Cardiac Part 1 Flashcards
What is the opposite of aldosterone?
When is is released?
ANP
When there is increased preload so it causes us to lose Na and water
CO = ___ x ____
CO = Stroke Volume x HR
Stroke volume
Amount of blood pumped out of the ventricles with each beat
What 3 things affect CO
HR and rhythm (arrhythmias)
Blood volume
Contractility (MI, meds, disease)
When to worry about arrhythmias? What 3?
What are we going to do if they occur?
When they affect CO
V fib, pulseless V tach, Systole
NEED TO ASSESS BEFORE CALLING THE PHYSICAIN!
H-T assessment to see if they affect CO (LOC, chest pain, SOB, crackles, cold/clammy, low UO, weak pulses)
What is the most common type of cardiac disease?
What does this include?
CAD
Chronic stable Angina & Acute Coronary Syndrome
What causes CHRONIC stable angina?
What is the pain due to?
What relieves it?
Decreased blood flow to the myocardium causing ISCHEMIA and temporary pain/pressure in the chest
Pain d/t low O2 usually due to exertion
Rest and SL NTG should relieve
Effects of NTG
How to take it?
How is it stored?
SE?
Venous and arterial VD
Decrease Preload & afterload
Dilation of coronary arteries
DECREASED BP - but should return
SL - may burn/fizz
Dark, glass bottle - don’t mix, keep it cool and dry
SE: Headache
How often should the patient renew NTG?
What about the spray?
3-5 months
2 years
What if the BP doesn’t come back up after NTG?
They are unstable!! Need medical attention
NEVER LEAVE AN UNSTABLE CLIENT! If BP changes, DON’T LEAVE! The BP could keep decreasing
3 drug types that prevent angina
BB, CCB, aspirin
Affects of BB on angina and the heart
SE
PREVENT angina
Decreased BP, HR, contractility,
Decrease CO
Decreased heart workload
Beta cells are receptor sites for the catecholamines that release epi and NE –> We block this
Examples of CCB
Nifedipine, Verapamil, amlodipine, diltiazem, nicardipine
CCB affect on angina and the heart
PREVENT angina Decreased BP Arterial vasodilation Dilate coronary arteries Decreased afterload Increase O2 to the heart
Generic name for Aspirin
Acetylsalicylate Acid
Client teaching for Chronic stable angina
Rest? Diet/Eating? Exercising? Temperature changes? NTG Avoid what kind of exercising and why?
Rest frequently
Avoid overeating, lose weight
Avoid excess caffeine or drugs that increase HR
Wait 2 hours after eating to exercise
Dress warm in cold weather (Temp change can precipitate an attack)
Take NTG prophylactically - Need to sit down wile taking!
Smoking cessation
Reduce stress (relaxation)
Avoid isometric exercises (exercises that squeeze muscles - increases workload)
Chronic Stable Angina NCLEX RULE OF THUMB
DO EVERYTHING YOU CAN DO TO DECREASE THE WORKLOAD ON THE HEART
Surgical way to diagnose Chronic unstable angina
Cardiac Cath
What to do before cardiac cath Ask what? Check what? What may be given especially with kidney problems? How will they feel?
Allergy to iodine or shellfish
Check kidney function because dye is nephrotoxic
acetylcysteine (Mucomyst) to protect the kidneys
Hot shot (dye may make them feel like they are peeing)
Palpitations are normal
Post-cardiac cath
Monitor what?
Watch for what?
Big thing to asses?
How should they lie?
Monitor VS
Watch for bleeding/hematoma at the puncture site
Assess extremity distal to site (5 Ps)
Bed rest, flat, leg straight for 4-6 hours
What are the 5 P’s?
Post cardiac cath distal extremity assessment
Pulselessness Pallor Pain Paralysis Paresthesia
CIRCULATION! Skin and cap refill are also important
What do we hold after the a cardiac cath? For how long? Why?
Metformin if they are on it
48 hours
It is nephrotoxic
What is the major complication post-cardiac cath?
Bleeding and pain - Report ASAP
What 2 things does Acute coronary Syndrome include?
MI and unstable angina
ACS/MI/Unstable Angina
What is happing with the blood flow?
There is decreased blood flow leading to ischemia AND necrosis
S/S of an MI
Pain - SOB, GI with women Cold/clammy hands Decreased cO ECG changes Vomiting
Unstable Angina / MI
Can it occur at rest?
Where does the pain occur and what does it feel like?
What else may occur besides pain?
