exam 1 - cardiac 1 Flashcards

1
Q

Identify 3 priority-nursing diagnoses for MI

A

acute pain (evidence of continuing cardiac damage),

ineffective cardiac tissue perfusion (the root cause of the problem), and

decreased cardiac output

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2
Q

important monitoring when giving amiodarone

A

QT interval assessment because it prolonges the refractory period

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3
Q

PTCI discharge 4 for femoral

A

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

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4
Q

PTCI discharge

A
  • 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*
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5
Q

4 aspects of a crisis

A

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

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6
Q

4 phases of crisis response

A

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

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7
Q

4 stages of crisis theory

A

equilibirum
stressful event
disequalibirum
need to restore equil

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8
Q

3 balancing factors and needs for crisis

A

Realistic Perception of the Event
Adequate Situational Support
Adequate Coping Mechanisms

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9
Q

goal of crisis intervention

A

get person to return to pre-crisis stage

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10
Q

5 steps for crisis intervention

A

Assess - Assess the person’s perception of the event, living situation, support available, and current coping mechanisms
Diagnose -
Plan -
Implement -
Evaluate -

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11
Q

general vs generic support for crisis intervention

A

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.

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12
Q

4 needs of CCU families

A

info
proximity
support and assurance
comfort

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13
Q

4 key principles of pt and family care

A

Respect and Dignity
Information Sharing
Participation
Collaboration

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14
Q

5 characteristics of cardiac conduction

A

Automaticity - automatic
Rhythmicity
Conductivity – pass electrical impulse
Excitability
Contractility – muscle contracts

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15
Q

SA, AV and purkinjie fibers/ventricles HRs

A

SA Node – normal rate 60-100 bpm

AV Node – normal rate 40-60 bpm

Ventricles/Purkinje Fibers – normal rate 20-40 bpm

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16
Q

what is the problem when Hr is too high or low

A

perfusion

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17
Q

what is the normals for P and QRS and what does each represent

A

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*

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18
Q
A

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

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19
Q
A

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

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20
Q

atropine
MOA
SE
nursing

A

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.
21
Q

Epi
MOA
SE

A

catecholamine, causes vasoconstriction, cardiac stimulant, strengthens myocardial contraction and increases heart rate.

anxiety, dizziness, dyspnea, palpitations.

22
Q
A
  1. Heart rhythm—regular
  2. Heart rate—greater than 100 beats per minute - 180
  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

SINuS TACHY

interventions:
#1 assess
#2 correct cause
#3 IV access for adensoine, BB, Ca channel blockers

23
Q
A

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

24
Q

adenosine
MOA
given
SE
nursing

A

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

25
Q
A

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

26
Q

amiodarone
MOA
SE
nursing

A

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

27
Q

lidocaine
MOA

A

Blocks sodium channels, decreasing cardiac automaticity and depolarization.

28
Q
A

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

29
Q

procainamide
MOA
nursing

A

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

30
Q
A

VFIB

CPR
DEFIB
CPR and epi same time

31
Q

asystole interventions

A

CPR, epinephrine, vasopressin (all same time)

32
Q

characterstics of unstable angina 4

A

new onset,

increasing in duration, frequency or severity,

occurs at rest or with minimal exertion,

resistant to nitroglycerin

33
Q

what is MI

A

sustained ischemia causing irreversible myocardial cell death due to build up of plaque in coronary artery dec O2 to the heart

34
Q

1 priority for pt with chest pain

A

put them on cardiac monitoring

35
Q

MI s/s

A

depends on location

an anterior MI - catecholamine release aka inc HR and BP

inferior /posterior MI - parasympathetic response (n/v, hypotension, bradycardia)

36
Q

troponin
peak?
normal?

A

4-12 hours
0-0.04
if > 0.1 high risk for death

37
Q

myoglobin
peak?
use?

A

peaks 1-4 hours
NOT cardiac specific

38
Q

5 s.s of cardio shock

A
  • Tachycardia.
  • Hypotension.
  • Decreased urine output (less than 0.5 mL/kg/hr).
  • Cold, clammy skin.
  • Agitation.
39
Q

pericarditis s/s

A

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

40
Q

ventricular aneurysm

A

stretched out and ballooning and weakening of the muscle

41
Q

MI interventions 7

A

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

42
Q

NTG
MOA
dose use
SE 2
contraindications 2
education 2

A

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

  1. cant use when hypotensive (<90/<50) - 2. cant use when on ED drugs
  2. STORE IN DARK PLACE,
  3. only lasts 3 months
43
Q

when is morphine used in MI
and what to monitor

A

when chest pain not relieved by NTG

monitor RR (resp depression), BP (hypotension), pain levels

44
Q

Eptifibatide (Integrilin), tirofiban (Aggrastat), abciximab (RePro):

MOA
what to monitor
contraindications

A

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

45
Q

PTCI 7 preop

A

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

46
Q

7 post op PTCI

A

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)

47
Q

tpa/alteplase/rpa

moa
nursing given
complications
contraindications
nursing

A

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

48
Q

PTCI/MI discharge

A

meds : aspirin, BB, ACE, statins, NTG

smoking cessation

control BG

do PA

control HTN

weight management

cardiac rehab

depression screen