CCS Flashcards
What are the anticoagulants?
Warfarin, rivaroxaban, dabigatran, apixaban, clexane, heparin
What can contrast media cause to cardiac cycle?
Transient bradycardia and hypotension
What sensation can CM cause?
A warm sensation especially in the pelvic region during contrast injection of the LV
What’s in contrast media and how does it work?
Iodine. Which absorbs X-rays and makes the image black
What are contrast reactions?
They can be mild (sneezing, flushing , itching), moderate or severe (angiedema, diffuse urticaria, laryngospasms and bronchospasms, stridor, wheezing, hypotension, tachycardia
What to do for a severe contrast reaction?
Stop further administration.
Call for help
Intitiate ALS
Start o2 therapy
Administer adrenaline 0.1mg IV (1ml of 1:10,000 dilution)
Fluid resus for hypotension
What are the premeds for a CM allergy?
Corticosteroids and histamine blockers.
Elective: 50mg PO pred at 13,7 and 1 hour prior. Plus diphenhydramine 50mg 1 hr prior.
Urgent: methpred IV OR hydrocortisone IV and diphenhydramine IV
What is CI AKI?
CM is a nephrotoxic and can worsen renal function.
Third leading cause of HA AKI’s. Affects 5-40% of patients.
What is eGFR and what is normal?
The amount of blood that passes through the glomeruli per minute. Which provides a more accurate assessment of nephron function.
> 60ml/min
Why should metformin be withheld in patients with CKD?
It is associated with severe and potentially fatal lactic acidosis when CM administered in pts with renal insufficiency. Withheld for 48 hours.
How to decrease the risk of CI AKI?
Adequate fluid administration
Avoid dehydration and the use of NSAIDS
Use less contrast
When is warfarin and NOACs stopped?
Warfarin 3 days.
Dabigatran, rivaroxaban, apixaban
2 days
Nursing implications for opioids
Fent, morph, hydromorph. Can cause resp depression, hypo ventilation, hypercapnia.
Monitor RR, o2, capnography levels.
Know hospitals sedation P&P
What are some benzos? How does it work on the body?
Nursing implications for benzodiazepines?
Midaz, Diaz, lorazepam.
Provide anxiolytics and induce hypnotic state, amnesia, sedation. No analgesic properties.
Can cause resp depression and hypotension at high doses.
What is the reversal of opioids?
Nalaxone. Reverses over sedation.
0.4-2mg IV every 2-3 minutes PRN to increase RR and LOC
What is the reversal medication for benzos?
Flumazenil.
0.2mg IV every 1 minute PRN to max 3mg/hr.
What is ETCO2 monitoring?
Asses for adequate ventilation. It measures exhaled CO2 and helps asses for hypoventilation and co2 retention.
Normal 35-45mm hg
What does a ETCO2 >45 mm hg indicate?
Hypercapnia and possible hypoventilation and over sedation
What do anticoagulants do?
Slow down the bodies process of making clots.
Heparin, warfarin, apixaban, rivoroxaban
How does anti platelets affect the body? What are some?
Prevent platelet blood cells from climbing together to form a clot.
Aspirin and clopidogrel. For heart attack and stroke prevention post.
How does atropine work?
It blocks the parasympathetic NS (rest and digest) activation of vagus nerve in SA and AV nodes.
- rapid firing of nodes
- decrease conduction time of AV node
- increase HR
- symptomatic bradycardia
- vasovagal
How does atropine work?
It blocks the parasympathetic NS (rest and digest) activation of vagus nerve in SA and AV nodes.
- rapid firing of nodes
- decrease conduction time of AV node
- increase HR
- symptomatic bradycardia
- vasovagal
What is CTO?
Chronic total occlusion.
complete or nearly complete blockage of one or more coronary arteries. The blockage, typically present for at least three months, is caused by a buildup of plaque within a coronary artery. When this happens, blood flow to the heart is compromised.
CTO is a common heart disorder in patients with CAD.
Between 20 and 25 percent of patients with CAD have CTO.
What is PFO?
Patent foramen ovale. Is a small opening between to atrias. Normally closed during birth 25% population it doesn’t.
Emboli shunt from right to left and can present post stroke mx.
What is a normal creatinine level?
Male 60-100 mmol/L
Female 45-90 mmol/L
Nephrotoxic meds to stop if you have pre existing kidney failure/ insufficiency or DM ?
Metformin
Ace inhibitors - ramipril, perindopril, captopril
