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COMPLEX > cardiovascular + lines > Flashcards

cardiovascular + lines Flashcards

1
Q

definition

acute coronary syndrome

A

impaired blood flow to the heart causing myocardial injury, ischemia, & infarction

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2
Q

what are the types of heart conditions characterized by acute coronary syndrome?

A
  • non-STEMI
  • STEMI
  • unstable angina
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3
Q

definition

myocardial ischemia

A

reversible incident of impaired oxygen supply

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4
Q

definition

myocardial injury

A

acute period of both ischemia & infarction

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5
Q

definition

myocardial infarction

A

irreversible myocardial necrosis

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6
Q

definition

unstable angina

A

a clinical syndrome typically resulting from atherosclerosis

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7
Q

when does chest pain usually occur for unstable angina?

A

at rest

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8
Q

unstable angina usually involves ischemia–what does this entail?

A

the condition is reversible

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9
Q

what is the difference between all the cardiac conditions?

A

severity of ischemia (duration) & the levels of cardiac markers

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10
Q

what are the 2 cardiac markers that can signify myocyte injury?

A
  • troponin
  • CK-MB isoenzyme
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11
Q

how long does complete necrosis of myocytes take?

A

4-6 hours

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12
Q

which of the cardiac markers is more sensitive than the other?

A

Troponin

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13
Q

how long after a cardiac injury do Troponin levels rise?

A

4-8 hours

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14
Q

for how long do Troponin levels remain elevated?

A

2 weeks

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15
Q

dependent cardiac risk factors

(7)

A
  • smoking
  • HTN
  • hypercholesterolemia
  • obesity
  • sedentary
  • stress
  • DM
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16
Q

characteristics of CP in MI

A
  • crushing
  • sustained
  • unrelieved (or partial by rest/ Nitro)
  • radiating
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17
Q

what are the treatments for MI?

MONA

A
  • Morphine
  • Oxygen
  • Nitroglycerin
  • Aspirin
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18
Q

what are the goals for a nurse who is treating an MI?

(4)

A
  • preserve LV function
  • decrease amount of myocardial necrosis
  • start fibrinolytic therapy quickly
  • percutanenous coronary intervention
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19
Q

what are contraindications to MI treatments?

(2)

A
  • ischemic stroke in the last 3 months
  • recent bleeds from GI, cerebral, & surgical
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20
Q

what does the nurse expect the provider to say in explaining cardiac catheterization to a patient?

A

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

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21
Q

what does a nurse assess for in a patient post-cardiac catheterization?

(5)

A
  • dysrhythmias
  • hematoma
  • temperature & color of site
  • agent-induced renal failure
  • (must advise for 2-6 hours bed rest)
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22
Q

what are some of the procedures that improve cardiac function?

A
  • CABG
  • IABP (intra-aortic balloon pump)
  • VAD
  • transplant
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23
Q

definition

endocarditis

A

infection of the inner layer of the heart

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24
Q

s/s of endocarditis

A
  • fever
  • heart mumur
  • chills
  • weakness
  • fatigue
  • malaise
  • anorexia
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25
Q

how does endocarditis manifest in the vessels?

(5)

A
  • splinter hemorrhages in nailbeds
  • Roth’s spots
  • Janeway lesions
  • Osler’s node on extremities
  • systolic murmur
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26
Q

what are the risk factors for endocarditis?

(4)

A
  • prosthetic valves
  • hemodialysis
  • IV drug abuse
  • invasive dental procedures
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27
Q

why does a nurse need to administer prophylactic ABX treatment to a patient who just had an invasive procedure?

A

to prevent endocarditis

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28
Q

thrombotic vegetation results from which cardiac condition?

A

endocarditis

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29
Q

what are the diagnostic procedures for endocarditis?

(6)

A
  • blood cultures
  • CBC ESR
  • C-reactive protein
  • CXR
  • ECG
  • echocardiography
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30
Q

what procedure does a patient with endocarditis need to undergo?

A

valve replacement or repair

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31
Q

why does a patient with endocarditis need repeat blood cultures?

