exam 1 - cardiac 1 Flashcards
Identify 3 priority-nursing diagnoses for MI
acute pain (evidence of continuing cardiac damage),
ineffective cardiac tissue perfusion (the root cause of the problem), and
decreased cardiac output
important monitoring when giving amiodarone
QT interval assessment because it prolonges the refractory period
PTCI discharge 4 for femoral
continuing to monitor the EKG, I&O, kidney function labs and electrolytes
Keep the patient on bedrest,
HOB no higher than 30 degrees,
leg straight for 4-6 hours
PTCI discharge
- Patient should be on antiplatelet therapy with aspirin and clopidogrel for 1 year.
- Patient should report signs and symptoms of MI or angina to doctor
- Patient should notify HCP is infection or bleeding occrur (fever, swelling, oozing, bruising, pain, numbness, tingling)
- Patient will be discharged with antiplatlet medications like aspirin or clopidogrel, and a statin to lower LDL, and a beta blocker (antihypertensives**)to reduce cardiac workload.
- Patient should avoid pressure on puncture site and lifting items heavier than 8 pounds
- Do not drive for 3-4 days
- Patient can resume normal activities after 1 week
- smoking cessation*
- control BG*
4 aspects of a crisis
Caused by a stressful event or perceived threat/loss
Person’s usual way of coping becomes ineffective in dealing with the treat which causes anxiety
The treat/loss is usually identifiable
It may have occurred weeks or days before the crisis, but is a recent event
4 phases of crisis response
1st Phase – anxiety activates the person’s usual coping mechanisms; if these methods don’t bring relief and/or support is inadequate, the person progresses to the next phase
2nd Phase – more anxiety since usual coping mechanisms have failed
3rd Phase – new coping mechanisms are tried, or threat is redefined so old ones
can work – often resolution occurs here
4th Phase – if no resolution occurs, severe or panic levels of anxiety ensue which may lead to psychological disorganization
4 stages of crisis theory
equilibirum
stressful event
disequalibirum
need to restore equil
3 balancing factors and needs for crisis
Realistic Perception of the Event
Adequate Situational Support
Adequate Coping Mechanisms
goal of crisis intervention
get person to return to pre-crisis stage
5 steps for crisis intervention
Assess - Assess the person’s perception of the event, living situation, support available, and current coping mechanisms
Diagnose -
Plan -
Implement -
Evaluate -
general vs generic support for crisis intervention
General Support – using empathy, warmth, acceptance and other therapeutic techniques.
Generic Approach – used for high-risk individuals and large groups. It applies specific methods to all the people faced with a similar crisis. Grief counseling is an example of the generic approach.
4 needs of CCU families
info
proximity
support and assurance
comfort
4 key principles of pt and family care
Respect and Dignity
Information Sharing
Participation
Collaboration
5 characteristics of cardiac conduction
Automaticity - automatic
Rhythmicity
Conductivity – pass electrical impulse
Excitability
Contractility – muscle contracts
SA, AV and purkinjie fibers/ventricles HRs
SA Node – normal rate 60-100 bpm
AV Node – normal rate 40-60 bpm
Ventricles/Purkinje Fibers – normal rate 20-40 bpm
what is the problem when Hr is too high or low
perfusion
what is the normals for P and QRS and what does each represent
P wave reflects atrial depolarization, normal is .12-.20 seconds
QRS wave reflects ventricular depolarization, normal is .06-.12 seconds
ST wave reflects ventricular repolarization – VULNERABLE PERIOD*
Regular
HR: 70 ( count between peaks and multiple by 10)
Uniform and upright P waves
1:1 P to QRS complex
0.12 PR interval
Normal QRS
NORMAL SINUS RHYTHM
intervention = monitor pt
Sinus brady
1. Heart rhythm—regular
2. Heart rate—less than 60 beats per minute – 30
3. P waves—uniform and upright
4. P to QRS ratio—one to one
5. PR interval—0.12 to 0.20 second -
6. QRS complex—narrow, less than 0.12 second
intervention =
#1 go assess patient
#2 if symptomatic, give O2 if less than 93, establish IV access for atropine and if atropine doesnt work, use EPI then pacemaker later
atropine
MOA
SE
nursing
anticholinergic that blocks cholinergic and parasympathetic stimulation of the heart, increasing conduction through the AV node. - INCREASES HR
Side effects – dry mouth, urinary retention, blurred vision.
- Atropine administration should not delay the implementation
of temporary external pacing for patients with poor
perfusion. - Assessment of cardiac rhythm for increase in heart rate.
Epi
MOA
SE
catecholamine, causes vasoconstriction, cardiac stimulant, strengthens myocardial contraction and increases heart rate.
anxiety, dizziness, dyspnea, palpitations.
- Heart rhythm—regular
- Heart rate—greater than 100 beats per minute - 180
- P waves—uniform and upright
- P to QRS ratio—one to one
- PR interval—0.12 to 0.20 second
- QRS complex—narrow, less than 0.12 second
SINuS TACHY
interventions:
#1 assess
#2 correct cause
#3 IV access for adensoine, BB, Ca channel blockers
SVT
1. Heart rhythm—regular
2. Heart rate—150 to 250 beats per minute
3. P waves—may differ in shape from sinus P waves;
may be hidden in preceding T wave
4. P to QRS ratio—one to one
5. PR interval—may be difficult to measure
6. QRS complex—narrow, less than 0.12 second
interventions:
#1 assess
#3 O2 if <93
#4 vagal meneuver
IV access for adenosine , BB, Ca channel blockers if those dont work
adenosine
MOA
given
SE
nursing
causes a transitory block at the AV node. to lower HR
Must be given over 1-3 seconds followed by a 20 mL flush using an antecubital vein or through a central line.
