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Critical Care Test 2 > cardiac problems > Flashcards

cardiac problems Flashcards

1
Q

Coronary Artery Disease (CAD) definition

A

atherosclerosis of the coronary artery and heart structures

- disturbs the balance between myocardial oxygen supply and demand

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2
Q

Peripheral Vascular Disease (PAD) tx

-(arterial)

A

-more chronic and does not require admission to ICU

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3
Q

Peripheral Vascular Dz pathophys

A
  • atheroscelrosis
  • spasms and inflammation
  • trauma
  • compression
  • thrombus
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4
Q

S/S of PAD

A
  • intermittent claudication-incr with activity, decr with rest
  • Rest pain
  • s/s acute occlusion- pain, loss of pulses, pallor, coldness, motor/sensory changes
  • Atrophic tissue changes-skin and nail changes
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5
Q

How to test for clots/occlusion in PAD

A
  • Homan’s sign
  • Angiogram
  • Doppler *definitive
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6
Q

Diagnosis test for PAD:

ANKLE-BRACHIAL INDEX

A

measures the SBP in the arm and in the leg.

arm SBP/leg SBP

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7
Q

Ankle-Brachial Index for PAD:

  • normal
  • mild
  • moderate
  • severe
A
  • 0.9-1.0

-0.71-0.90
-0.41-0.70
-

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8
Q

Medical management PAD

-pharmacology

A
  • anticoagulants (asprin)
  • vasodilators (hydrolazine)
  • antiplatelet agents
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9
Q

Medical Management PAD

-invasive

A
  • PTA/PTI- angioplasty through groin
  • stent placement
  • bypass surgery
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10
Q

PAD nursing management

A
  • monitor peripheral arterial pulses

- intervene to maintain skin integrity and pain

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11
Q

Nursing management AFTER ANGIOPLASTY

A
  • assess dysrhythmias (a-fib)
  • renal failure r/t dye. measure urine output
  • hematoma r/t puncture
    • CANT TAKE METFORMIN IF DIABETIC d/t dye
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12
Q

if patient comes to ED with s/s of heart attack, how fast does EKG need to be set up

A
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13
Q

Cardiac Enzymes:
Troponin-1
(also troponin-T, less significant)

A

**>0.49
most significant indicator of MI within 12 hrs of chest pain
-most sensitive to myocardial infarction

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14
Q

Cardiac Enzymes:

CK-MB

A

0.06-0.10

Increased shows there may be rhabdomyalosis or they could have just ran a marathon

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15
Q

Cardiac Enzymes:

BNP

A

> 100

-shows volume overload of ventricles

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16
Q

Cardiac Enzymes

change over times

A

peak elevations are typically seen within 12-24 hours,

return to baseline after 5-10 days

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17
Q

Imaging studies ordered after MI

A

1) CXR to rule out pnuemonia and check for fluid overload
2) Echocardiogram
3) Cardiac stress testing (treadmill)
4) coronary angiogram/ catheterization right away

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18
Q

where is an angioplasty inserted

A

femoral artery

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19
Q

PCI

-what is it

A

Angiogram with a stent- stent remains to keep artery open

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20
Q

Nursing management AFTER PCI

A
  • check for recurrent angina (spasm)
  • reperfusion arrhythmia (a-fib)
  • renal failure d/t dye
  • site care (hematoma)
  • peripheral pulses
  • check fluids
  • NO metformin
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21
Q

Cardiovascular symptoms

A
  • chest pain
  • SOB
  • dyspnea on exertion (DOE)
  • orthopnea
  • wheezing
  • syncope
  • palpitations
  • fatigue
  • edema (decreased venous return)
  • Intermittent claudication (IC)
  • cyanosis
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22
Q

OLD CART assessment

A

O- onset of pain
L- location of pain
D- duration of pain
C- characteristics
A-aggravating factors or associated factors
R- Radiating
T- treatments or temporal (has it happened before)

  • past medical hx and surgical hx
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23
Q

Risk factors:

waist circumference

A

Women: >35
Men: >40

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24
Q

what age to cardiovascular changes take place

A

after 30

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25
Q

Acute Coronary Syndrome (ACS)

A

clinical presentations of CAD range from unstable angina to acute MI

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26
Q

Stable angina

A

relieved by rest and Nitro

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27
Q

Unstable angina

A

myocardial infarction

- pain not relieved by rest, takes more Nitro, or is a new pain

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28
Q

Silent Ischemia

A

No s/s

  • low O2 to heart
  • See ST elevation on EKG
  • Most common in women, DM, and obese
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29
Q