A

determine the presence of bacteria, virus, or fungus that caused it

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32
Q

definition

pericarditis

A

inflammation of the outer lining of the heart

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33
Q

pericarditis is usually accompanied by which cardiac condition?

A

pericardial effusion

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34
Q

s/s of pericarditis

(5)

A
  • sudden & severe pain
  • dyspnea
  • pericardial friction rub
  • fever
  • anxiety
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35
Q

what are the complications for pericarditis?

(4)

A
  • pericardial effusion
  • cardiac tamponade
  • hiccups
  • pulsus paradoxus
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36
Q

what are the pharmacological interventions for pericarditis?

A
  • ABX
  • NSAIDS
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37
Q

what are the invasive interventions for pericarditis?

(2)

A
  • pericardiocentesis
  • pericardial window
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38
Q

what are the appropriate labs that allow for management of pericarditis?

A
  • CBC
  • CRP (C-reactive protein)
  • ESR
  • Troponin levels
  • blood culture
  • culture of pericardial fluid
  • pericardial biopsy
39
Q

what does the nurse anticipate to be ordered for a patient with presumed pericarditis?

(5)

A
  • 12 lead EKG
  • echocardiogram
  • CT
  • MRI
  • CXR
40
Q

what are the types of cardiomyopathies?

(4)

A
  • hypertrophic cardiomyopathy
  • dilated cardiomyopathy
  • arrhythmogenic RV dysplasia
  • restrictive cardiomyopathy
41
Q

definition

dilated cardiomypathy

A

the muscle in the LL chamber stretches & thins, causing the chamber to enlarge

42
Q

definition

arrhythmogenic RV dysplasia

A

replacement of muscle tissue in the LR chamber w/ scar tissue

43
Q

definition

restrictive cardiomyopathy

A

ventricles become stiff due to formation of fibrous tissue

44
Q

what are the medications administered for cardiomyopathies?

(6)

A
  • Nitrates
  • B-blockers
  • antiarrhythmics
  • diuretics
  • inotropes (Digoxin)
  • anticoagulants
45
Q

which invasive interventions can the nurse expect to suggest to a patient with cardiomyopathy?

(5)

A
  • VAD
  • cardiac resynchronization therapy
  • ICD
  • transplant
46
Q

s/s of dilated cardiomyopathy

A

LHF/ biventricular

47
Q

s/s of hypertrophic cardiomyopathy

(3)

A
  • CP
  • syncope
  • dyspnea
48
Q

s/s of restrictive cardiomyopathy

(3)

A
  • dyspnea
  • fatigue
  • RHF (progression to LHF)
49
Q

definition

aortic dissection

A

inner layer of aorta tears, causing other layers to dissect

50
Q

s/s of aortic aneurysm/ dissection

A

sudden CP
(accompanied with other symptoms common to cardiac dysfunction)

51
Q

what is the normal range for systemic vascular resistance?

A

700-1500

52
Q

systemic vascular resistance (SVR) indirectly affects stroke volume

A

true

53
Q

how is systemic vascular resistance calculated?

A

(MAP-CVP)/ CO

CVP - central venous pressure

54
Q

what reasons could the nurse infer why a patient needs a central line?

(6)

A
  • inadequate peripheral venous access
  • TPN
  • medications
  • hemodialysis
  • frequent blood draws
  • central venous & arterial monitoring
55
Q

for what purpose is a CVC preferable than a PVC?

A

measuring hemodynamics

56
Q

what are the risks that come with central lines?

(6)

A
  • CLABSI
  • hematoma
  • arterial puncture
  • hemothorax
  • thrombosis
57
Q

what are the indications for an arterial line?

(3)

A
  • need a live monitoring of BP
  • frequent ABG analysis
  • inability to use non-invasive monitoring on the pt
58
Q

for what events is a live monitoring of BP indicated?

(4)

A
  • critical illness
  • administration of vasoactive meds
  • hemorrhage
  • high-risk procedures that will cause drastic BP changes
59
Q

what does it mean to “zero” a pressure regulated transducer for arterial lines?

