cardiology

Question 1

what must a doctor do before putting a patient on quinadine

Answer 1

they need to digitilize the person first because the dig takes care of the heart rate.

Question 2

quinidine

Answer 2

exacabates CHF

causes thrombocyteapenia

extends refractory period

Question 3

Norpace side effects

Answer 3

dry mouth

exacabates CHF

urinary retention

thrombocytopenia

Question 4

Lidocaine for the heart

Answer 4

has to be preservative free (No epinephrine)

makes it harder for a patient to go into a v fib

treats pvc’s

prevents patient from going into v tach

anestasizes the heart

0.5-1 mg/kg depending on your person

Question 5

lidocaine IV can cause

Answer 5

causes seizures

push over 1-2 minutes (preferably 2 minutes)

can cause confusion (especially in elderly)

can get a psychosis

cardiovascular hypotension

bradycardia

possible blocks and arrests

other arrthymias

double vision

Question 6

important about lidocaine

Answer 6

make sure you pick the right lidocaine

make sure you put it in its own line. Do not mix with other drugs in IV line

Question 7

class 1 C drugs.

Answer 7

This class of drugs are used when other things don’t work.

Used for PAF, Life threatening ventricular arrhythmias. 150 to 300 mg po q. 8hrs.

Monitor for increase in arrhythmias, CNS effects ( dizziness, anxiety, ataxia, confusion, and seizures.

Used for life threatening ventricular arrhythmias. Can cause new or worse arrhythmias. CHF because of negative inotropic effect. Use for AF, PSVT.

100mg po BID. Maximum dose of 400 mg.

Monitor for increase & severity of arrhythmia. Monitor for CHF, tremors,

dizziness and visual disturbances.

Question 8

class 1 c drugs

Answer 8

Agents:

. Flecainide (Tambacor)

. Propafenone hydrochloride ( Rythmol )

Action:

. Most potent Class I agents. Slows conduction through atria , purkingee

 system and ventricals.  Decreases repolarization rate.  Decreases contractility.

. Causes decrease in PVCS and VT

Question 9

class 2 Beta blockers

Answer 9

Action:

. Only group of antiarrhythmics shown to prolong life

. Beta 1 receptors in heart attach to calcium channels. Blockage decreases Ca++

  influx.  Depresses phase 4 of depolarization.  Decreases automaticity, heart rate,

  and BP.  Decreases AV conduction.

Agents:

. Propranolol ( Inderal )—non selective

. Metoprolol ( Lopressor )—selective

. Atenolol ( Tenormin )

. Sotalol ( Betapace )

Adverse effects:

. CV: Bradycardia, hypotension, edema, CHF, Pulmonary Edema ,

. Resp: Bronchospasm

. CNS: Fatigue, weakness, dizziness, mental changes, insomnia, confusion

. GI: Constipation, diarrhea, nausea, vomiting

. GU: Impotence

endocrine: blood sugar variations

Question 10

negative inotropic effect causes

Answer 10

heart failure

Question 11

dromotropic effect causes

Answer 11

(1) Refers to a change in the speed of conduction through the AV junction
(2) A positive dromotropic effect results in an increase in AV conduction velocity
(3) A negative dromotropic effect results in a decrease in AV conduction velocity

Question 12

inotropic effect

Answer 12

(1) Refers to a change in myocardial contractility
(2) A positive inotropic effect results in an increase in myocardial contractility
(3) A negative inotropic effect results in a decrease in myocardial contratility

Question 13

chronotropic effect

Answer 13

(1) Refers to a change in heart rate
(2) A positive chronotropic effect refers to an increase in heart rate
(3) A negative chronotropic effect refers to a decrease in heart rate

Question 14

interactions with Beta Blockers

Answer 14

. Caution with other antiarrhythmics. Can cause additive effects.

. NSAIDS may decrease antihypertensive effect.

. Cimetidine can increase the effect of inderal.

. In diabetics can mask signs of hypoglycemia.

Question 15

nursing considerations for Beta Blockers

Answer 15

. Monitor vital signs frequently during period of adjustment. Notify MD if pulse

  falls below 50 to 60 beats / minute and / or SBP falls below 90 to 100.

. If meds given IV must be on a monitor during administration and for several

  hours later.  Monitor hepatic, renal and CBC function.

. Monitor I&O, daily weight, and check for CHF.

