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