Steps to take when 46 y.o male comes in with CP, 6/10 pain radiating to jaw, smoker, BMI 30

A
  • EKG within 10 min
  • MONA
  • CE-STAT then q8x3- (cardiac enxymes)
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30
Q

MONA

A

M- morphine
O-O2
N- nitro
A- aspirin

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31
Q

M- Morphine

A

morphine decreases cardiac preload and afterload, which lowers O2 demand and ischemic pain

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32
Q

O-oxygen

A

start low and go slow >92%

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33
Q

O- oxygen

A

start low and go slow- >92%

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34
Q

N-nitroglycerine

-if stable angina

A
  1. 4 mg SL Q 5 min up to 3 doses

- prophylactic patch 0.4 mg on chest wall Q4-6 hr

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35
Q

Nitro

-if NSTEMI

A 
multiple SL doses.
if no response start IV drip
-titrate to relieve chest pain and prevent hypotension
-anticoagulant-heparin started
-
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36
Q

What drug interacts with Nitro

A

VIAGRA. CANT TAKE

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37
Q

why use Nitro with caution if pt has right ventricular infarction?

A

b/c nitro has a profound effect on preload

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38
Q

A- Aspirin

A

81-650 mg chewable b/c better absorption

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39
Q

ST elevation with Positive Troponin?

A

ST elevation MI

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40
Q

ST elevation with Negative Troponin

A

Unstable Angina-
give nitro
and take cardiac enzymes for 24 hrs

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41
Q

Non-St elevation with Positive Troponin

A

Non-ST elevation MI

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42
Q

Non-ST elevation with Negative Troponin

A

Unstable angina

-Nitro and CE

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43
Q

STEMI

A

ST elevation MI

ST elevated >1 small box

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44
Q

NSTEMI

A

Non-ST elevation MI but cardiac enzymes are elevated

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45
Q

persistent STEMI pathophys

A

shows total occlusion of a coronary artery that causes transmural ischemia of the myocardial tissue, causing myocardial necrosis

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46
Q

Transmural ischemia

A

All three layers of the heart are effected

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47
Q

MI patho

A

1) myocardial ischemia- T wave inversion
2) *if not revascularized : myocardial injury- ST elevation
3) * if not revascularized: Myocardial Infarction- Long Q wave

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48
Q

EKG Layout

1) Anterioseptal
- vessel
- leads
- s/s

A
  • LAD
  • V1-V4
  • SICK! Left ventricle failure, cardiogenic shock
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49
Q

EKG Layout

2) Inferior
- vessel
- leads
- s/s

A
  • RCA
  • II, III, aVf
  • bradycardia, AV blocks, N/V
50
Q

EKG Layout

3) Lateral
- vessel
- leads
- s/s

A
  • Circumflex
  • I , aVL, V5, V6
  • arhythmias, VF, VT, PVC
51
Q

Management of NSTEMI/STEMI

-within how much time should you treat them

A

TIME IS TISSUE

-tissue is best saved within 2 hours of onset of S/S

52
Q

Management of /STEMI

-Goals for STEMI: PCI angiogram timing

A
53
Q

Management of NSTEMI/STEMI

-what to do if PCI takes >120 minutes

A

give Fibrinolytics within 30 min of arriving to ER

ST ELEVATION MUST BE PRESENT to use thrombolytic tx

54
Q

What is a fibrolytic?

A

tPA (intrgralin)

-used as a clot buster in ER only for ST ELEVATION

55
Q

When can you NOT give fibrolytics?

A

if pt has a Q wave- this means they had an MI >24 hrs ago and are not a candadit for thrombolytics

56
Q

What to monitor when giving fibrolytics?

A

MONITOR BLEEDING

-make sure all IVs are already in!

57
Q

Cardiac Enzymes Diagnosis :Troponin

  • indicates
  • normal value
A

-Most significant indicator of MI within 12 hr of CP
-more sensitive than CKMB
-done for 24 hrs
-

58
Q

Cardiac Enzyme Diagnosis: CK-MB

-indicates

A
  • Creatine Kinase: shows any tissue damage, not heart specific
  • MB- cardiac damage
59
Q

Nursing consideration with Cardiac Enzymes

A

CE’s may not be elevated initially and may continue to rise after reperfusion

60
Q

Other Meds to give for MI

A

ACE inhib

  • BB
  • Diuretics
  • Anticoagulants
  • antiplatelets
  • vasodilators
  • inotropics
  • saline therapy
61
Q

