CRNA Flashcards
diagnostic criteria for an acute STEMI (including labs)
-symptoms of ischemia
-New ST changes/left BBB
-wall motion abnormality (ventricular wall dyskinesia)
-full thickness myocardial damage
-troponin elevation (protein that’s found in the cells of your heart muscle)
-CPK-MB elevation (creatine phosphokinase MB cardiac marker/enzyme, indication of muscle damage non specific to cardiac tissue)
-ESR (marker of inflammation d/t increase in proteins-measures how quickly erythrocytes (RBCs) separate from blood sample-if damaged RBCs stick together and settle faster - elevated in cases of MI)
-Myoglobin (protein that is found in striated muscles/skeletal muscles-carries and stores oxygen in muscle cells-elevated in MI-nonspecific to cardiac injury but released from the myocardium during MI)
-LDH (lactate dehydrogenase-enzyme that’s excreted during organ damage)
Risk factors for acute coronary syndrome
-atherosclerosis
-HTN
-obesity
-cholesterol
-sedentary lifestyle
-smoking
nursing assessment for acute MI
-lightheadedness
-anxiety
-choking sensation??
-diaphoresis
-chest pain
-extra heart sounds
-women (n/v epigastric pain) jaw pain
difference between NSTEMI and STEMI
STEMI-complete occlusion of coronary vessel with EKG changes
NSTEMI-severe stenosis, microclots, transient occlusion, usually doesn’t result in full thickness myocardial damage.
Treatment for NSTEMI/STEMI (nursing and medical)
-MorphineOxygenNitroAspirin
-heparin
-beta blockers (-olol): block epinephrine and reduce myocardial workload/oxygen demand
-ACE inhibitors (-pril): angiotensin converting enzyme inhibitors. reduces preload and after load w/vasodilation, prevents angio2(substance that narrows blood vessels)
-Glycoprotein lab/llla inhibitors (tirofiban, abciximab and eptifibatide) prevent platelet aggregation by blocking these receptors. used after stents. rarely used anymore replaced with anti platelet agents
-statins: lower LDL, reduce the amount of cholesterol made by the liver. it inhibits HMG-CoA reductase enzyme in the cholesterol pathway
-anti platelet medications (aspirin, clopidogrel, ticagrelor..) P2Y12 receptor antagonists inhibit clot formation by preventing platelet activation and aggregation
-go to Cath lab for stents
-STEMI- fibrinolytic in 30min or less, door to PCI 90mins
-CABG
complications of STEMI
-cardiogenic shock
-papillary muscle rupture
-heart failure
death
Pappilary Muscle Rupture
tx, s/s, contraindications
what is it: chordae tendinae (tendons) that connect pappillary muscles to AV valves rupture
causes: acute MI, connective tissue disorder, cardiac trauma
s/s: severe mitral valve regurg, cariogenic chock, pulmonary edema
treatment: after load reduction, diuretics, emergency surgery
contraindications: beta blockers (tachycardia reduces regurgitation)
6 Ps of compromised vascular perfusion
Pain
Poikilothermia (hypothermia)
Paresthesia
Paralysis
Pulselessness
Pallor
Carotid Stenosis
causes, diagnostic tests, treatment, symptoms, contraindications
causes: artherosclerosis, cystic medial necrosis (disorder of large arteries-cyst accumulation), arteritis, dissection, diabetes, CAD, PVD
s/s: weak carotid pulse, TIAs, stroke
dx test: carotid US, CTA
meds: statins, aspirin, antiplatelets
tx: stents
Arterial Occlusion tx
vascular surgery, fibrinolytics (–ase, alteplase, tenecteplase TPA converts plasminogen to plasmin activating the fibrinolytic system), embolectomy, arterial bypass surgery, daily aspirin
Cardiogenic Pulmonary Edema what is it, causes, dx tests, s/s, med tx, contradindications
what it is: pulmonary edema as a result of heart failure
causes: heart failure, left ventricular failure, cardiomyopathy, regurgitation
s/s: SOA, orthopnea, exertional dyspnea, edema
dx tests: increased PA pressures, PAWP >18 (wedge pressure) echo, chest XR
treatment: decrease pre load/afterload diuretics, vasodilators, beta blockers inotropes
severe tx: balloon bump cabg L valve replacement LVAD
of note avoid beta blockers during shock
SWAN Lumen Yellow
-distal port, measurement of PA pressures and mixed venous gases. do not infuse.
