Care Of A Cardiac Patient Flashcards by Elizabeth Gausin

How do cardiac pt take aspirin

Chew it .. goes to blood stream faster

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When a pt is prescribed nitro what should we teach

Increases blood flow to area , you may pass out due to low BP and low HR

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In an emergent situation and a pt is getting a heart attack and you are not at the hospital .. what do we give ?

Aspirin

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When a pt is taking an ACE/ARB for acute coronary syndrom.. what do we teach

It may cause a dry hacking cough … adverse effect so report

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Nstemi

No ST elevation
12-72 hours in cath lab
Partial occlusion
Still important ..cath labor meds
Cardiac enzymes will be raised

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After how many hours will necrosis take place in a nstemi

12 hours

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Stemi

Complete occulision
Code stemi , 02
Cath lab within 90 minutes
Elevated cardiac enzymes

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How can you assess for unstable angina

Give them nitro and chest pain goes away

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After how many hours does necrosis take place in a stemi

4-6 hours

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First thing you do when a patient comes in with a NSTEMI and it converts to a stemi …

Call the physician to go to cath lab immediately

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Squeezing description

Burning /heartburn

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Rightness feeling for MI

Band like sensation

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Why is the first thing we do not cardiac enzymes lab work after suspected MI

Takes 5-6 hours to increase

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Stress test

Done physically on a treadmill …chemically is typically more expensive but is IVP

Long term treatment

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Collateral circulation

How your body compensates to get blood flow but can be a bad thing because you can get a clot into one of the small trees

Can live with it but higher BP and until you get a clot

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Troponin

**BEST lab that determines an MI

Elevated 4-6 hours after injury and peaks 10-24 hours
Level is <0.03 (I)
<0.1 NG/mL (T)

Returns to baseline 10-14 days

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Creatine kinase (CK )

found in the muscle but not specific to the heart
All it does is tell us muscle damage ( so not accurate for MI just in general can be high if you just worked out)

Can be + but does not mean you had an MI

Elevated 6 hours after injury peaks at 18 hours

Level 30-170 U/L
Returns to normal 24-36 hours following injury

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Myoglobin (CK-MB)

Tells us how much heart damage was

Specific to cardiac
Elevates within two hours peaks at 3-15 hours
Level = <90
Returns to normal 12-24 hours after injury

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Medications for MI

NITRATES
Beta blockers
Antiplatelets agents
Anticoagulants
Thrombolytic therapy

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Nitrates

Nitroglycerin

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Betablocker for MI

Metoprolol

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Your patient complains of Chest pain what do you do?

Rest
Apply o2 non rebreather
Vital signs- also check manually
EKG
Ensure adequate IV access ( large bore)
Meds
Get pt ready for repurfusion therapy

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Thrombolytic therapy for MI

Alteplase ( not given often)

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Why do you need large bore access and 2 IV when a pt has a stemi

Fluids and bloods getting them ready for cath lab

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Order for chest pain of meds

Nitrates 3X Morphine In cath lab for PCI

What is the function of a Betablocker for an MI

Lower BP HR and pumping ability

What does the PT. And INR tell us

How fast it clots should be elevated 2-3X normal be therapeutic

Heparin half life

30 minutes

Antiplatelet agents for mi

ASA /clopidogrel eptifibatide Aspirin

What tells me if heparin or ENOXAPARIN is therapeutic

Pt and INR Must be 2-3x normal to be therapeutic

Before we take pt to cath lab what is the reason we give them heparin instead of an anti platelet agent?

Heparin has a half life of 30 minutes and the anti platelet like plavix has a 6 hour half life

What should we do immediately if we notice the pt has heparin induced thrombocytopenia ( HIT)

D/c heparin immediately

When do we suspect HIT

Pit. <150 or a drop of 50% or more from baseline ** Arterial or venous thrombosis Acute systemic reactions after admin

Gold standard for MI treatment

PIC

Biggest thing we are worried about after PCI or cardiac bypass

Bleeding out

Signs of bleeding out

Low bp , high hr , no pulses

What do we do when we realize a pt is bleeding out

Call doc Apply pressure lots

How are we assessing for bleeding out

Whatever leg it was on - right or left peripheral vascular assessment ( is it warm, can they move it, do they have a pulse, can they feel it, can’t move big toes, what’s the color) Do also a peripheral vascular on opposite one to know baseline to see a change