MONA (S)

-S= surveillance

A

continuous monitoring of:

  • arrthythmias
  • ventricular aneurysm
  • rupture of ventricular septal, papillary muscle, cardiac wall
  • pericarditis
  • heart failure
62
Q

Rupture of cardiac wall

A

FATAL- cardiogenic shock

  • hypotension
  • decompensation fast
63
Q

Monitoring:

  • Hemodynamics-
    • CVP
    • CO
    • SCVO2
A
  • preload
  • afterload
  • oxygen supply and demand
64
Q

Monitoring:

Echocardiogram

A
  • transthoracic

- transesophageal

65
Q

Monitoring:

-Stress test

A

Non-ST elevation MI

  • exercise
  • dobutamine
66
Q

systolic HF

A

decreased contractility during systole (ejection) that lessens the quantity of blood pumped out of the heart

67
Q

SHF:

how does this affect the Ejection Fraction (EF)

A
68
Q

S/S of SHF

A

dyspnea

  • exercise intolerance
  • fluid volume overload
  • JVD
  • Edema : systemic
69
Q

SHF causes

A
  • CAD
  • HTN
  • valve disease
  • ETOH
70
Q

patho of SHF

A

weak heart muscle that cant pump out blood- fluid overload

71
Q

Diastolic Heart Failure

A

heart muscles unable to relax, stretch, or fill during diastole

72
Q

Diastolic Heart Failure EF

A

> 45% maintained normal

73
Q

DHF changes to the left ventricle

A

LV becomes thick and stiff

  • lowers Left Ventricular End Diastolic Volume
  • Highers Left Ventricular End Diastolic Pressure
74
Q

DHF S/S

A

exercise intolerance

  • fatigue
  • pulmonary congestion
  • pulmonary edema
75
Q

DHF patho

A

can pump blood out but unable to fill properly- pulmonary back up * thick stiff left ventricle

76
Q

what will you see on a CXR for HF

A

enlarged heart or pulmonary edema

77
Q

BNP levels in HF

  • moderate
  • severe
A
  • > 100

- >400

78
Q

HF medical management

-Inotropes

A

Dopamine
Doputamine
*these improve C.O

79
Q

HF Meds:

Dopamine dosing

A

5 mcg/kg/min increase by 5 Q 10-30 min up to max of 50 mcg

*increases cardiac contractility

80
Q

HF Meds:

other

A
  • diuretics
  • Vasodilators
  • ACE inhibitors -preserve kidney function
  • CCB & BB
  • Anticoagulants
81
Q

ACE- inhibitors side effects

A

dry cough and angioedema

-give ARB if ACE not working

82
Q

Management of HF other than meds

A 
monitor BNP
-oxygen
-hemodynamics
-rest and pain control
-emotional support
-nutrition
education
83
Q

Cardiomyopathy

A

disease of the heart muscle

84
Q

Cardiomyopathy

-Primary

A

unknown cause
-viral? autoimmune?
Hypertrophic muscle and dilated

85
Q

Cardiomyopathy

-secondary

A

-result of systemic dz such as valvular dz, CAD, HTN, ETHO abuse, autoimmune

86
Q

meds to give for impaired contractility

A

Inotropes

-DIG, DOPAMINE, DOBUTAMINE, PACEMAKER

87
Q

Meds to give for LV dysfunction

A

BB

(CARVEDILOL, ATENOLOL

88
Q

Meds to give for Dysrhythmias

A

anti-arrhythmic agents (AMIODARONE)

89
Q

Meds for dilated cardiomyopathy

A

ACE-I
(Lisinopril)
-first line treatment whether symptomatic or asymptomatic

90
Q

Mechanical Circulatory Assist Devices

  • IABP: intra-aortic balloon pump
  • VAD- ventricular assistant device
A

used in treatment of heart failure when meds have failed

-decreases myocardial workload and maintain adequate perfusion to vital organs

91
Q

Indications for Intra Aortic Balloon Pump

-IABP

A
  • failure to wean off of bypass
  • recurrent angina after acute MI
  • hemodynamic support for high risk PCI and CABG
  • complications from acute MI
  • Bridge to definitive therapy (LVAD, heart transplant)
92
Q

IABP

-what are complications of MI that would call for an IABP

A
  • cardiogenic shock
  • papillary muscle dysfunction of rupture with MR
  • Ventricular septal rupture
93
Q