. Give with meals or immediately after eatting. Extended release tablets should

   be swallowed whole.  Do not crush.

Question 16

potassium channel blockers

Answer 16

Action: Block potassium channels, prolong repolarization and refractory

           periods.  They effect fast tissue and commonly are used to manage

           difficult to treat arrhythmias.

Agent: Amiodarone ( Cordarone)

          Ibutilide fumarate ( Corvert )

Question 17

potassium channel blockers

Answer 17

ex. AMIODARONE

Use:

. Treatment of life threatening recurrent V-Fib and hemdynamically unstable

  V-Tach and SPVT, AF, PAF.

Dose: PO—800 to1600 mg/ day for 1 to 3 wk and reduce to 600 to 800 mg/ day

        for 5 wks:  usual maintenance dose, 400 mg/ day.

        IV:  Give through central line if possible.

Question 18

contraindications of potassium channel blockers

Answer 18

. Severe sinus bradycardia since drug slows heart rate by interfering with SA

  nodal firing.  AV nodal blockage since drug slows conduction through AV

  node.  May cause complete heart block resistant to atropine.

Question 19

precautions for potassium channel blockers

Answer 19

CHF may be worsened. Hypokalemia may block amiodarone action.

Side Effects / Adverse reactions:

. CNS—ataxia, tremors

. CV—–SA & AV blockage, bradycardia, myocardial depression, IV-hypotension

. EYE—small corneal deposits that can impair vision may develop with long term

               use.  When drug is discontinued deposits may slowly disappear.

. GI——anorexia, nausea, constipation, abdominal pain

. PULMONARY—pulmonary fibrosis, pneumonitis

. SKIN—light sensitivity caused by crystals deposited in the skin producing a

                bluish color

Question 20

nursing considerations for potassium channel blockers

Answer 20

. Assess EKG , BP and pulse

. Assess lung sounds. Rales, decreased lung sounds or friction rub may indicate

  pulmonary toxicity.  Check weight, I&O and signs of CHF

. Check skin for bluish coloration. Check gait and check for tremors

. Eye exam should be done before and at regular intervals during therapy. Avoid

  sunbathing, tanning salons because of photosensitivity.  Limit outdoor activity

  between 10 am and 2 pm.

. Increase dietary intake of fruit, fiber , fluids and exercise to combat

  constipation.

. Missed dose: Omit. Do not double up on missed dose. Notify MD if two or

   more doses are missed.

Question 21

covert

Answer 21

potassium channel blocker

Used for AF, Atrial Flutter. 1mg IV over 10 min. for patients > 60kg. 0.01mg/kg for patients < 60 kg over 10 mg min. Stop infusion as soon as arrhythmia is stopped or if sustained VT or marked QT prolongation.

Question 22

class 1 sodium channel blockers

Answer 22

. Decrease rate of conduction

. Prolongs action potential duration

. Reduces speed of impulse conduction

. For atrial and ventricular dysrhythmias

CLASS Ia

AGENTS

. Procainamide ( Pronestyl )

. Disopyramide ( Norpace )

. Quinidine ( Quinidex )

Question 23

indications of sodium channel blockers

Answer 23

ex: PROCAINAMIDE (PRONESTYL )

Indications:

Ventricular arrhythmias

  .  Stable ventricular tachycardia

  .  Premature ventricular contractions

  .  Ventricular fibrillation

Supraventricular tachyarrhythmias

  .   PSVT,  PAT,  Junctional tachs. , 

  .   Atrial flutter and fibrillation

Question 24

actions of sodium channel blockers

Answer 24

. Slows conduction. Is a negative inotrope with a ischemic myocardium

  .   Decreases myocardial excitability 

  .   Is often used as drug of choice if resistance to lidocaine

Contraindicated in patient with myasthenia gravis.

Caution with patients with MI, CHF, Digoxin intoxication.

Question 25

adverse effects of sodium channel blockers

Answer 25

Adverse effects: . Myocardial depression. Prolongs duration of QRS, QT interval, AV conduction. . Hypersensitivity. Confusion, seizures, dizziness. . Hypotension if given too fast IV. Blood dyscrasias like thrombocytopenia. . Gastric: anorexia, diarrhea, nausea, vomiting. Nursing: . PO: Give with meals or snack to lessen GI distress. . Monitor EKG, BP, and pulse continously throughout IV administration. . Keep patient supine during IV admininstration. Assess QRS and QT intervals. . When IV, discontinue if QT increases by 50% or PR more than .20 second or if BP drops 15mm Hg.

