CV Diagnostic Interventions

Question 1

invasive lines

Answer 1

arterial line- GIVES CONTINUOUS BLOOD PRESSURE IN ICU OR ER AND DRAW BLOOD; anything poked in to pt
central venouse pressure with double lumen or swans catheter. Connected to transducers and tubing plugs in to monitor and it is level with phlebostatic axis (4th intercostal to nipple lin) with level of atrium and aorta- has to be flat SO ADEQUATE PRESSURES. When you lower it number goes up make sure you zero it. RISK FOR INFECTION AND INCREASES MORTALITY RATE. CENTRAL VENOUS PRESSURE INTO SUP VENA CAVA THRU JUGULAR AND MEASURES RIGHT ATRIUM PRESSURE . KNOWS IF PT IN FLUID OVERLOAD. NORM 8-12 MMHG. GIVE CRYSTALLOID (NS) OR BLOOD INTO VASCULAR SYSTEM OR PULL OUT

Question 2

NOn invasive hemodynamic monitoring

Answer 2

blood pressure, EKG, SPO2, rectal & bladder and nasopharyngeal temps, HR,Cepnography(monitoring CO2) SKIN PINK WARM DRY AND URINE OUTS GREATER 30 ML/HR IN HEMO STABLE. IF HAS A FIB/ARRYTHMIAS GET MANUAL BP

Question 3

triple lumen catheter

Answer 3

distal end goes to start of right atrium and gives central venous pressure. KNows how much fluid to give people, if it raises e need to diureses. IF IN FEMORAL VEIN(HIGHER RISK INFECTION, BLEEDING, LIMIT MOBILITY) BC CO IS LOW AND CIRCULATORY BAD

Question 4

Swan Ganz Catheter

Answer 4

NEXT STEP FROM TRIPLE LUMEN.Only for cardiac surgery pt . Can go to RA, RV theninto PUlm artery and gives idea Thats in LV(PULM PRESSURES-PULM HYPERTENSION). Not just info for fluid balance. Huge infection rate and concern for arrythmias with Vfib and Vtach arrest bc ventricles get irritable, potential for blood clot which can go to lungs. Wedge pressure (balloon on end of catheter being blowned up) should be questioned bc it dangerous. Normal range for central venous pressure or right atrial 8-12 mmHG.Pulm pressuer 18-25 mmHg, Wedge P 4-12

Question 5

Mean arterial pressure (MAP)

Answer 5

3
Average arterial P throughout one cardiac cycle(systole and diastole)
Should be 65-75mmhg, can below as 60(NOT ADEQUATE CV PERFUSION- CUT BACK ON BP MEDICINE, IN SHOCK GIVE VASOACTIVE MED TO INCREASE NUMBER) and go up to 100; NORM 70-100 IDEAL
means good cardiac output/perfusion
low MAP means fluid balance low
TRUE INDICATOR PERFUSION FROM HERAT TO BRAIN TO KIDNEYS TO EXTREMITIES.
HR LESS 100 SYSTOIC GREATER 100 MAP GREATER 65 GOOD

Question 6

5 most common cardiac disease

Answer 6

Heart attack(CAD), Stroke (occlusion of carotid artery), Heart failure ,arrhythmia(higher risk blood clots; Vtach SVT Vfib) a fib and flutter is fine as long as good perfusion with BP, Heart valve complications (stenosis, regurgitation, extra leaflets)
ATHEROSCLEROSIS DEVELOPSIN BETWEEN ARTERY TISSUE AND SLOWLY PUSHES IT TOGETHRT

Question 7

Nursing care for disorder of myocardial perfusion

Answer 7

heart not gtting enough blood and O2
Coronary artery disease
Acute Coronary syndrome- pain or discomfort

Question 8

Patho of CAD

Answer 8

Atherosclerosis- plaque in between walls you cant directly remove but can open artery
fatty streaks, fibrous plaques, plaque rupture form thrombus, inflammatory cells
start anticoagulant- heparin

Question 9

Left anterior decending coronary artery(COMES DOWN MAIN MIDDLE HEART)

Answer 9

widow maker, if blocked go into sudden cardiac arrest. Main one that feeds blood to heart. GOES INTO ARRYTHMIA OR DROP DEAD

Question 10

Angina

Answer 10

chest pain caused by lack of blood supply within coronary arteries OR COPD,EMPHYSEMA, RESP PROB, COVID

Question 11

Stable angina

Answer 11

Vasoconstriction, doesnt need to go to hospital or 911, can be relieved on own after sitting or med, not diaphoretic or pain
KNOW CAUSE, WHAT TREATS IT, AVOID ACTIVITY CREATES IT, ON LONG ACTING DAILY NITRATES- IMDOR

