenic shock

A

acute MI

23
Q

what else could cause cardiogenic shock

A

blunt injury to heart, heart failure, dysrhythmia, any abnormality to the heart

24
Q

what manifestations would we expect to see in cardiogenic shock

A

pale, diaphoretic, clammy skin, tachycardia at start then bradycardia, crackles in lungs, altered mental status, lightheadedness

25
Q

why is fluid detrimental to cardiogenic shock pt

A

because there heart is not pumping well so adding more fluid will just overload them with fluid

26
Q

only give ______ inotropic drugs to the cardiogenic shock pt

A

positive
*norepinephrine shunts blood where its needed so keep an eye on peripheries
*dopamine increased heart contractility to get every drop of blood with every pump
will see pt’s with both of these drips going at the same time

27
Q

if pt is having a massive MI throwing them into cardiogenic shock we want to make sure they don’t have an ______ and want to ____ it up so these pt will be on anticoagulants, anti platelets, and GP IIb/IIa inhibitors

A

occlusion; break

28
Q

how does TPA work

A

pt has a clot and binds to fibrinogen killing the clot

*antidote is amniocarbacid

29
Q

in a code blue what are the steps

A

check for responsiveness
call for help
start CPR
*person who found the person is the “leader”

30
Q

what is important to tell the pt who had an MI

A

it is normal that you don’t want to eat and that you feel fatigues
rest is so important
avoid red meats, salty foods, fried foods
quit smoking
diet and meds are important

31
Q

if the blockage can not be fixed by anything the last resort is

A

cardiac bypass

32
Q

a pt post of of cardiac bypass will have chest tubes and what kind of blood will be draining immediately after surgery

A

frank blood

33
Q

what type of blood should be draining an hour after cardiac bypass

A

serosanguinous >1 hr post op

34
Q

drainage after cardiac bypass should not be more than

A

100ml/hr

35
Q

what should be done if chest tube disconnects from set up or breaks

A

put in sterile water to keep pressure from building in cavity

36
Q

if chest tube is pulled out what should be done

A

cover puncture site with NON occlusive dressing to allow air to escape (when in doubt)

37
Q

if a blood transfusion is needed because of major surgery it should be started within ___ minutes and infused within __ hours

A

30 min; 4hrs

38
Q

RBC transfusion is a

A

2 nurse check

*consent is necessary

39
Q

when giving a RBC transfusion what should be infusing with it

A

normal saline

*help to keep line patent

40
Q

when should vital signs be taken BEFORE blood transfusion

A

30 minutes before (also get vitals after transfusion)

*remain with the patient for the first 15 minutes of transfusion

41
Q

when an artery wall weakens causing it to widen abnormally or balloon out

A

aneurysm

42
Q

what are S/S of a non ruptured aneurysm

A

abd, back, or flank pain
pulsating abd
pain or discoloration in the feet

43
Q

what are S/S of a ruptured aneurysm

A

severe pain
hypotension (bleeding out)
pulsatile abd mass
*medical emergency

44
Q

aorta tears and blood flows between the artery layers

A

aortic dissection

  • type A- affects the ascending aorta and arch
  • type B- begins in the descending aorta
45
Q

what would you expect to see with an aortic dissection at the aortic arch

A

altered mental status

46
Q

what would you expect to see with an aortic dissection at the kidney level

A

back pain, decreased urine output

47
Q

what would you expect to see with an aortic dissection at the ‘Y’ before the legs

A

pale legs, decreased pulses

48
Q

how can we evaluate for a dissection

A

MRI, CT, TEE

49
Q

how can we manage or treat a dissection

A

surgery, BP meds

50
Q

a pericardial effusion extends the sac beyond its limits

A

cardiac tamponade

51
Q

what would be expected to see in a pt with cardiac tamponade

A

HR will increase to overcome, go into dysrhythmia, hypotension, anxious, chest pain

module 7 (8 decks)

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