Question 26

QUINIDINE (QUINIDEX)

Answer 26

action: ## Footnote . Slows conduction through cardiac tissue. Refractory period is lengthened especially in atria. Used for atrial flutter or fibrillation to maintain sinus rhythm. . Has anticholinergic effect by inhibiting vagal action on SA and AV nodes. Sinus node may accelerate causing a dangerous sinus tachycardia. If Quinidine is given to people with A. Flutter or A. Fibrillation, they should be digitalized first to slow the SA and AV nodes. Dosage: . Quinidine Sulfate—200 to 400 mg every 4 to 6 hours. . Sustained release ( Quindex Extentabs—300 to 600 mg every 8 to 12 hours. . Quinidine Gluconate—324mg every 6 to 8 hours. . Quinaglute 324mg every 6 to 8 hours IM or IV Adverse Effects: . Most common effect is diarrhea. May have nausea and vomiting. . Can cause thrombocytopenia. . Hypotension, tinnitus, vertigo, visual disturbances, confusion, psychosis. . Arrhythmias like SA and AV blocks, sinus arrest. . Asthma like symptoms. Systemic Lupus like symptoms. Interactions: . Will increase digoxin levels. Nifedipine will decrease Quinidine levels. Nursing: . Prior to giving drug need baseline QT interval since drug can prolong it. . Give with meals to decrease GI upset. Do not crush sustained release. . Monitor vital signs, EKG and intake and output. Monitor platelets. . Monitor for CHF.

Question 27

DISOPYRAMIDE ( NORPACE )

Answer 27

Action: . Prolongs refractory period. Decreases myocardial contractility. Has anticholinergic effect so patients with A. Flutter and A. Fibrillation should be digitalized first. Adverse effects: . Neuro: Blurred vision, dizziness, headache, agitation, depression. . Cardio: Conduction disturbances, hypotension, chest pain, CHF, fatigue, edema, weight gain. . GI: Dry mouth, constipation, nausea, pain, bloating, anorexia, diarrhea. . Resp: SOB . Thrompocytopenia . Renal: Urinary retention, hesitancy,and frequency . Endocrine: Hypoglycemia . Rash Nursing: . Monitor vital signs, EKG, QRS and QT intervals, I and O, weight. . Monitor for CHF. Check platelets. . Sugarless gum for dry mouth . Take on empty stomach . Eat high fiber diet. Bulk laxatives to treat constipation. . Monitor potassium levels. Ineffectve in hypokalemia. Toxic with hyperkalemia.

Question 28

class 1 b drugs

Answer 28

Agents: . Lidocaine (Xylocaine) . Tocainide ( Tonocard) . Mexiletine ( Mexitil)

Question 29

LIDOCAINE ( XYLOCAINE )

Answer 29

Action: . Elevates ventricular fibrillation threshold . Treats symptomatic PVCS. Suppresses ventricular tachycardia. Dosage: . Adult: 1mg/kg to 1.5 mg/kg bolus IV followed by 0.5 mg to 0.75/kg in 10 minutes. About 50 to 100mg. Reduce bolus dose by 5% in patients with CHF. . Infusion rate is 1 to 4 mg/minute. Can give endotracheal if IV not available. . Onset of action is 30 to 60 seconds IV . Therapeutic level is 1.5 to 6 ug/ml Adverse effects: . CNS: Paresthesias, numbness, agitation, confusion, seizures. . CV: Hypotension, bradycardia, cardiac arrest, arrhythmias . GI: vomiting . Integ: Phlebitis Nursing; . Monitor vital signs, EKG, QRS and QT levels (3) . Monitor serum levels. Signs of toxicity include confusion, excitation, blurred or double vision, nausea, vomiting, tinnitus, tremors, convulsions, difficulty breathing. . Use only 1% or 2% solutions without epinephrine or preservative. . Administer over 1 to 2 minutes . If given too fast, increase risk of seizures. . Use infusion pump. Do not mix with other drugs.