-PAWP/PAOP: pulmonary arterial wedge pressure/pulmonary artery occlusion pressure- left ventricle preload
normal Wedge pressure: 2-10
PA pressure 15-30/5-15
SWAN lumen blue
blue port-right Atrial Lumen, proximal port
-can monitor SVC/RA pressures (CVP/RAP)
-can be used for fluids/drugs
normal RA pressures 0-6
CVP pressures
RV 25/0
Thermistor on SWAN
Red/White connector-temperature sensitive wire
-lies in PA
-connect to CO monitor allows determination of CO
normal CO:
SWAN lumen WHITE
proximal infusion port, terminates in right atrium. only used for infusing drugs
RED lumen on SWAN
balloon inflation deflation
1.5 ml of air
what pressures are measured with a SWAN
Q: 4-8L/min
CI: 2.5-4L/min
CVP: 2-6mmHg
PAWP: 8-12mmHg
PAP: 25/10mmHg
SvO2: 0.65-0.70SV: 50-100mL/beat
SVI: 25-45mL/beat/m2
SVR: 900-1300 dynes-sec/cm5
SVRI: 1900-2400 dyne-sec/cm5
PVR: 40-150 dyne-sec/cm5
PVRI: 120-200 dynes-sec/cm5
what pressures would be seen in the following conditions (Invasive hemodynamics)
RHF
LHF
Pericardial tamponade
Hypovolemia
Cardiogenic
Sepsis
Right heart failure: high CVP, low CI, high PVR
Left heart failure: high PCWP, low CI, high SVR
Pericardial tamponade: high PCWP, high SVR, CVP = PCWP
Hypovolemia: low CVP, low PCWP, low CI, high SVR
Cardiogenic: high CVP, high PCWP, low CI, high SVR
Sepsis (Distributive): low CVP, low PCWP, high CI, low SVR
Cardiomyopathy/heartfailure s/s
Right side: fluid in the tissue
Left side: fluid in the lungs
aortic aneurysm sx canidates
symptomatic >5cm
congenital heart defects
Atrial septal defect (ASD)
Patent foramen ovale
Ventricular septal defect (VSD)
Aortic stenosis/regurgitation
Mitral stenosis/regurgitation
Pulmonary valve stenosis
Coarctation of the aorta (CoA)
Hypoplastic left ventricle
Tetralogy of Fallot
Transposition of great vessels
Truncus arteriosus
Atrioventricular canal defect
Ebstein’s anomaly
Patent ductus arteriosus (PDA)
TAPVC
acquired heart defects
Any alteration of the heart’s shape or function related to any of the following:
Rheumatic fever
Rubella
ETOH/drug abuse
Endocarditis
Tumors
Lupus
Syphilis
HTN
Rheumatoid arthritis
Myxomatous degeneration
Calcific degeneration
Aging
Pregnancy
Cardiomyopathy
sg 1 ARDS
first 12 hours
decreased breath sounds
mild tachycardia
mild tachypnea
normal bp
normal skin color
normal ABG
sg 2 ARDS
12-48 hours
expiratory crackles
tachycardia
anxiety/agitation
elevation bp
cool clammy skin
compensated respiratory acidosis
stage 3 ARDS
acute respiratory failure
diffuse crackles infiltrations XR
tachyarrhythmias
dyspnea RR >30
lethargy
labile BP
pale cyanotic skin
respiratory acidosis
stage 4 ARDS
severe hypoxemia
bradyarrythmias
bradypnea
obtunded
hypotension
pale cyanotic skin
metabolic and resp acidosis
PE causes, s/s, dx tests
causes hypercoagulability
hypoxemic vs hypercapnic resp failure
Hypoxemic (type I, most common): PaO2 < 60 mmHg with low/norm PaCO2
Hypercapnic (type II): PaCO2 > 50 mmHg; may or may not have hypoxemia
Acute failure develops over min/hours, without time for metabolic compensation, so pH is usually < 7.3.
bronchiolitis causes/tx, dx test
viral infection (RSV human metapneumovirus)
viral antigen testing CRP
types of pneumothorax
Spontaneous pneumothorax: caused by bleb rupture; tachycardia, sudden chest pain and dyspnea
Iatrogenic pneumothorax: caused by underlying lung disease and medical interventions; tachycardia, sudden chest pain and dyspnea
Tension pneumothorax: usually caused by chest trauma; chest pain, tachycardia, dyspnea, low BP, hypoxia, tracheal deviation, unilateral breath sounds, JVD
Catamenial pneumothorax: caused by menstruation in women most often 30–40 yrs old, related to thoracic endometriosis; S/S within 48–72 hours of menstruation; most often a right-sided pneumothorax
Pneumomediastinum: caused by trauma, infection, or increased pressure in the lungs (extreme coughing, sneezing, vomiting); sore throat, dysphagia, dyspnea, cough, may or may not have chest pain
pneumopericardium
causes:
Trauma, RDS, mechanical ventilation, perforated ulcers, bronchial fistulas, pericarditis, thoracic surgery, pericardiocentesis, endo/laparoscopy
s/s:
Chest pain, low BP, low/high HR, dyspnea, pulsus paradoxus, ST-elevation with low voltage QRS
treatment: needle aspiration pericardial chest tube thoracotomy pericardotom reduce peep
Emphysema tx
bronchodilator abs vaccinations chest PT
Pulmonary hypertension what is it
types, what causes it
dx tests
s/s
treatment
idiopathic primary-
genetic-
s/s-
dx tests- echocardiogram
treatment-
