cardiovascular + lines Flashcards
definition
acute coronary syndrome
impaired blood flow to the heart causing myocardial injury, ischemia, & infarction
what are the types of heart conditions characterized by acute coronary syndrome?
- non-STEMI
- STEMI
- unstable angina
definition
myocardial ischemia
reversible incident of impaired oxygen supply
definition
myocardial injury
acute period of both ischemia & infarction
definition
myocardial infarction
irreversible myocardial necrosis
definition
unstable angina
a clinical syndrome typically resulting from atherosclerosis
when does chest pain usually occur for unstable angina?
at rest
unstable angina usually involves ischemia–what does this entail?
the condition is reversible
what is the difference between all the cardiac conditions?
severity of ischemia (duration) & the levels of cardiac markers
what are the 2 cardiac markers that can signify myocyte injury?
- troponin
- CK-MB isoenzyme
how long does complete necrosis of myocytes take?
4-6 hours
which of the cardiac markers is more sensitive than the other?
Troponin
how long after a cardiac injury do Troponin levels rise?
4-8 hours
for how long do Troponin levels remain elevated?
2 weeks
dependent cardiac risk factors
(7)
- smoking
- HTN
- hypercholesterolemia
- obesity
- sedentary
- stress
- DM
characteristics of CP in MI
- crushing
- sustained
- unrelieved (or partial by rest/ Nitro)
- radiating
what are the treatments for MI?
MONA
- Morphine
- Oxygen
- Nitroglycerin
- Aspirin
what are the goals for a nurse who is treating an MI?
(4)
- preserve LV function
- decrease amount of myocardial necrosis
- start fibrinolytic therapy quickly
- percutanenous coronary intervention
what are contraindications to MI treatments?
(2)
- ischemic stroke in the last 3 months
- recent bleeds from GI, cerebral, & surgical
what does the nurse expect the provider to say in explaining cardiac catheterization to a patient?
analgesics are administered in order for a catheter to be inserted through the groin or arm to reach the coronary vessels & inject a dye that will allow blockages to show on an x-ray or use the catheter to clear blockages
what does a nurse assess for in a patient post-cardiac catheterization?
(5)
- dysrhythmias
- hematoma
- temperature & color of site
- agent-induced renal failure
- (must advise for 2-6 hours bed rest)
what are some of the procedures that improve cardiac function?
- CABG
- IABP (intra-aortic balloon pump)
- VAD
- transplant
definition
endocarditis
infection of the inner layer of the heart
s/s of endocarditis
- fever
- heart mumur
- chills
- weakness
- fatigue
- malaise
- anorexia
how does endocarditis manifest in the vessels?
(5)
- splinter hemorrhages in nailbeds
- Roth’s spots
- Janeway lesions
- Osler’s node on extremities
- systolic murmur
what are the risk factors for endocarditis?
(4)
- prosthetic valves
- hemodialysis
- IV drug abuse
- invasive dental procedures
why does a nurse need to administer prophylactic ABX treatment to a patient who just had an invasive procedure?
to prevent endocarditis
thrombotic vegetation results from which cardiac condition?
endocarditis
what are the diagnostic procedures for endocarditis?
(6)
- blood cultures
- CBC ESR
- C-reactive protein
- CXR
- ECG
- echocardiography
what procedure does a patient with endocarditis need to undergo?
valve replacement or repair
why does a patient with endocarditis need repeat blood cultures?
determine the presence of bacteria, virus, or fungus that caused it
definition
pericarditis
inflammation of the outer lining of the heart
pericarditis is usually accompanied by which cardiac condition?
pericardial effusion
s/s of pericarditis
(5)
- sudden & severe pain
- dyspnea
- pericardial friction rub
- fever
- anxiety
what are the complications for pericarditis?
(4)
- pericardial effusion
- cardiac tamponade
- hiccups
- pulsus paradoxus
what are the pharmacological interventions for pericarditis?
- ABX
- NSAIDS
what are the invasive interventions for pericarditis?
(2)
- pericardiocentesis
- pericardial window
what are the appropriate labs that allow for management of pericarditis?
- CBC
- CRP (C-reactive protein)
- ESR
- Troponin levels
- blood culture
- culture of pericardial fluid
- pericardial biopsy
what does the nurse anticipate to be ordered for a patient with presumed pericarditis?
(5)
- 12 lead EKG
- echocardiogram
- CT
- MRI
- CXR
what are the types of cardiomyopathies?
(4)
- hypertrophic cardiomyopathy
- dilated cardiomyopathy
- arrhythmogenic RV dysplasia
- restrictive cardiomyopathy
definition
dilated cardiomypathy
the muscle in the LL chamber stretches & thins, causing the chamber to enlarge
definition
arrhythmogenic RV dysplasia
replacement of muscle tissue in the LR chamber w/ scar tissue
definition
restrictive cardiomyopathy
ventricles become stiff due to formation of fibrous tissue
what are the medications administered for cardiomyopathies?