Question 30

calcium channel blockers (class IV)

Answer 30

Action: These drugs work by inhibiting the slow channel pathways or the calcium Dependent channels. By doing this they depress phase 4 depolarization. Therefore these drugs: . Prolong AV node effective refractory period . decrease AV node conduction and reduce rapid ventricular conduction due to A. Flutter, AF. Used for SVT Agents: . Ditiazem ( Cardizem ) . Verapamil ( Calan )

Question 31

DILTIAZEM ( CARDIZEM )

Answer 31

Use: . Temporary control of rapid ventricular response in a patient with A. FIB or A. Flutter. Supraventricular arrhythmias . Vasospastic angina. Essential Hypertension . Unlabled use—prevention of reinfarction in non Q wave MI Contraindications: . Hypersensitivity, sick sinus syndrome, 2nd or 3rd Heart , severe hypotension ( less than 90/60 ). Patients undergoing cranial surgery, bleeding aneurysms Caution: . CHF especially if on beta blocker. Conduction abnormalities. Renal or hepatic impairment Dose: . IV—bolus dose 0.25mg/kg over 2 minutes; second dose 0.35mg/kg over 2 minutes after 15 minutes prn; then 5-10 mg/hr or higher by continuous infusion . PO---usual dose 180 to 360 mg/day in divided doses or 60 to 120 mg sustained release Adverse / Side effects: . CNS—headache, fatique, dizziness, drowsiness, nervousness, insomnia, confusion, tremor, gait abnormality . CV—edema, arrhythmias, angina, 2nd and 3rd degree heart block, bradycardia, CHF, hypotension, palpitations, syncope, flushing . GI –nausea, constipation, anorexia, vomiting, diarrhea, impaired taste, increased weight. .Skin rash Drug Interactions: . Increases digoxin levels. Additive effects on AV conduction with beta blocker. . Cimetidine can increase cardizem levels Nursing: . Withhold drug if SBP is\< 90 or diastolic is \< 60 . Monitor for arrhythmias, heart blocks. Position changes slowly. Avoid driving until reaction to drug is known. Keep follow up appointments. . PO—AC and HS. IV—may be given direct as bolus over 2 minutes. May be continuous IV infusion. Recommended rate-5 to 15 mg/hr. Can add to D5W, NS and combos.

Question 32

VERAPAMIL ( CALAN )

Answer 32

Dose: . PO—start with 80mg 3 to 4 times daily; daily range 240 to 480 mg.. . IV---5 to 10 mg bolus over 2 minutes; repeat dose of \< 10 mg may be given after 30 minutes Interactions: . Beta blockers increase risk of CHF, bradycardia,heart block . Increases digoxin levels. . Lithium and cyclospore may be increased to toxic levels. Nursing: . PO—with food to decrease GI ditress. Capsules can be opened & sprinkled on food. Do not dissolve or chew capsule. . Transient asymptomatic hypotension may accompany IV bolus. Have patient remain in recumberant position for at least 1 hour after dose. (7) . Same as with cardizem

Question 33

ADENOSINE ( ADENOCARD )

Answer 33

Action: . Slows impulse formation in SA node. Slows conduction time through AV node. Depresses left ventricular function and restores NSR. . General cardiac depressant Uses: . Paroxysmal supraventricular tachycardia Precautions: . Sick sinus syndrome may be worsened by drug and produce sinus arrest Dosage: . IV—6 mg by rapid push with saline flush over 1 to 2 seconds. If not effective, 12 mg by rapid push may be given 2 minutes later; repeat once if necessary Side Effects: . Arrhythmias , flushing, heart block, chest pain, SOB, cough, dizziness , numbness, tingling in arms. Nursing: . Continuous EKG. Monitor BP and pulse, lung sounds, respiratory

Question 34

ATROPINE SULFATE

Answer 34

Used for bradycardia and heart block. 0.5 to 1mg IV bolus may be repeated every 3 to 5 min up to 0.04mg/kg. Monitor heart rate and rhythm. Assess for chest pain, urinary retention.

