Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

High Acuity Hesi > Decreased Cardiac Output > Flashcards

Decreased Cardiac Output Flashcards

1
Q

What are manifestations of low cardiac output?

A

Skin:

  • Cool, Pale
  • Diaphoretic

Neuro:

  • Dizziness, Syncope,
  • Change in Level of Consciousness, Restlessness

Cardiovascular:

  • Chest Pain,
  • Low Blood Pressure,
  • Weak Peripheral Pulses, Decreased Capillary Refill

Respiratory:

  • Shortness of Breath, Tachypnea
  • Orthopnea

Renal:

  • Decreased Urine Output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the order of medical interventions for a STEMI?

A
  1. ASA
  2. Clopidogrel (Plavix)- with or without perfusion
  3. Oxygen
  4. Nitroglycerine (NTG)
  5. Morphine (Class 1 intervention)
  6. D/C NSAIDS
  7. Beta Blockers within 24 hours
  • ACE Inhibitors w/in 24 hrs in impaired Ejection Fraction, HTN, DM or Chronic Kidney disease
  • Anticoagulants (related to reperfusion strategy)
  • Heparin
  • Lovenox
  • IV Insulin indicated in 1st 24-48 hrs after STEMI to tightly control glucose
  • Fibrinolytics if time from onset of Sx •Goal is DOOR to NEEDLE is 30 minutes!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can an intravascular ultrasound?

A
  • Evaluates coronary artery walls, stent placement and post PCI procedure for stent/angioplasty integrity
  • Used in conjunction with Cardiac Cath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do beta-blockers decrease myocardial oxygen demand?

A
  • (SLOW IVP Metoprolol, Labetalol)
  • Decreases myocardial oxygen consumption by lowering heart rate and contractility,
  • ALSO: Prevents ventricular remodeling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some nursing interventions to decreased O2 demands during a cardiogenic shock?

A
  • vadminister analgesics & sedatives
  • position patient for comfort
  • limit patient activities
  • reduce anxiety
  • provide calm/quiet environment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some medical treatments to restore perfusion and decrease O2 demands?

A
  • Oxygen: if SpO2
  • Aspirin: 160-325 mg- chew it, Blocks Thromboxane A2; Prevents clots at thrombus
  • Nitrates: Vasodilates coronaries à Increases perfusion through coronary arteries
    • Not if pt has recently taken Phosphodiesterase Inhibitor (Viagra, Cialis, etc)=> DECREASED BP…
    • “Nitrates should NOT be given to pts w/in 24 hrs of (Viagra) or (Levitra) adminis- tration or w/in 48 hrs of (Cialis)”
  • Beta Blockers:
    • Decreases heart rate and extends diastoleà since coronary arteries fill during diastoleà Increases O2 supply to myocardium
  • Invasive Medical - Surgical / Technological Therapies:
    • Percutaneous Interventions: Stents; Angioplasty; Atherectomy; etc..
    • Intra-Aortic Balloon Pump
    • Coronary Artery Bypass Graft
    • Left Ventricular Device, Extracorporeal Mechanical Oxygenation (ECMO)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does ECMO work and when are the indications for it?

A

Extracorporeal Membrane Oxygenation (ECMO)

  • Blood is removed from venous end and oxygenated, by a membrane oxygenator
  • Blood is then delivered to the aorta or venous site, using an external mechanical pump

Indications:

  • Refractory cardiogenic shock w/ underlying potentially reversible heart condition,
  • Used as a bridge to a ventricular assist device or cardiac transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What causes cardiac tamponade, what are some complications and manifestations of it, and how would you treat it?

A

Causes:

  • This occurs from bleeding into pericardial sac (it is an Emergency)
  • Pericarditis, Myocardial rupture, Recent Cardiac surgery, End-stage renal disease (uremia), Metastatic cancer

Complications:

  • Obstructive shock, death
  • Pulseless electrical activity

Manifestations:

  • Associated with increased mediastinal drainage
  • Pulsus paradox= Exaggerated decrease of SBP during inspiration (> 10 mm Hg drop)
  • Beck’s Triad:
    • Increased CVP
    • Low BP
    • Muffled heart sounds

Tx:

  • Pericardiocentesis
  • Pericardial window surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some contraindications to the administration of fibrinolytics?