A

for every position change the reference point of pressure needs to be reset to ZERO for accurate measurement of BP

60
Q

at what level does transducer needs to be placed?

A

phlebostatic axis (in level with atria)

HOB 30 + arm level

61
Q

what kind of data about blood pressure does an arterial line provide?

A

real-time systolic, diastolic, & MAP

62
Q

what does the central venous pressure represent?

A

right atrial pressure (venous return to the heart)

63
Q

what is another term for venous return to the heart?

A

preload

64
Q

what causes increased CVP?

(3)

A
  • fluid overload
  • cardiac tamponade
  • RHF
65
Q

what causes decreased CVP?

(3)

A
  • dehydration
  • hypovolemia
  • venous dilation
66
Q

where are the possible placements of an arterial line?

A
  • radial
  • brachial
  • femoral
67
Q

what does a decreased MAP indicate?

A

poor tissue perfusion

68
Q

what is MAP used for?

A

assess perfusion pressure

69
Q

what is the normal range for MAP?

A

70-100 mmHg

70
Q

how is pulse pressure calculated?

A

SBP-DBP

71
Q

what is the normal range for a pulse pressure?

A

30-100

72
Q

what does an elevated pulse pressure indicate?

A

aortic incompetence

73
Q

what does a narrow (lowered) pulse pressure indicate?

A

hypovolemia

74
Q

how is a pulmonary artery catheter placed?

(4)

A
  1. SVC
  2. RA
  3. RV
  4. PA
75
Q

what are the indications for a pulmonary artery catheter?

(3)

A
  • acute pulmonary HTN
  • cardiac tamponade
  • measurement of various cardiac pressures
76
Q

what does a pulmonary artery catheter measure?

(6)

A
  • CO
  • SV (stroke volume)
  • SVR (systemic vascular resistance)
  • RAP
  • PAP
  • pulmonary wedge pressure
77
Q

where does the catheter of a central line end up?

A

inferior or superior vena cava

78
Q

which vein is easiest to access for a CVAD?

A

internal jugular vein

moderate risk of infection

79
Q

what are the indications for using the subclavian vein for access?

A

lowest risk of infection

HOWEVER, more difficult to access

80
Q

why is the femoral vein least desirable for a CVAD access?

A

high risk for infection

HOWEVER, easier to access for emergency

81
Q

what are the indications for a CVAD?

(8)

A
  • vesicant medications
  • multiple infusions
  • large rapid infusions (for emergency)
  • TPN
  • lipids
  • PIV cannot be achieved
  • central monitoring of BP
  • temporary dialysis access
82
Q

what are the nursing actions to ensure patient safety with a CVAD?

(3)

A
  • do not bolus with vasopressors
  • do not draw blood (PV most appropriate for blood cultures)
  • push + pause w/ 10cc syringes
83
Q

what is the standard dressing change rule?

A

every 7 days or PRN

84
Q

how often does the gauze for a CVAD need to be replaced?

A

q24h

85
Q

what does the nurse need to look out for when performing CVAD removal?

A
  • SOB
  • hypotension
86
Q

what does the nurse do when the patient becomes SOB & hypotensive while removing CVAD?

A

lay on left side in order to trap the air in RA

87
Q

how is the patient positioned for a CVAD removal?

A
  • flat
  • deep breaths w/ forced exhale
88
Q

how does the nurse remove a CVAD?

A
  • quick
  • stop for resistance
  • hold pressure w/ gauze for 5mins.
  • place occlusive dressing
89
Q

STEMI ECG

A
90
Q

what kind of heart sound is heard in pericardial tamponade?

A

friction rub

91
Q

what are the typical complications of hemodynamic lines?

A
  • hemothorax
  • pneumothorax
92
Q

what is pulsus paradoxus?

A

a decrease in SBP upon inspiration concurrent with cardiac tamponade

93
Q

for how long can a PICC line stay in place?

A

1 week for vascular access

94
Q

for how long can a midline catheter stay in place?

A

4 weeks

COMPLEX (11 decks)

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