Critical Care: Cardiac Flashcards
Myocardial Infarction/Chest Pain
Notice- Chest pain, diaphoresis, Nausea/vomiting, SOB, cool/pale skin, increased HR + RR
Analyze- Death of cardiac muscle tissue from lack of oxygenation/perfusion
Hypothesize- Obtain labs [Troponin, CK-MB, Myoglobin, 12-lead ECG, BMP, CBC, aPTT/INR, PT, BUN, creatinine, electrolytes, glucose
Solutions- MONA
M-Morphine
O-Oxygen
N-Nitroglycerin Q5 min x3 until pain = 0 [make sure IV is in + pre/post check BP)
A-Aspirin 81mg x 4 to prevent blood clotting/thrombus
Actions- Admin O2, High fowlers, 2 IV’s, 12 lead ECG
What medications would be contraindicated in a patient needing nitroglycerin?
Erectile dysfunction meds[Viagra/ Sildafinel] /vasodilators
What would we do for a patient who came in for chest pain and demonstrates ST elevation on the ECG?
Prepare for CABG (code cart nearby!)
Ensure 1 IV in saline locked + 1 other for nitro/heparin
Verify pt allergies
Admin 4x Aspirin
Ensure resuscitation equip at bedside
Following a CABG/PCI, what would be your nursing interventions?
Check site for bleeding, swelling, infection, hemorrhage
Strict bed rest for 2-6 hrs + keep affected leg straight
Cardiovascular assessments Q15 min for 1st hr, 30 min for 2nd hr
Monitor EKG + trending labs
Home pharmacy = Aspirin, beta blockers, ACE inhibitors
What would we do for a patient who was admitted for chest pain but is not a candidate for a PCI/Nitro is not effective?
Begin thrombolytic therapy (Alteplase, Reteplase, Tenecteplase) + prepare for cardiac Cath afterwards
Draw V-Tach
State Interventions
^^^^^^^^^^^^^
Interventions: Check on patient, check pulse, admin O2 if pt not on vent
With pulse: Administer Amiodarone + complete synchronized cardioversion
Without Pulse: Call code, begin chest compressions + defibrillation 3x, afterwards admin Epi, then perform CPR then provide “dead dose”of Amiodarone (300mg IVP)
Draw V-Fib
State Interventions
^v^vvv^v (ugly) will never have pulse
Interventions: Call code, begin chest compressions with O2 for 2 minutes, prepare for defibrillation, administer Amiodarone + Epinephrine
*Amiodarone will require filter + vent tubing
Draw A-Fib
State Interventions
–^-^^–^^-^ Goal= Decrease HR + monitor BP
Interventions: Administer O2, Administer anticoagulants (warfarin), Cardizem/Diltiazem, Metoprolol, Amiodarone, Digoxin, complete Ablation + synchronized cardioversion
Asystole Interventions
Interventions: Check lead placement, begin CPR if no pulse, administer epinephrine
Acute Decompensated Heart Failure
Notice- Edema, SOB, Crackles, JVD, ALOC, decreased urine output, tachypnea
Labs/Dx: Increased BNP, Troponin, Echocardiogram = EF less than 40%
Tx: O2, Low sodium diet, high fowlers
Furosemide/Lasix/Bumex = Diuretic
Ace Inhibitors= Lisinopril, Losartan, Valsartan
Beta Blocker= Metoprolol, Nitroglycerin
Digoxin, Primacor/Milrinone, Dobutamine
Mechanical - Impella [heart pump], LVAD [controller + battery pack on outside of body]
Abdominal Aortic Aneurysm
Notice- Abdominal swelling, back pain/abdominal pain
Analyze- CAT scan
Tx: Endoluminal Graft W femoral Access (ELG)
Interventions: Keep pt on strict bedrest, monitor BP to keep low, complete cardiovascular assessments[pedal pulses], check abdomen diameter, stool softeners, pain management
(low BP + hematocrit)
Cardine & Labetalol = lower BP
Endocarditis
Notice- !!Chest pain, fever!!, SOB, heart murmur, back/joint pain, petechiae on body
Analyze- 2 sets of blood cultures, echocardiogram to determine cardiac damage, CBC, PET, increased ESR + WBC, C-reactive protein, troponin, + Rheumatoid factor
Tx- Prophylactic ABX or antifungals (do not give both at same time), supportive therapies, antipyretics
**Pt will need PICC line for at-home ABX
Nursing Interventions for Cardiogenic Shock
Nursing interventions- Admin + inotropic (Milrinone/Primacor) , Digoxin, Dobutamine, Dopamine, Nitro, Epi
If CVP too high= admin diuretic
What is our CVP and MAP goal?
CVP= 8-12 mmHg
MAP= 65
How can CPAP help with CHF exacerbations?
Increasing oxygen availability which decreases cardiac workload/preload
**Continuous oxygen provided, used for hypoxemia
Why is BiPAP used for patients with COPD/CHF?
Inspiratory oxygen + pressure support keeps alveoli open + increase ventilation
Expiratory settings can help blow off Co2
If afterload is reduced, what would this signify?
Decreased SVR
What labs signify respiratory failure?
PaO2 < 60 mmHg (corresponding to oxygen saturation, or SpO2, of 90%)
PaCO2 > 50 mmHg with a pH < 7.35 (hypercarbic)
What is normal CVP, cardiac output and cardiac index?
CVP = 6
CO = 4-8L/min
CI= >2.2 (based on h x w)
Provide the standard value for stroke volume
60-130mL/min
What does the P wave indicate?
P wave = Atrial kick/depolarization
What is the CATH lab prep?
2 20G IV’s - Nitro/heparin
Heel protectors on coccyx
Shave pt –> delegate to UAP
Verify allergies & creatinine due to contrast used
Ensure O2 and defibrillation pads on
Ensure resuscitation equipment at bedside
What is CATH lab post op nursing interventions?
Check site for bleeding/swelling/infection/hemorrhage (petechiae/bruising)
Strict bed rest for 6 hours & keep affected leg straight
Cardiovascular assessments Q15 min for 1st hour Q30 min for 2nd hour
Monitor EKG + trending labs
Assess for pain & need for emergency revision
What is the treatment option for pt who PCI is not available?
Thrombolytic therapy (Alteplase, Reteplase, Tenecteplase)
What is the standard clotting times for PTT? aPTT?
Heparin
PTT: 60-70 seconds
aPTT: 30-45 seconds
What is the standard clotting times for INR?
0.81-1.2
What would indicate a true coronary event?
Pain relieved at rest
Pain relieved by nitro
What types of shock can cause decreased vascular tone?
The distributive shocks
S- Sepsis
N- Neurogenic
A- Anaphylaxis
What is the formula for Cardiac Output?
CO = HR x SV
Heart rate x Stroke volume
What form of cardiac measurement is more accurate for monitoring hemodynamic stability? Cardiac index or cardiac output?
Cardiac index because it is based on height & weight (unique per pt)
What 3 electrolytes affect heart contractility?
Calcium, Potassium, Magnesium
What would an increase in PAWP indicate?
Left ventricular failure