Question 35

inotropic

Answer 35

force of contraction positive inotropic increases the force negative inotropic decreases the force

Question 36

dromotropic

Answer 36

conduction pattern negative dromotropic slows conduction positive dromotropic speeds up contraction conduction goes from arrythmia to heart block

Question 37

Chronotropic

Answer 37

heart rate (can go both ways) positive chronotropic speeds up heart rate negative chronotropic slows down heart rate

Question 38

negative inotropic

Answer 38

if contraction not forceful enough blood backs up causing heart failure

Question 39

when starting a drip

Answer 39

know baseline QT interval

Question 40

if there is 50% or more distance between 2 complexes

Answer 40

may be a block

Question 41

cardioversion

Answer 41

used for every rhythm that has a T wave

Question 42

defribilization

Answer 42

only for v fib (only only only) before you shock someone yell all clear and make sure you are not touching the patient

Question 43

sodium channel blockers

Answer 43

stabilize membranes decreases irritation decreases etopic beats from starting

Question 44

beta 2

Answer 44

lungs

Question 45

beta 1

Answer 45

heart

Question 46

lopresser IV

Answer 46

5mg (3 bolus') then PO

Question 47

if adenosine doesnt work

Answer 47

cardiovert

Question 48

anatomy and physiology of an MI

Answer 48

. Sudden blockage of one of the branches of the coronary arteries. When blood flow acutely decreases by 80% to 90% ischemia develops. b. If blood flow is not restored myocardial tissue necrosis can happen over a period of hours.

Question 49

what rhythm are patients usually in with an M.I.

Answer 49

V. Fib

Question 50

M.I. anatomy and physiology

Answer 50

Can result in sudden death or gradual scarring over necrotic area. d. Most MIs are secondary to thrombus formation. Other factors are coronary artery spasm, platelet aggregation, and emboli. e. Cardiac cells can withstand ischemia about 20 minutes before injury occurs.

Question 51

during an M.I.

Answer 51

Within 4 to 6 hours the entire thickness of the heart will become necrotic.

Question 52

Around the area of infarction there are two zones:

Answer 52

. Zone of Injury Zone of ischemia

Question 53

necrotic tissue is

Answer 53

electrically inert

Question 54

zone of ischemia

Answer 54

really electrically unstable thats why the first 72 hours after an M.I. is so important because that ischemic tissue is so unstable and arrthymic

Question 55

acute coronary syndrome

Answer 55

* When ischemia prolonged and not immediately reversible, ACS develops. * Encompasses a spectrum of unstable angina, non-ST segment elevation Myocardial Infarction ( NSTEMI ) and ST segment elevation Myocardial In farction. * Reflects the relationship among these disorders.

Question 56

pathology of an MI

Answer 56

* Ischemia causes a decrease in cardiac functioning. * Can produce a permanent loss of contractile function in the injured area. * Cardiogenic shock can develop from decreased cardiac output and decreased contractility and pumping capacity. * Actual extent of MI depends on collateral circulation, anaerobic metabolism and workload demands on the myocardium.

Question 57

promestyl

Answer 57

iv bolus give Over 5 minutes if too fast causes seizures, blocks, hypotension

Question 58

anterior wall MI

Answer 58

absolute worst MI ## Footnote . Obstruction of left anterior descending artery. 25% of all MIs. Highest mortality. b. Most likely to cause left ventricular heart failure and ventricular dysrhythmias. c. People with anterior MI more likely to die in the first year after the MI than those with other MIs. d. EKG shows ST elevations, abnormal Q waves.

Question 59

inferior wall MI

Answer 59

right sided ## Footnote Results from occlusion of right coronary artery. Is 17% of all MIs. 10% mortality rate. b. About 1/3 have right ventricular MI and right ventricular failure. c. EKG can show ST and T wave changes and Q waves. (T wave inverts, thats NOT NORmal)

Question 60

posterior and lateral wall MI's

Answer 60

least complications •Result from obstruction of the circumflex artery. * Posterior MI is 2% all MIs. Is uncommon. * Lateral wall MIs have the least complications.

Question 61

gender differences in acute coronary syndrome (Men)

Answer 61

Men are developing CAD at a younger age than women and their death rates are declining. b. Initial cardiac event is more often MI than angina. c. Have higher rate of left ventricular hypertrophy. d. Have greater collateral circulation.

Question 62

gender differences in acute coronary syndrome (Women)

Answer 62

CAD causes more deaths in women than men. Usually older and sicker with first MI. b. Initial cardiac event more often angina. c. After menopause risk of MI quadruples. Prior to menopause have higher HDL levels than men. After, LDL levels increase. Fewer women than men present with classic symptoms of MI. Fatigue often 1st sign of ACS. C/o palpitations more than men. e. More likely to experience fatal cardiac event within 1st year after an MI. f. Delay longer before seeking medical help. •Have higher mortality rate and complications after CABG surgery. h. Those on oral contraceptives and who smoke at greater risk for MI.