Side effects – temporary asystole, facial flushing, diaphoresis, lightheadedness, chest pain, a sense of doom.
DOESNT affect BP, can give even if hypotensive
PVC
Not regular – the drops you see are premature contractions
80 HR
No P waves
Bottom priority because it is multifocal PVCs
interventions:
O2 if <93
correct cause - caffeine, anxiety, electrolyte imbalances
if unstable - give amiodarone !! or procainamide or lidocaine and then cardioversion
amiodarone
MOA
SE
nursing
slows conduction and prolongs refractoriness at the AV node and prolongs the duration of cardiac action potential via sodium and potassium channels.
Side effects – hypotension, bradycardia, QT interval prolongation, torsades de pointes.
monitor QT interval
lidocaine
MOA
Blocks sodium channels, decreasing cardiac automaticity and depolarization.
VTACH
1. Heart rhythm—usually regular
2. Heart rate—110 to 250 beats per minute = 200
3. P waves—usually absent
4. P to QRS ratio—the PVC does not have a P wave
preceding
it
5. PR interval—none
6. QRS complex—greater than 0.12 second; the shape, width,
and amplitude of QRS complexes are all similar; T waves
are often difficult to distinguish from QRS complexes – WIDE QRS
interventions:
pulse? amiodarone and cardioversion
no pulse? CPR, Defib, epi, amiodarone
procainamide
MOA
nursing
An antiarrhythmic that blocks sodium channels and prolongs cardiac action potential, slowing conduction of both atrial and ventricular arrhythmias and reducing myocardial irritability.
stop if hypotensive
VFIB
CPR
DEFIB
CPR and epi same time
asystole interventions
CPR, epinephrine, vasopressin (all same time)
characterstics of unstable angina 4
new onset,
increasing in duration, frequency or severity,
occurs at rest or with minimal exertion,
resistant to nitroglycerin
what is MI
sustained ischemia causing irreversible myocardial cell death due to build up of plaque in coronary artery dec O2 to the heart
1 priority for pt with chest pain
put them on cardiac monitoring
MI s/s
depends on location
an anterior MI - catecholamine release aka inc HR and BP
inferior /posterior MI - parasympathetic response (n/v, hypotension, bradycardia)
troponin
peak?
normal?
4-12 hours
0-0.04
if > 0.1 high risk for death
myoglobin
peak?
use?
peaks 1-4 hours
NOT cardiac specific
5 s.s of cardio shock
- Tachycardia.
- Hypotension.
- Decreased urine output (less than 0.5 mL/kg/hr).
- Cold, clammy skin.
- Agitation.
pericarditis s/s
chest pain and ECG changes.
The pain is located in the anterior precordium, which can
radiate to the upper abdomen, upper arms, and back.
The pain usually increases with inspiration and is
relieved by having the patient lean forward
ventricular aneurysm
stretched out and ballooning and weakening of the muscle
MI interventions 7
Initiate Cardiac monitoring
Give O2 if stat less than 93
NTG and aspirin same time
If pt BP okay and still pain, Then give Morphine/fentanyl to dec pain, and lower BP/HR
BB - > continue after discharge
ACE/ARBS -> to reduce remodeling
NTG
MOA
dose use
SE 2
contraindications 2
education 2
vasodilation to increase blood flow and reduce BP , reducing preload
3 times every 5 minutes, if not relived after 15 min then CALL 911
SE: headache, hypotension
- cant use when hypotensive (<90/<50) - 2. cant use when on ED drugs
- STORE IN DARK PLACE,
- only lasts 3 months
when is morphine used in MI
and what to monitor
when chest pain not relieved by NTG
monitor RR (resp depression), BP (hypotension), pain levels
Eptifibatide (Integrilin), tirofiban (Aggrastat), abciximab (RePro):
MOA
what to monitor
contraindications
blocks binding of fibrinogen
Monitor CBC, platelet count, PTT, INR.
Contraindications: bleeding, history of internal bleeding, CVA in the past month, thrombocytopenia, and renal dialysis. Use with caution in AVM, aneurysm, severe HTN
PTCI 7 preop
Explain procedure to the patient
Assess allergies (with special attention to contrast media)
Review pre-procedure lab values (CBC, platelets, electrolytes, kidney function because contrast is nephrotoxic – check BUN and CR before cath lab).
Discontinue metformin because dye + med can kill kidneys
Assess peripheral pulses
Assess hydration status
Initiate IV therapy as ordered
7 post op PTCI
Monitor for myocardial ischemia,
thrombosis and bleeding (s/s low BP, low HandH)
Monitor for reperfusion dysrhythmias
Monitor vital signs and insertion site frequently
Monitor patient’s Hgb, Hct, platelet count, renal function
Monitor perfusion of the extremity below the insertion site
Monitor intake and output
Maintain the patient’s activity restrictions (based on site used)
tpa/alteplase/rpa
moa
nursing given
complications
contraindications
nursing
works by breaking up fibrin network in clots, used in MI with ST segment elevation
Must be given within 4-6 hours of onset of chest pain (optimal within 30 min)
Complications - bleeding
Contraindications – absolute (uncontrolled HTN, any stroke within past year), pregnancy, hemorragic stroke, untreated clotting disorder, recent major surgeries, and relative
Followed by heparin infusion and with antiplatelet therapy to prevent new clots from forming
PTCI/MI discharge
meds : aspirin, BB, ACE, statins, NTG
smoking cessation
control BG
do PA
control HTN
weight management
cardiac rehab
depression screen
