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Module 7 > Care Of A Cardiac Patient > Flashcards

Care Of A Cardiac Patient Flashcards

1
Q

How do cardiac pt take aspirin

A

Chew it .. goes to blood stream faster

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2
Q

When a pt is prescribed nitro what should we teach

A

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

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3
Q

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

A

Aspirin

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4
Q

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

A

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

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5
Q

Nstemi

A

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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6
Q

After how many hours will necrosis take place in a nstemi

A

12 hours

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7
Q

Stemi

A

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

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8
Q

How can you assess for unstable angina

A

Give them nitro and chest pain goes away

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9
Q

After how many hours does necrosis take place in a stemi

A

4-6 hours

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10
Q

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

A

Call the physician to go to cath lab immediately

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11
Q

Squeezing description

A

Burning /heartburn

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12
Q

Rightness feeling for MI

A

Band like sensation

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13
Q

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

A

Takes 5-6 hours to increase

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14
Q

Stress test

A

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

Long term treatment

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15
Q

Collateral circulation

A

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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16
Q

Troponin

A

**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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17
Q

Creatine kinase (CK )

A
  • 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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18
Q

Myoglobin (CK-MB)

A

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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19
Q

Medications for MI

A

NITRATES
Beta blockers
Antiplatelets agents
Anticoagulants
Thrombolytic therapy

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20
Q

Nitrates

A

Nitroglycerin

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21
Q

Betablocker for MI

A

Metoprolol

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22
Q

Your patient complains of Chest pain what do you do?

A

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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23
Q

Thrombolytic therapy for MI

A

Alteplase ( not given often)

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24
Q

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

A

Fluids and bloods getting them ready for cath lab

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25
Q

Order for chest pain of meds

A

Nitrates 3X
Morphine
In cath lab for PCI

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26
Q

What is the function of a Betablocker for an MI

A

Lower BP HR and pumping ability

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27
Q

What does the PT. And INR tell us

A

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

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28
Q

Heparin half life

A

30 minutes

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29
Q

Antiplatelet agents for mi

A

ASA /clopidogrel eptifibatide
Aspirin

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30
Q

What tells me if heparin or ENOXAPARIN is therapeutic

A

Pt and INR

Must be 2-3x normal to be therapeutic

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31
Q

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

A

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

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32
Q

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

A

D/c heparin immediately

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33
Q

When do we suspect HIT

A

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

34
Q

Gold standard for MI treatment

A

PIC

35
Q

Biggest thing we are worried about after PCI or cardiac bypass

A

Bleeding out

36
Q

Signs of bleeding out

A

Low bp , high hr , no pulses

37
Q

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

A

Call doc
Apply pressure lots

38
Q

How are we assessing for bleeding out

A

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

39
Q

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

A

Call doctor immediately its an emergency

40
Q

Cardiogenic shock

A

Low bp high HR

41
Q

common cause of cardiogenic shock

A

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

42
Q

Difference between cardiogenic shock and hypovolemic shock

A

Cardiogenic shock is a pump problem

Hypovolemic is a fluid problem

43
Q

What symptoms are we treating for cardiogenic shock

A

Dysrhythmias
Hypotension
Fluid over load

44
Q

Modifiable risk factors

A

Diet
Lifestyle
Bad habits
Smoking
Etc

45
Q

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

A

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

46
Q

Why do we need a heart pillow after cardiac bypass

A

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

47
Q

When you are in pain how do you breath

A

Shallow

48
Q

Why would someone with cardiac bypass have a high glucose

A

Due to stress so will have an insulin slide scale

49
Q

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??

A

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

50
Q

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

A

To encourage healing

51
Q

How does chest tube fluid present immediately after post op

A

Frank blood

52
Q

Chest tube drainage greater than 1 hour post op

A

Serosanguinous

53
Q

What should drainage not be in chest tube

A

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

54
Q

What should we never do with chest tubes

A

Never milk or clamp them .. not our scope of practice

And it can cause trauma

55
Q

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

A

Eats the sutures and attracts bacteria

56
Q

How is the dressing on a chest tube

A

Sterile dressing with tape so tape on 3 sides

57
Q

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

A

Change the collection system

58
Q

if chest tube is pulled out ?

A

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

59
Q

How many times do you lay eyes on chest tube drainage

A

Every hour

60
Q

3 major symptoms of cardiac tampomade. “Becks triad”

A

Hypotension
JVD
Muffled heart sounds

61
Q

Preload

A

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

62
Q

When is preload increased in

A

Hypervolemia
Regurgitation of cardiac valves

63
Q

After load

A

Resistance left ventricle must over come to circulate blood

64
Q

After load Increased in

A

Hypertension
Vasoconstriction

65
Q

Stroke volume

A

Amount of blood put out by left ventricle in one contraction

66
Q

Cardiac out put

A

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

67
Q

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

A

Swollen ankles , generalized edema

68
Q

If in left sided failure what are we going to see

A

Pulmonary congestion , decreased cardiac output which big toe lacks perfusion

69
Q

Decrease perfusion means

A

Decrease o2 and nutrients

70
Q

Meds for CAD

A

Metformin beta blockers , statin

71
Q

Statin education

A

Take at night body produces more chol at night

Makes your face flush

72
Q

What do we assess for calcium blockers

A

Hr above 60

73
Q

What do we assess for beta blockers

A

Hr and bp

74
Q

Nitrates are given how

A

Under the tongue

75
Q

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

A

Pulmonary congestion, course crackles , trouble breathing

76
Q

Main goal of cardiac bypass and PCI

A

Reprofusion of cardiac muscle

77
Q

Dysrhythmia treatment for cardiogenic shock

A

Amiodarone

78
Q

Hypotension treatment for cardiogenic shock

A

Positive inotropic and vasopressor agents such as norepinephrine and dopamine

79
Q

What should we avoid when treating cardiogenic shock

A

Beta blockers lower bp

80
Q

Why do we treat cardiogenic shock with 250 mp fluid challenge

A

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

81
Q

Treatment for fluid overload with cardiogenic shock

A

Diuretics and vasodialators

82
Q

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

A

Leads to decrease CO , and stroke volume

Module 7 (24 decks)

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