If a pt comes back from surgery and have no pulse after what do we do

Call doctor immediately its an emergency

Cardiogenic shock

Low bp high HR

common cause of cardiogenic shock

trauma .. due to MI Is life threatening / high mortality rate 50-75%

Difference between cardiogenic shock and hypovolemic shock

Cardiogenic shock is a pump problem Hypovolemic is a fluid problem

What symptoms are we treating for cardiogenic shock

Dysrhythmias Hypotension Fluid over load

Modifiable risk factors

Diet Lifestyle Bad habits Smoking Etc

Why do we want someone who had a cardiac bypass to cough

To clear out secretions and to open up lungs to avoid pneumonia

Why do we need a heart pillow after cardiac bypass

So when they cough it hurts like crazy so holding the pillow and applying pressure helps

When you are in pain how do you breath

Shallow

Why would someone with cardiac bypass have a high glucose

Due to stress so will have an insulin slide scale

You are administering insulin to a pt and the family member comes in saying they dont need it because they are not diabetic.. what do you do??

Educate.. when our body is stressed it releases epinephrine which increases our blood glucose so pt does need to be on insulin sliding scale to counteract that and control sugar

Why is it important to control blood glucose in a cardiac bypass pt

To encourage healing

How does chest tube fluid present immediately after post op

Frank blood

Chest tube drainage greater than 1 hour post op

Serosanguinous

What should drainage not be in chest tube

Not greater than 100 mL /hr If it is greater than 100 ml /hr something is wrong so it messes with hemodynamics so call doctor asap Pt may feel weak , tired, hr may drop bp may drop

What should we never do with chest tubes

Never milk or clamp them .. not our scope of practice And it can cause trauma

Why dont we use petroleum jelly with dressing on chest tube any more

Eats the sutures and attracts bacteria

How is the dressing on a chest tube

Sterile dressing with tape so tape on 3 sides

If chest tube disconnects from set up or set up breaks?

Change the collection system

if chest tube is pulled out ?

Put the tip in sterile water put pale over it immediately and cover the hole to prevent anything bad from being sucked in

How many times do you lay eyes on chest tube drainage

Every hour

3 major symptoms of cardiac tampomade. “Becks triad”

Hypotension JVD Muffled heart sounds

Preload

Volume of blood in ventricles at ther end of diastole ( end diastolic pressure)

When is preload increased in

Hypervolemia Regurgitation of cardiac valves

After load

Resistance left ventricle must over come to circulate blood

After load Increased in

Hypertension Vasoconstriction

Stroke volume

Amount of blood put out by left ventricle in one contraction

Cardiac out put

Amount of blood if the heart pumps through circulatory system in one min

If the right side of my heart fails what will we see

Swollen ankles , generalized edema

If in left sided failure what are we going to see

Pulmonary congestion , decreased cardiac output which big toe lacks perfusion

Decrease perfusion means

Decrease o2 and nutrients

Meds for CAD

Metformin beta blockers , statin

Statin education

Take at night body produces more chol at night Makes your face flush

What do we assess for calcium blockers

Hr above 60

What do we assess for beta blockers

Hr and bp

Nitrates are given how

Under the tongue

If a pt goes from nstemi to stemi what do the patients typically have

Pulmonary congestion, course crackles , trouble breathing

Main goal of cardiac bypass and PCI

Reprofusion of cardiac muscle

Dysrhythmia treatment for cardiogenic shock

Amiodarone

Hypotension treatment for cardiogenic shock

Positive inotropic and vasopressor agents such as norepinephrine and dopamine

What should we avoid when treating cardiogenic shock

Beta blockers lower bp

Why do we treat cardiogenic shock with 250 mp fluid challenge

To see if it would work and if it doesn’t we would stop

Treatment for fluid overload with cardiogenic shock

Diuretics and vasodialators

At a hr greater than 180.. what starts to happen

Leads to decrease CO , and stroke volume