Question 63

gerontologic considerations with an MI

Answer 63

* May have decreased responses to neurotransmitters so often pain is atypical. May have jaw pain of faint. * Have had time to develop collateral circulation so may not have lethal complications.

Question 64

cultural and ethnic consideration for MI's

Answer 64

* White, middle-aged men have highest incidence of CAD. * African Americans have early age onset od CAD. * African American women have higher incidence and death rate r/t CAD than white women. * African Americans have more severe CAD than whites. * Native Americans under 35 yrs have twice heart disease mortality as other Americans r/t obesity and diabetes. * Hispanics have lower death rates from heart disease than non Hispanic whites.

Question 65

Risk Factors for CAD

Answer 65

•Non Modifiable: ## Footnote Age Gender (men \> women until 60 yr) Ethnicity (whites \> African Americans) Genetic predisposition and family history of heart disease) •Modifiable Risk Factors: Elevated serum lipids Hypertension: 140/90 or greater Smoking Physical inactivity Obesity: waist circumference greater than 39.8 in men & 34.3 in women. •Contributing factors: Diabetes Mellitus Fasting blood sugar \> 110 mg/di Psychologic states Homocysteine levels-if elevated can contribute to atherosclerosis

Question 66

stages of MI healing

Answer 66

•Onset until 3rd day ## Footnote Acute tissue degeneration. Infarct area soft, mushy & necrotic. Dead tissue electrically inert. Peri-infarct area ischemic and electrically unstable. Critical time period-majority of deaths from dysrhythmias.

Question 67

stages of MI healing

Answer 67

•4th to 7th day: ## Footnote Softening of infarct area. Danger of aneurysm formation. •8th to 10th day: Newly formed capillaries develop around infarct but it is 2 to 3 weeks before any significant circulation.

Question 68

stages of MI healing

Answer 68

•11th day on: ## Footnote Collagen forms about 12th day. Rupture of ventricle possible from onset 14th day. Takes 3 to 4 weeks before scar is firm. Takes 2 to 3 months before scar is at maximum strength.

Question 69

clinical manifestations of an MI

Answer 69

* Severe continuous chest pain not relieved by nitroglycerine or rest. * Shortness of breath, pallor, cold clammy diaphoresis, dizziness, nausea, vomiting, BP changes, dysrhythmias, cyanosis, restlessness, and intense anxiety. * Women may experience heaviness, squeezing type of chest pain. May have sharp, fleeting pain that returns. May have pain in jaw, neck, back & shoulder. Often have palpitations, may faint, nausea & vomiting

Question 70

Deviations in the manifestations of an MI

Answer 70

* Patients with diabetes may have dull pain r/t neuropathies. * African Americans may have dyspnea as major symptom. * Elderly may have mild or absent pain. May have associative symptoms like SOB. Patients over 80 may display confusion or disorientation with decreased cardiac output.

Question 71

diagnostic evaluation

Answer 71

* Electrocardiogram-serial readings to monitor evolution of MI. * Troponin Levels-establishes diagnosis of MI. * Cardiac Enzymes-CK (Creatine Kinase). * Isoenzymes: CK-MB-Heart * Myoglobulin * White blood cell count, sedimentation rate * Coronary Angiography- patient with NSTEMI may have this to evaluate extent of MI. * Stress Test & Echocardiograms-may need to do dobutamine (Dobutex) stress echocardiogram if patient unable to exercise.

Question 72

with an MI the

Answer 72

st segment elevates T wave inversion

Question 73

with ischemia of the heart

Answer 73

st segment depression T wave inversion

Question 74

what meds do they hold for Heart tests

Answer 74

usually beta blockers

Question 75

goals for med management of MI

Answer 75

* Minimize myocardial damage, relieve pain & provide rest * Prevent complications

Question 76

emergency management of an MI

Answer 76

* Ensure patent airway. Oxygen at 2 to 4 L via nasal cannula. * Insert 2 IV catheters. * Obtain ECG. Place on monitor. * Assess for pain (PQRST) * Nitro. sl and aspirin if not already done by EMTs. Morphine for pain. * Baseline blood work (cardiac markers) & chest xray * Assess for antiplatelet, anticoagulant, and thrombolytic therapy. * Give beta blocker and antidysrhythmic drugs as needed.