Intra-Aortic Balloon Pump Function

A

Inflates during diastole –> incr. perfusion to coronary artery–> incr. perfusion to kidneys–> displaces blood (decr. afterload, incr. CO)–> improves balance bewteen O2 supply and demand

94
Q

therapeutic effects of IABP

  • what increases
  • what decreases
A

1) INCR
- coronary artery BF
- CO
- UO
- improved mentation

2) DECR
-s/s myocardial ischemia (angina, ST changes, ventricular, arrythmias)
-myocardial oxygen demand
HR

95
Q

IABP nursing considerations

A
  • assess perfusion- pulses, temp, calf circumference
  • anticoagulation
  • balloon rupture
  • balloon migration
  • timing of IABP
96
Q

IABP balloon migration assessment

  • upwards
  • downwards
A
  • assess radial pulses and LOC

- assess U.O , GI s/s

97
Q

what CANNOT do if a pt has IABP

A

SIT THE PT UP!

98
Q

IABP

-Timing: what does 8:1 indicate

A

weaning the pt off device, only for a short amt of time

99
Q

Education IABP

A
  • activity restriction (minimal leg mvmt)

- s/s report to nurse- pain in back, leg, or chest

100
Q

Ventricular Assist Device (VAD)

-indications

A
  • partially or completely replace the function of the heart

- used for failing RV, LV, or both

101
Q

VAD

-flow rate

A

flow rate of 1-10 L/min

  • decreases V workload
  • maintains adequate CO
102
Q

When would a pt need a VAD

A
  • Bridge to recovery
  • Bridge to transplantation
  • destination therapy
103
Q

what about VAD and pt pulses?

A

THERE IS NO PULSE OR BP!

if patient dies this machine continues to run

104
Q

VAD: Bridge to Recovery

A

Continues to demonstrate persistent HF despite aggressive medical treatement, BUT shows potential for regaining normal heart function if heart is given time to rest

105
Q

Diseases that would use VAD

A

acute post op myocardial dysfunction

  • refactory cardigenic shock after acute MI
  • acute viral myocarditis
106
Q

Nursing considerations for LVAD

A
  • pulseless
  • heart tones machine like
  • Use MAP for BP (no S/DBP)
  • rely on basic assessments such as circulation, mentation, UO
  • prevent line infection
107
Q

Aortic Aneurysm

A

localized dilation of the arterial wall that results in an alteration in vessel shape and blood flow (abdominal and thoracic)

108
Q

visible sign of an aortic aneurysm

A

pulsatile mass in umbilical region- abdominal aneurysm

109
Q

something patients c/o with aortic aneurysm

A

BACK PAIN!

-dont press hard on their stomach

110
Q

Aortic Aneurysm Diagnosis

A
  • detected with palpation of umbilical
  • fleeting peripheral pulses
  • new murmur
  • HTN
111
Q

Aortic Aneurysm:

Diagnosis with procedures

A

CXR- only helpful if thoracic aneurysm

  • **-CT and TTE(Transthoracic echocardiogram): two most helpful tests for rapid dx
  • DEFINITIVE- aortogram
112
Q

Aortic Aneurysm Etiology

A
  • Atherosclerosis
  • HTN
  • Trauma
  • Marfans Syndrome
  • Pregnancy
113
Q

aortic dissection

A

column of blood seperates the vascular layers. This creates a false lumen which communicates with the true lumen through a tear in the intima

114
Q

Aortic Dissection S/S

A
  • Sharp pain that radiates to back
  • cardiac murmur, HTN, Unequal BP in upper extremities
  • Decreased LOC
115
Q

Aortic Dissection

-Diagnosis

A

CT ultrasound MRI

116
Q

Aortic Dissection Tx

A

SURGERY

-give vasodiator to decrease BP (Nipride drip)

117
Q

Cardiac Tamponade

A

accumulation of blood in the pericardial sac

118
Q

Cardiac tamponade s/s

A

decreased CO
PEA or tachycardia
Becks triad

119
Q

Beck’s triad (cardiac tamponade)

A
  • neck vein distenstion
  • increased CVP
  • hypotension
  • Muffled heart sounds
120
Q

Cardiac tamponade tx

A

pericardiocentesis

121
Q

Cardiac tamponade management

A

surgical repair >5 cm= surgery

122
Q

Nursing management of cardiac tamponade

A 
monitor Q1hr
-BP
-Pain
-Vasodilators
-UO
-aortic murmurs
-circulation
-5 P's
A-line: tx HTN with Labetalol (dec. CO)

Critical Care Test 2 (6 decks)

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