(6)
- Nitrates
- B-blockers
- antiarrhythmics
- diuretics
- inotropes (Digoxin)
- anticoagulants
which invasive interventions can the nurse expect to suggest to a patient with cardiomyopathy?
(5)
- VAD
- cardiac resynchronization therapy
- ICD
- transplant
s/s of dilated cardiomyopathy
LHF/ biventricular
s/s of hypertrophic cardiomyopathy
(3)
- CP
- syncope
- dyspnea
s/s of restrictive cardiomyopathy
(3)
- dyspnea
- fatigue
- RHF (progression to LHF)
definition
aortic dissection
inner layer of aorta tears, causing other layers to dissect
s/s of aortic aneurysm/ dissection
sudden CP
(accompanied with other symptoms common to cardiac dysfunction)
what is the normal range for systemic vascular resistance?
700-1500
systemic vascular resistance (SVR) indirectly affects stroke volume
true
how is systemic vascular resistance calculated?
(MAP-CVP)/ CO
CVP - central venous pressure
what reasons could the nurse infer why a patient needs a central line?
(6)
- inadequate peripheral venous access
- TPN
- medications
- hemodialysis
- frequent blood draws
- central venous & arterial monitoring
for what purpose is a CVC preferable than a PVC?
measuring hemodynamics
what are the risks that come with central lines?
(6)
- CLABSI
- hematoma
- arterial puncture
- hemothorax
- thrombosis
what are the indications for an arterial line?
(3)
- need a live monitoring of BP
- frequent ABG analysis
- inability to use non-invasive monitoring on the pt
for what events is a live monitoring of BP indicated?
(4)
- critical illness
- administration of vasoactive meds
- hemorrhage
- high-risk procedures that will cause drastic BP changes
what does it mean to “zero” a pressure regulated transducer for arterial lines?
for every position change the reference point of pressure needs to be reset to ZERO for accurate measurement of BP
at what level does transducer needs to be placed?
phlebostatic axis (in level with atria)
HOB 30 + arm level
what kind of data about blood pressure does an arterial line provide?
real-time systolic, diastolic, & MAP
what does the central venous pressure represent?
right atrial pressure (venous return to the heart)
what is another term for venous return to the heart?
preload
what causes increased CVP?
(3)
- fluid overload
- cardiac tamponade
- RHF
what causes decreased CVP?
(3)
- dehydration
- hypovolemia
- venous dilation
where are the possible placements of an arterial line?
- radial
- brachial
- femoral
what does a decreased MAP indicate?
poor tissue perfusion
what is MAP used for?
assess perfusion pressure
what is the normal range for MAP?
70-100 mmHg
how is pulse pressure calculated?
SBP-DBP
what is the normal range for a pulse pressure?
30-100
what does an elevated pulse pressure indicate?
aortic incompetence
what does a narrow (lowered) pulse pressure indicate?
hypovolemia
how is a pulmonary artery catheter placed?
(4)
- SVC
- RA
- RV
- PA
what are the indications for a pulmonary artery catheter?
(3)
- acute pulmonary HTN
- cardiac tamponade
- measurement of various cardiac pressures
what does a pulmonary artery catheter measure?
(6)
- CO
- SV (stroke volume)
- SVR (systemic vascular resistance)
- RAP
- PAP
- pulmonary wedge pressure
where does the catheter of a central line end up?
inferior or superior vena cava
which vein is easiest to access for a CVAD?
internal jugular vein
moderate risk of infection
what are the indications for using the subclavian vein for access?
lowest risk of infection
HOWEVER, more difficult to access
why is the femoral vein least desirable for a CVAD access?
high risk for infection
HOWEVER, easier to access for emergency
what are the indications for a CVAD?
(8)
- vesicant medications
- multiple infusions
- large rapid infusions (for emergency)
- TPN
- lipids
- PIV cannot be achieved
- central monitoring of BP
- temporary dialysis access
what are the nursing actions to ensure patient safety with a CVAD?
(3)
- do not bolus with vasopressors
- do not draw blood (PV most appropriate for blood cultures)
- push + pause w/ 10cc syringes
what is the standard dressing change rule?
every 7 days or PRN
how often does the gauze for a CVAD need to be replaced?
q24h
what does the nurse need to look out for when performing CVAD removal?
- SOB
- hypotension
what does the nurse do when the patient becomes SOB & hypotensive while removing CVAD?
lay on left side in order to trap the air in RA
how is the patient positioned for a CVAD removal?
- flat
- deep breaths w/ forced exhale
how does the nurse remove a CVAD?
- quick
- stop for resistance
- hold pressure w/ gauze for 5mins.
- place occlusive dressing
STEMI ECG
what kind of heart sound is heard in pericardial tamponade?
friction rub
what are the typical complications of hemodynamic lines?
- hemothorax
- pneumothorax
what is pulsus paradoxus?
a decrease in SBP upon inspiration concurrent with cardiac tamponade
for how long can a PICC line stay in place?
1 week for vascular access
for how long can a midline catheter stay in place?
4 weeks