A
  • Prior intracranial hemorrhage
  • Known structural cerebral vascular lesion
  • Malignant intracranial neoplasm
  • Significant closed head injury within the last 3 months
  • Ischemic stroke within the last 3 months
  • Active bleeding
  • ST-segment depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are factors that can decrease cardiac output?

A
  • Heart Rate:
    • Excessive Increases and Decreases in HR due to Dysrhythmias
  • Preload:
    • Decreased preload from Dehydration, Third spacing (Ex: Burns)
    • Increased preload from Fluid Overload
  • Contractility:
    • Altered conduction (Contractility) from specific Dysrhythmiasà decrease atrial kick à reducing contractility
    • Decreased contractility (Ex: Myocardial Ischemia, Injury, Infarction- MI, Cardiogenic Shock)
  • Afterload:
    • Excessively Increased afterload (Ex: HTN crisis)
    • Decreased afterload -> less blood return to the heart, peripheral pooling 2o to vasodilation (Ex: Sepsis, Anaphylaxis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some complications associated with fibrinolytics?

A
  • Active bleeding
  • Hypersensitivity
  • Intracranial bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some complications associated with coronary artery bypass machine?

A

Bleeding d/t:

  • Mechanical damage to platelets and clotting factors, consumption coagulopathy,
  • Incomplete neutralization of heparin used to prime CBM
  • Thromboembolism d/t: Cannulation to CPM
  • Neurological deficits d/t:
  • Decreased systemic arterial pressure while on CP bypass
  • Embolus from cannulation to CBM
  • Inadequate renal blood flow associated w/ CBM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the Nursing Management with IABP & VAD Care

A
  • Monitor for dysrhythmias, peripheral ischemia, and bleeding
  • Monitor for balloon perforation
  • Monitor for migration (IABP), loss of L brachial /radial pulse, or renal damage. The ballon could have moved and blocked one of these
  • Monitor for device failure (VAD)
  • Prevent infection at insertion site
  • Prevent atelectasis or pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some complications from getting a CABG

A
  • Hypovolemia and Vasodilation
  • Diuresis
  • Cardiac Tamponade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do ACE inhibitors/ARBs Decrease Myocardial Oxygen Demand?

A
  • Vasodilates and reduces workload of heart
  • ALSO: Prevents ventricular remodeling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some drugs that increase cardiac output?

A

vamrinone, digoxin, dobutamine, dopamine, norepinephrine

Nitroglycerin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some characteristics of a HTN emergency?

A
  • Same BP range as HTN Urgency (> 180/110-120 mmHg OR Diastolic BP > 120 mmHg)
  • Positive target organ damage present:
    • Stroke, Cerebral hemorrhage, HTN encephalopathy
    • Acute MI, Pulmonary Edema, Aortic dissection
    • Acute Renal Failure
  • Manifestations:
    • Severe HA, Neuro deficits, Vertigo
    • Nausea and Vomiting
    • Chest Pain
  • Others: based on target organ
18
Q

Describe the pathophysiology associated with cardiogenic shock

A
  • Impaired ability of ventricle to pump blood forward leads to
    • Decreased stroke volume (SV) &
    • Increased blood in left ventricle @ end of systole
  • The decrease in stroke volume (SV) causes a decrease in cardiac output (CO) which leads to:
    • decreased cellular O2 supply
    • decreased tissue perfusion
  • An ineffective left ventricle results in increased ­ end-systolic volume which ­ pulmonary pressures increases & pulmonary edema
  • Pulmonary edema causes impaired gas exchange & decreases oxygenation which leads to further
    • decreases cellular O2 supply
    • decreases tissue perfusion
19
Q

What are some characteristics of a unstable angina?

A
  • ST segment or T wave depression + Negative biomarker
    • Absence of ST-segment elevation in NSTEMI is understood to involve less than full thickness (partial thickness) damage of heart muscle.
    • No biomarkers because there is no damage being done to the heart yet

T wave inversion

20
Q

What are the symptoms associated with successful reperfusion with fibrinolytics?