Question 12

Unstable angina

Answer 12

pain relieved WITH REST, poor cardiac output- tachy, hypertensive, happens more frequently and VS influenced by it
administer meds, relax them with benzodiazopine . Possible to not have heart attack, EKG AND LABS NORM
TREAT WITH NITTROGLYCERIN TO VAODILATE ARTERIES
BRING TO HOSP- STRESS TEST, ECHOS; DETERMINE CAUSE

Question 13

Variant angina

Answer 13

might have to wait for all tests to determine what is, influences them everyday but periods where it doesnt

Question 14

Angina diagnosis

Answer 14

Cardiologists - symptomatic and get relief or not

Question 15

Chest pain with MI

Answer 15

Chest pain (Heavy, intense)
Radiating to L arm, jaw, back
Unrelievef by NTG (nitroglycerin is fast acting vasodilator) or rest (suspect MI)
Sweating (may become cool)
Hard to breathe
Increased HR and BP or irregula HR
Nausea and Vom
Going to be anxious and scared
WOMAN-RIGHT SIDED, INDEGESTION, FATIGUE, SCAPULA PAIN

Question 16

Chest pain meds
(first sign of chest pain do VS )
CHEST PAIN ,EKG NORM- CALL PCP

Answer 16

-Antianginals/Nitrates(sublingual)- FIRST LINE QUICK vasodilates and drops BP so make sure IV in place to give bolus of fluid to fill intervascular space(but if give too much fluid can put into heart failure).1 0.4 MG SUB TAB EVERY FIVE MIN UP TO 3 - GET VS AND EKG BEFORE ADMINISTERING
-Beta-adrenergic blockers- can give first degree AV block;tells SA node to slow down and HR and BP decreases- LIKE WHEN HR LESS 60
-Ca-Channel blockers- CALCIUM HELPS WITH CONTRACTILITY FIRING SO BLOCK AND LESS IRITABILITY
-ACEI- allergic reaction can cause angioedema then switch to diuretic; LISINOPRIL- DECREASES BP AND WORK OF HEART
-statins- preventatie and with MI-LIPITOR
-antiplatelets- low dose aspirin or Plavix(more aggressive) , second choice after nitroglycerin. to prevent platelet aggregation and clotting

Question 17

Myocardial infarction

Answer 17

1.5 M cases annually, men and african american
Pain is not different than angina unless more info
Diagnosis - EKG gold standard first then Nitrate

Question 18

ST Elevation Myocardial Infarction (STEMI)

Answer 18

look like fireman helmets
Actively symptomatic- crushing chest pain, SOB, diaphoretic, N/V, grey, cyanosis
Can diagnosis with 12 LEAD EKG
ST ELEVATION ON ^ SHOWS WHERE HEART ATTACK IS(ISCHEMIA) OCCURING- CALL PRACTICIONER

Question 19

NSTEMI

Answer 19

non ST elevated MI
dont alway get ST wave depression
cant always diagnose based on EKG it can be normal
diagnosed based on triponin levels(NORM LESS 1)
PAIN DOESNT GO AWAY- GET VS FIRST

Question 20

Cardiac Cath w/ Balloon and Stent

Answer 20

Angioplasty. Diagnostic cath into radial artery(less chance for bleeding) or femoral into atrium and put dye in to see how much is blocked, is stable or unstable angina, done for congenital heart defect, HF- to diagnose and get EF number, CAD, Heart valve disease and microvascular heart disease
IV heparin before to reduce clotting
balloon- tries to put plaque against wall INTO LUMEN ARTERY
Stent- guide wire that goes through artery
PATIENT AWAKE, CONSCIOUS SEDATION
BIGGGER THAN IV CATH- HIGH CHANCE BLEEDING

Question 21

Pre- procedure Cardiac Cath

Answer 21

-NPO and stay flat- for complications that require intubation
-Stop all ORAL anticoagulation- harder to control and bleeding
-stop oral diabetic med- the dye has to be excreted by kidneys and metformin(#1 drug for kidney failure) will bind to that; give insulin
-teaching-invasive safer procedure there is sedation to take edge off; diagnostic
-informed consent
-IV
-sedation

Question 22

!!!!Post procedure Cath

Answer 22

-Site checks for bleeding/hematoma- every 15 min first hour then
-Frequent VS-IF BLEEDING BP DOWN AND PULSES LOST
-Check LOC (need to be awake enough to take PO)- conscious sedation diminishes gag reflex so check that before giving drink or food!
-Pulse /circulatory checks (especially distal to extremity affected SO ADEQ PERFUSION)- cap refill
-May have to immobilize affected extremity/lay flat if femoral approach
-IV fluids TO FLUSH DYE, other meds- dont need heparin if worked, put back on antiplatelet orally (Plavix) for rest of life
NEUROVASCULAR CHECKS !

