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)
