Care Of A Cardiac Patient Flashcards
How do cardiac pt take aspirin
Chew it .. goes to blood stream faster
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
In an emergent situation and a pt is getting a heart attack and you are not at the hospital .. what do we give ?
Aspirin
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
Nstemi
No ST elevation
12-72 hours in cath lab
Partial occlusion
Still important ..cath labor meds
Cardiac enzymes will be raised
After how many hours will necrosis take place in a nstemi
12 hours
Stemi
Complete occulision
Code stemi , 02
Cath lab within 90 minutes
Elevated cardiac enzymes
How can you assess for unstable angina
Give them nitro and chest pain goes away
After how many hours does necrosis take place in a stemi
4-6 hours
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
Squeezing description
Burning /heartburn
Rightness feeling for MI
Band like sensation
Why is the first thing we do not cardiac enzymes lab work after suspected MI
Takes 5-6 hours to increase
Stress test
Done physically on a treadmill …chemically is typically more expensive but is IVP
Long term treatment
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
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
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
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
Medications for MI
NITRATES
Beta blockers
Antiplatelets agents
Anticoagulants
Thrombolytic therapy
Nitrates
Nitroglycerin
Betablocker for MI
Metoprolol
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
Thrombolytic therapy for MI
Alteplase ( not given often)
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
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