Question 23

suspect heart attack

Answer 23

listen to complaint, VS, ask questions, EKG, bloodwork
triponin less than 14 norm

Question 24

atherectomy

Answer 24

usualyy for PAD for lower extremity diesease; dvice into coronary artery and tries to withdrawl plaque ; not used that much anymore bc it breaks off and casue ischemic stroke

Question 25

concerns stent placement

Answer 25

metal and mesh; need long term anticoagulation treatment. cant vasodilate with stent

Question 26

CORONARY ARTERY BYPASS GRAFTING

Answer 26

IF STENTS (MAX12) DONT WORK
ON PUMP- ON HEART AND LUNG BYPASS MACHING- STOP IT WITH LOT OF ANESTHESIA AND INTUBATION; CIRCULATING BLOOD OUT OF BODY, REOXYGENATING AND PUTTINH IY BACK
OFF PUMP- OPERATE ON HEART WHILE BEATING WITH ANESTHESIA AND INTUBATE, BETTER

Question 27

INTRA AORTIC BALLOON PUMP

Answer 27

EJECTION FRACTION SO LOW SO PUMPING MECH STOPS. PUT STENT; HEART PUMS AND CREATES SYTOLE SO IT GETS MAX BLOOD BACK TO HEART FROM FEMORAL ARTERY TO AORTA AND IDENTITIFIES WHEN DURING DIASTOLE AND SYSTOLE(HEART GOES OUT TO REST OF BODY) AND BALLOON INFLATES TO GIVE HEART REST BEFORE INTERVENE WITH STENT, CABG, VALVE REPLACEMENT.; PUMPS WITH EVERY CARDIAC CYCLE

Question 28

antiplatelet- prevents aggregation; in MI, stroke, HTN, diabetes; not treatment with clot deeloped

Answer 28

aspirin- 81 mg POqday; adult 325 mg po qday
plavix(clopidigral)- for stents prevents aggregation; 75mg po qday and maybe with aspirin
brillinta-loading dose 90 mg po once; post cardiac cath
effient- 60 mg po qday

Question 29

anticoagulation- helps blood clot from getting bigger; already developed; slows clotting process

Answer 29

heparin- subq low dose prevent dvt ; vte prophylaxis; IV drip if clot broke off to thin blood more; 6-12 h effectiveness; vit k reversile
coumadin- monitor PT/INR , PT is pt specific top number ratio; INR (should be 3 higher shows sig bleeding)you contol; doesnt work quickly, monitor efffectiveness usually takes 2-3 days; might give when weaning heparin- reversile not always accurate
eliquis- is pt more symptom free, watch cbc and pt/ INR; wont affect those numbers
pradaxa
xarelto- no lab tests with these new 3
lovenox- low molec heparin; sub q for vte prophylaxis (PE, DVT) 40 mg ; for therapeutic anticoagulation; larger dose weight based (under 50 mg prophylaxis; weight based 70-100 sub q q 12 for true treatment for blood clot; bridge to coumadin, with higher dose bridge to 3 new ones

Question 30

thrombolytics- emergency treatment breaks up clots, more dangerous; look pmh are on anticoags

Answer 30

streptokinase
alteplase- tpa - no reversile , ischemic stroke(take to cat scan to determine if neuro deficit is bleed to treat to make sure its not for hemorrhagic head bleed stroke) not hemorrhagic pts, MI,STEMIS they go right to cath lab; risks outweigh benefits;
urokinase-Iv thru central lines

Question 31

arrythmia- rhthym;

Answer 31

bottom one- vfib, are leads misplaces, unresponsive, do cpr first and early defibrillation
middle one- vtach , used AED, ventricles irritable turn into vfib with Damar
top one- ventricular taachycardia/ PVC; heart is irritable
FIRST CPR UNTIL AED

Question 32

CAD progress to dysrythmias evaluation

Answer 32

psychosocial- scary, anxiety,depressed
physical- airway compromised, SOB, tachypnea, resp distress, breathing rapid shallow, apnea, circulation (BP, HR, RR, SPO2, )pale cool clammy skin, diaphoretic , pain, NV, fatigue, dizzy, lightheaded, indigestion(look VS, look food, call pcp, then give ekg or antacids

Question 33

nursing diagnoses

Answer 33

decreased cardiac output
ineffective tissue perfusion
excess fluid volume until hmesostasis
activity intolerance
deficient knowledge
acute pain