A
  • Relief of presenting symptoms
  • Reduction of atleast 50% of the intital st-segment elevation
  • Hemodynamic and electrical stability
  • Reperfusion arrhythmias such as PVCs or V tachy
  • Early peaking of the CKMB
21
Q

What are the clinical manifestations of an MI?

A
  • •Chest discomfort (lasting longer than 20 minutes, but
  • Pressure, crushing, gripping
  • **Some may have silent MI: DM, Older adults, Women
  • Epigastric discomfort
  • Shortness of Breath
  • Nausea Vomiting -> with R. coronary artery
  • Excessive diaphoresis (ANS)
  • Pallor, Gray skin color (ANS)
  • Palpitations, Dysrhythmias
  • Anxiety, Sense of impending doom
  • S3, Rales (if MI complicated w/ CHF)
  • S4 (stiff ventricle from infarcted tissue)
  • Low grade temp (2o to inflammation, necrosis
22
Q

What are some characteristics of a HTN urgency?

A
  • BP= > 180/110-120 mmHg OR Diastolic BP > 120 mmHg
  • No target organ damage
  • May be w/out symptoms OR
    • HA
    • Anxiety
    • Epistaxis
    • Dyspnea
23
Q

What are some nursing implications with patients with LVAD?

A
  • Monitor Hemodynamics, Dysrhythmias,
  • Labs,
  • Anticoagulant therapies;
  • Ventilator management;
  • Sedation/Paralytics;
  • Psychosocial support;
  • Prevent infection
24
Q

How would you treat a HTN emergency?

A
  • MEDICAL EMERGENCY
  • Admit To ICU
    • Begin Anti-HTN Therapy: Bring BP down by 10% 1st hr; In 2-3 hr down by another 15%
      • Adrenergic Inhibitors- Esmolol, Labetalol, Metoprolol
      • Vasodilators- Nitroprusside, Nitroglycerine, Nicardipine
      • Diuretics- Furosemide (lasix)
  • Treat End Organ damage Problems
  • Symptom Management
    • Nausea- Antiemetic
    • Severe H/A- Analgesics
25
Q

What are some clinical manifestations of cardiogenic shock?

A
  • SBP
  • MAP
  • Decreased sensorium
  • Cool, pale, moist skin
  • UO
  • Chest pain
  • Tachycardia
  • Weak, thready pulse
  • Decreased S1 & S2
  • S3 heart sound
  • Tachypnea, Crackles
  • Dysrhythmias
  • Decreased cardiac output
  • Increased preload
26
Q

What are some manifestations of an MI seen in women?

A
  • Chest Pain: most commonly reported acute symptom among men & women, but more women than men report non–chest pain
  • Atypical
    • Fatigue,
    • Upper back and neck pain,
    • Nausea
27
Q

What are some risk factors for CAD?

A
  • Smoking*
  • Hypertension* (>140/90)
  • Age (M > 45; F > 55)
  • Dyslipidemia*
    • Low HDL
    • Elevated LDL / TG
  • Family Hx of premature CHD in 1st degree relative (M

Chronic conditions:

  • Diabetes Mellitus
  • Chronic Kidney Disease
  • Obesity
  • Lack of regular physical activity
  • Lack of diet rich in fruit, veggies, fiber
28
Q

What are some characteristics of a STEMI?

A
  • ST elevation + Pathological Q waves
    • Becuase when an atheromatous plaque ruptures in a coronary vessel and the clot which forms completely obliterates the vascular lumen, the entire thickness of the myocardial wall supplied by that vessel becomes ischaemic and is at risk of infarction. This process evolves over a series of hours and is associated with characteristic ECG changes at different time-points during its evolution.
  • Positive Biomarkers
    • ↑ CPK-MB - Rises within 4-6 hrs of damage; Peaks at 18-24 hrs, Stays elevated for 3-4days
    • ↑ Detected in blood w/in 2-4 hrs after ischemia starts; peaks 18-24 hours, stays elevated for 5-9 days
29
Q

What are some complications with an LVAD?

