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Critical Care > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

___________ angina is causes by exertion and relieved with rest or nitro.

A

Stable

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2
Q

___________ angina usually occurs at rest and is more prolonged and severe.

A

Unstable

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3
Q

What causes Angina?

A

Ischemia resulting from an imbalance of oxygen demand and myocardial oxygen supply

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4
Q

What are the risk factors for Angina?

A
  • Smoking
  • Obesity
  • Sedentary lifestyle
  • CAD
  • HTN
  • DM
  • Hyperlipidemia
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5
Q

What are the clinical manifestations associated with Angina?

A

Chest pain (substernal, left-sided, or epigastric) that is usually described as heaviness, squeezing, or choking and may radiate to arm, neck, back, or jaw

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6
Q

What is the treatment goal for Angina?

A

Restore balance between O2 supply and demand

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7
Q

What is the immediate management for Angina?

A

MONA

  • M - morphine
  • O - oxygen
  • N - nitro
  • A - aspirin
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8
Q

What medications are used for the long-term management of Angina?

A

Beta-blockers or calcium channel blockers

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9
Q

__________ is characterized by ST elevation and indicated full coronary blockage.

A

STEMI

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10
Q

In an __________ there is no ST elevation and partial coronary blockage is indicated.

A

NSTEMI

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11
Q

________ means decreased oxygen supply

A

Ischemia

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12
Q

__________ means complete loss of oxygen resulting in cell death

A

Infarction

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13
Q

What causes a MI?

A

Prolonged ischemia (lack of oxygen supply) to the cardiac tissue that leads to an infarction (irreversible cell damage and tissue death), usually the result of a thrombotic occlusion

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14
Q

How is an MI diagnosed?

A
  • EKG changes - changes in T wave, ST segment, Q wave
  • Labs - myoglobin and troponin
  • X-ray or angiography
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15
Q

What are the clinical manifestations associated with an MI?

A

Chest discomfort, diaphoresis, dyspnea, weakness, fatigue, anxiety, confusion, SOB, n/v, cool & moist skin, HTN, tachycardia, irregular pulse

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16
Q

What is the treatment goal of MI management?

A

Reperfusion

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17
Q

What is the initial management for an MI?

A
  • MONA
  • Serial ECG’s
  • Serial troponins
  • PTCA or fibrinolytic therapy
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18
Q

What is the ongoing management following an MI?

A
  • daily aspirin
  • IV heparin for STEMI patients
  • ACE inhibitors - prevent ventricular remodeling and preserve ejection fraction
  • Beta-blockers, nitrates, statins, antiplatelets
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19
Q

Nitroglycerin Patient Education

A
  • Carry with you at all times
  • Keep in a dark-colored glass bottle to protect from sunlight
  • Sublingual - place under the tongue and let dissolve
  • Take one tablet every 5 minutes for a total of 3 tablets
  • If pain continues, seek immediate care
  • Side effects: headache, flushing, dizziness
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20
Q

____________ is the best lab indicator of infarction and is released into circulation after necrosis and rupture of myocardial cells.

Peaks at ___ hours

A

Troponin

24

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21
Q

Acronym for CV assessment

A
  • N - normal
  • O - onset
  • P - precipitating and palliative factors
  • Q - quality and quantity
  • R - region and radiation
  • S - severity
  • T - time
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22
Q

_____ is the hormone released by the heart in response to stretching, indicates _________ __________.

A

BNP

Heart Failure

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23
Q

Pre-operative Care for a PTCA

A
  • Monitor labs - cardiac enzymes, coagulation, electrolytes, Creatinine and BUN
  • May need to administer aspirin or antiplatelet
  • Discontinue Coumadin (risk of bleeding) and Metformin (if contrast dye is being used, renal)
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24
Q

Post-Operative Care for a PTCA

A
  • Monitor labs
  • Monitor chest pain
  • Incision site (bleeding, hematoma, pain, swelling)
  • Assess distal pulses
  • Keep extremity straight and bed lowered
  • Meds - aspirin and plavix, calcium channel blockers
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25
Q

Pre-Op for CABG

A
  • consent
  • shave and bathe
  • lab work & x-rays
  • patient teaching - what to expect (lots of equipment, puffy appearance, ask for meds when in pain, respiratory care)
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26
Q

Post-Op for CABG

A
  • Prevent hypothermia - lights, bear huggers, blankets
  • Manage pain - meds
  • Support cardiac output - fluids
  • Monitor for dysrhythmias
  • Bleeding - chest tube drainage
  • Prevent pulmonary complications - turn, cough, deep breath, incentive spirometry, pillow to splint, early mobilization
  • UOP
  • Neuro status
  • Monitor for infection
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27
Q

Nursing Care for Intra-Aortic Balloon Pump

A
  • Assess pulses
  • Assess UOP - perfusion
  • Monitor for bleeding
  • Prevent and monitor for infection
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Critical Care (5 decks)

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