Yes
Crushing pain / pressure radiating to left arm and jaw, may be between shoulder blades
N/V - vomiting stimulates vagus nerve and causes decreased CO
Signs of an MI in women
GI symptoms Epigastric complaints Pain between shoulders Aching jaw Choking sensation
What is the #1 sign of an MI in the elderly?
SOB - they may not feel pain
Could have behavioral changes
General NCLEX rule of thumb concerning a patient with a STEMI
They are having an MI!
Goal it to get them to the cath lab for a PCI in less than 90 minutes
What is CKMB
When does it elevate and peak?
Cardiac specific isoenzyme that increases with damage to cardiac cells
Elevates in 3-12 hours
Peaks in 24 hours
What is troponin?
When does it elevate and peak?
Cardiac biomarker with HIGH specificity to myocardial damage
Elevates in 3-4 hours
Remains elevated for up to 3 weeks
What is myoglobin?
When does it elevate and peak?
Protein in heart and skeletal muscle that increased with muscular damages
Elevates in 1 hour and peaks in 12
We want this to be negative
What tis the most sensitive indicator of an MI?
Troponin, especially if the patient is delayed in getting treatment because it stays elevated for 3 weeks
What addition arrhythmia can lead to sudden death?
Bradycardia
Priority treatment for V Fib
What if this doesn’t work?
What is that doesn’t work?
Defibrillation with CPR between shocks
Epi or vasopressor
Amiodarone
What do we give when V fib and pulseless V tach are resistant to treatment?
What is it’s important SE?
Amiodarone
Decreased BP that can lead to further arrhythmias
What will we give to prevent a second episode of V fib?
Amiodarone and Lidocaine
Sign of lidocaine toxicity
Neuro changes
What drugs are given for chest pain in the ED
How do we position them?
O2
Aspirin chewable is faster - prevent platelets
NTG
Morphine if NTG doesn’t work (Know this order of MONA)
HOB elevated to decrease the workload on the heart and increase CO
How do fibrinolytic work?
How soon after the MI should they be given?
They dissolve the clot that is blocking flow to the heart muscle, thus decreasing the size of the infarction
Give within 6-8 hours - MUCH SOONER if they have a stroke
4 examples of fibrinolytic
Which one is prone for allergies?
Streptokinase *** allergy - have to treat allergy but still give it
Alteplase
Tecnecplase
Reteplase
Major complication of fibrinolytic
What do we need?
Precautions?
Can we do an ABG?
Hemorrhage
Need to have a peripheral line
Need bleeding history
Bleeding precautions - less picture sites (draw blood from lines)
NO ABG!!!!!!!!!!
What are major contraindications to fibrinolytic?
Intracranial neoplasm, brain bleed, suspected aortic dissection, internal bleeding, liver disease or NSID OD
Example of platelets
Are these a part of fibrinolytic therapy?
How are they given?
Acetylsalicylic acid
Clopidogrel
Abciximab
Eptifibatide
These are given continuously
What is the best way to give tPA?
We want a peripheral line (vs a central line) because if it starts to bleed, we are able to apply pressure to it
How does a PCI (Percutaneous Coronary Intervention) work?
Interventions opens a coronary artery up to restore blood flow
What is the major complication of an angioplasty?
MI
What does CP after surgery indicate? What do we do?
Reocclusion!! Surgery is need if any problems occur
What kind of anti-platelets are given after a PCI to a patient who is at high risk and have a stent or are awaiting cath lab?
Clopidogrel, Abciximab, Epitifibatide
These will keep the artery open if they have a stent and keep the clot from getting bigger if they are waiting for cath lab
What is CABG and when is it used?
Another name for heart surgery (ED or scheduled)
Used with multiple vessel disease or left main coronary artery occlusion
What does the left main coronary artery supply?
The entire left ventricle!! If there is an occlusion we are going to think SUDDEN DEATH!!!! Or widow maker..
Cardiac Rehab
Smoking?
What kind of plan?
Diet?
What to avoid?
Stop smoking
Stepped care plan - Increase activity gradually
Low fat, low salt, low cholesterol - fried foods once a month, shop the parameter of the grocery store
Avoid isometric exercises
Avoid straining, suppositories - give them Docusate!
Avoid valsalva
Cardiac Rehab
When can sex be resumed?
When is the safest time for sex?
Best kind of exercise?
Resume sex when the patient can walk up stairs / around the block without discomfort
In the morning - well rested
Walking
Cardiac Rehab
What to teach the patients about heart failure?
Symptoms
Weight gain
Ankle edema
SOB
Confusion