Question 77

ongoing monitoring of an MI

Answer 77

* Monitor vital signs, level of consciousness, cardiac rhythm, and O2 sat * Monitor response to medications. Remedicate or titrate medications as indicated. * Provide emotional support and reassurance to patient and family. * Explain all procedures/interventions to patient in simple terms. * Anticipate need for intubation if respiratory distress is evident. * Prepare for CPR, defibrillation, cardioversion and transcutaneous pacing as indicated.

Question 78

thrombolytic therapy

Answer 78

* Used to dissolve the thrombi in coronary arteries and to restore blood flow. * Most effective if done within 4 to 6 hours after start of chest pain where there is evidence of hyperacute or acute ECG changes in 2 or more leads. * Works directly or indirectly to convert plasminogen to plasmin, an enzyme that acts to digest the fibrin matrix of clots.

Question 79

Thrombolytic side effects/adverse reactions

Answer 79

* Hemorrhage and anemia * Hypotension, fever * Bronchospasm, anaphylaxis * Periorbital swelling, itching, urticaria, headache * Reperfusion dsyrhythmias

Question 80

contraindications for thrombolytic therapy

Answer 80

•Absolute: ## Footnote Active internal bleeding History of cerebral aneurysm, brain tumor, previous cerebral hemorrhage Ischemic stroke within 3 months. Significant closed head or facial trauma within 3 months Aortic dissection •Relative Contraindications: Active peptic ulcer disease Current use of anticoagulants Pregnancy Ischemic stroke over 3 months ago, dementia, intracranial pathology Recent internal bleeding within 2 to 4 weeks. Serious systemic disease. Uncontrolled hypertension over 180/110 Prolonged CPR Patients who weigh less than 65 kg have to dose adjusted because of increased likelihood of bleeding.

Question 81

nursing implications of thrombolytic therapy

Answer 81

•Prior to treatment: Assess vs, neuro, and cardiac rhythm. Patient needs two IV lines Draw required labs. Avoid non essential punctures. Don’t shake the drug. It will foam. •During treatment: Assess vs, neuro, cardiac rhythm q 15 min. Check for signs of bleeding Monitor lab values •After treatment: Assess vs, neuro, cardiac rhythm q 15 min. then q 2 hours for 24 hours Monitor for signs of bleeding for 72 hours.

Question 82

signs of reperfusion (thrombolytic therapy)

Answer 82

* Abrupt cessation of chest pain * Resolution of ST elevation/depression * Rapid rise of CK-MB * Reperfusion dysrhythmias---generally self limiting

Question 83

complications of thrombolytic therapy

Answer 83

* Reocclusion of the artery. May start heparin therapy to prevent this. * Bleeding

Question 84

nitroglycerine drug therapy

Answer 84

* May be used short term to reduce the infarct size, decrease heart workload and increase blood supply. * Hypotension, reflex tachycardia are side effects so BP and heart rate are monitored closely and drug is carefully titrated, * Want to keep BP above 90 systolic and heart rate below 110.

Question 85

morphine sulfate

Answer 85

* Given for chest pain unrelieved by nitroglycerine. Is a vasodilator so decreases cardiac workload by lowering myocardial oxygen consumption. * Reduces contractility, BP and heart rate * Reduces fear and anxiety * In rare cases can depress respirations.

Question 86

good thing about TPA

Answer 86

specific. Goes right for the clot

Question 87

Drug therapy

Answer 87

* Beta blockers * Angiotensin-Converting Enzyme Inhibitors * Angiotensin II Receptor Antagonists * Aspirin * Anticoagulants * Antidysrhythmic drugs * Stool Softners * Lipid lowering drugs

Question 88

nursing care for drug therapy

Answer 88

* Continue to monitor vs, cardiac rhythm, response to drug therapy. * Space activities with rest * After 48 hrs encourage gradual increase in self care activities. Monitor response to activity ie. Vs, O2 sat, changes in cardiac rhythm, chest pain. * Decrease meal time fatigue ## Footnote Small, frequent meals, no very hot or cold foods. Sufficient time for meals * Begin rehab teaching early * Encourage and supervise increased activity level. Start with lying & sitting exercises Increase length of ambulation Encourage exercise for 20 minutes twice a day. * Teach patient to monitor pulse during exercises and to stop if pulse doesn’t increase or if it rises to 20 over resting pulse. * Reinforce plans for home activity program