Exam 2: Perfusion

Question 1

Nitroglycerin

Answer 1

• Vasodilator that reduces cardiac pre load and therefore cardiac workload
• Routes: Sublingual or oral spray- Should work in 1 to 5 mins, can give up to 3 doses, 5 mins apart
• Side Effects: Hypotension, H/A
• Considerations: Requires frequent monitoring of BP
  Ensure pt is not taking sildenafil (both vasod)

Question 2

Largest Coronary Artery

Answer 2

• Left anterior descending artery; biggest supplier of oxygenated blood to your left ventricle. A complete blockage can result in “ widow maker “ heart attacl which is often fatal.

Question 3

Cardiac Catheterization

Answer 3

• Procedure: A tiny flexible catheter is inserted into blood vessels near your heart. This is typically followed by a dye that highlights any potential blockages.
• Provides images of the inside of your heart and arteries.
• Monitors show the arteries and chambers of your heart to determine
  1. If your heart is working properly
  2. If blood is flowing to and from your heart properly. ( Blockages )
  3. The reason your heart is not working properly.

Question 4

Procedures performed in CC

Answer 4

• Clearing a blocked vessel –> angioplasty
• Placing a stent in a blood vessel –> keeps a blocked artery open
• Implanting a pacemaker –> stimulates the heart and normalizes heartbeat
• Applying heat or cold to heart tissue to correct an irregular heartbeat –> cardiac ablation

Question 5

After Procedure CC

Answer 5

• VS
• Entry site ( Infection or hematoma )
• Cardiac dysrhymias ( ECG )
• Peri pulses, temp, color in affected extremity
• Potassium levels
• Bed rest for 2-6 hours ( if femoral site was used )

Question 6

CC Patient Education

Answer 6

• Monitor urine output, pt recieving oral IV fluids for excretion of medium contrast
• Pain meds for insertion site or back discomfort
• Limit activity for several days, NO lifting, exercising
• Leave dressing in place
• Observe insertion site over weeks for swelling, redness, warmth, pain, bruising

Question 7

Med Admin for Post CABG

Answer 7

• Statins: Control cholesterol
• Antihyperglycemics: Manage BG
• Antihypertensives: Manage BP
• Antiplatlet Therapies: Prevents thrombus formation
  : Aspirin 100-325 mg daily
  : Clopidogrel 1 year
• Beta blockers: Reduce heart rate and BP –> lowers workload of heart
• Cont IV Reg Insulin: Short time to reduce post op complications
• Antibiotics: Prevent sternal infection

Question 8

Heart Valve Disease

Answer 8

• Prevent valves from working correctly
• May reduce blood flow and cause heart to work harder
  Types:
• Stenosis
• Regurgitation
• Prolapse

Question 9

Heart Valve Disease Post Op Education
( TAVR )

Answer 9

• Lifelong anticoagulant therapy with warfarin is required: INR goal is 3.0-4.0 )
• Low dose aspirin
• S/S of bleeding
• Prophylactic antibiotics before dental procedures to prevent infection

Question 10

Pericarditis: Cardiac Tamponade

Answer 10

• Medical Emergency!
• Fluid accumulates in pericardium and causes sudden decrease in CO
• S/S: JVD, pulse paradoxus, tachyc, muffled heart sounds

Question 11

Preload

Answer 11

• Volume of blood in ventricles at end of diastole
• Stretch

Question 12

Afterload

Answer 12

• Resistance left ventricle must overcome to circulate blood
• Squeeze
• If inc afterload, inc cardiac workload

Question 13

Cardiogenic Shock Interventions

Answer 13

Vasopressors ( Norepinephrine or dopamine for hypotension )
Inotropes ( Dobutamine and milrinone ) help the heart pump forecfully )
Diuretics ( Furosemide ) for hypervolemia