A

•Bleeding,

Coagulation, Disconnection,

Emboli, Drive line Infection

30
Q

What is primary PCI and what is it used for?

A

Primary PCI:

  • Procedure of choice for STEMI
  • DOOR to BALLOON time goal = 90 minutes
  • Especially elder pt who may not be eligible for Thrombolytics

Early Tx for Unstable NSTEMI:

  • V-Tachy, Hemodynamics poor, Heart Failure, ST deviations, Refractory chest pain
31
Q

How would you treat a HTN urgency?

A
  • Give Oral anti-HTN meds to decrease BP gradually over 12-24 hours to a lower BP Target
  • This will decrease chance of ischemia from a rapid BP change
  • Manage any other symptoms
    • Alleviate Pain, Anxiety
    • Monitor for escalation of BP and movement into HTN Emergency
  • If OK, can go home with good medical follow-up
32
Q

How do calcium channel blockers Decrease Myocardial Oxygen Demand?

A
  • (Cardizem, Cardene)
  • Decreases Heart Rate and contractility à decreases workload
33
Q

What are the indcations for using an intra-aortic balloon pump?

A

Indications:

  • Acute MI,
  • Cardiogenic Shock refractory to meds
  • Ejection Fraction

Function:

  • Catheter inserted through femoral until tip located in Descending Aorta
  • Balloon inflates on diastole→ ↑Myocardial O2 supply
  • Balloon deflates on systole →↓LV afterload (decreases myocardial O2 demand)
34
Q

When would you start a patient on oxygen?

A

If SpO2

35
Q

How do analgesics Decrease Myocardial Oxygen Demand?

A
  • Morphine 2-4 mg IVP q 5 min prn)
  • Provides relief of pain
  • Reduces anxiety
  • Opioids will venodilate like NTG with same good effects
36
Q

How do nitrates (nitroglycerine) work to Decrease Myocardial Oxygen Demands by?

A

Dilates peripheral veins –> decreases Preload & Afterload thereby, decreases O2 demand

37
Q

What is the pathogenesis of a HTN crisis?

A
  • Elevated BP itself
    • Mechanical stress and vessel wall damage
    • Increased vascular permeability, activation of clotting cascade
    • Endothelieal damage -> Release of vasoconstrictors
  • RAAS activation ->
    • Angiotensin II -> Vasoconstriction + release of Proinflammatory cytokines
  • Oxidative Stress ->
    • Decreased Nitric Oxide (vasoconstriction)-> Increased BP
    • Increased reactive Oxygen free radicals (H2O2, etc..)-> cellular damage
  • Endothelial dysfunction ->
    • Activated Common Final Pathway
    • Activated platelet adhesion
    • Decreased vasodilation
38
Q

What can echocardiography be used for?

A
  • Evaluates heart structural function and heart wall movement
    • Determines pt’s ejection fraction after MI to detect cardiac contractility changes
  • Can detect post ACS- MI complications such as:
    • Valvular dysfunction
    • Ventricular aneurysm
    • Akinesis or Hypokinesis (No or Decreased heart wall movement)
39
Q

What are some characteristics of a NSTEMI?

A
  • ST segment or T wave depression + Positive biomarker
    • Absence of ST-segment elevation in NSTEMI is understood to involve less than full thickness (partial thickness) damage of heart muscle.
    • There is a positive biomarker because the heart muscle is getting ischemic

ST depression

40
Q

What is the order of medical interventions for a NSTEMI?

A
    1. ASA
    1. Oxygen (1st 6 hours) for SpO2
    1. NTG
      * IV in first 48 hrs for persistent ischemia, HTN, Heart Failure
      * Should NOT interfere with mortality reducing beta blockers and ACE inhibitors
    1. Morphine
      * If NTG is unsuccessful AND other anti-ischemic meds on board)
    1. Beta Blockers (within 24 hrs)
      * Start PO when hemodynamically stable
      * May use if HTN
    1. ACE Inhibitors (within 24 hrs)
      * Used mostly in select patients (HFailure or LVEF

High Acuity Hesi (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions