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3-Third semester > Exam 3- Cardiac 1 > Flashcards

Exam 3- Cardiac 1 Flashcards

1
Q

Systemic circulation-
what side of heart
what pressure
produces

A

Left side of heart to the rest of body with exception to the lungs

High pressure

Produces systolic blood pressure

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2
Q

Pulmonary circulation-

what side of heart
what pressure

A

Right side of heart with lungs

its low pressure circulation

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3
Q

“Widowmaker”

what side of heart
if blockage

Coronary Blood Supply

A

Left ventricle is most important for action

If blockage in LAD then that’s where we see sudden cardiac arrests from heart attack

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4
Q

Cardiac cycle

uses what
contraction/followed by

A

Uses the- Atria //Ventricles

Contraction of atria, followed by contraction of ventricles a fraction of a second later

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5
Q

Cardiac output-
amount
= to

A

amount of blood pumped in one minute

= to sv x hr

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6
Q

Stroke volume-
amount

A

amount of blood in one beat

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7
Q

Cardiac output is influenced by 4 factors

h
p
a
c

A

heart rate

preload

after laod

contractility

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8
Q

Preload- increased with
f
r

Cardiac Output

A

fluid volume excess

regurgitation

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9
Q

After load- increased by
h
v

Cardiac Output

A

hypertension

vasoconstriction

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10
Q

Contractility- what is it

Cardiac Output

A

strength of the heart muscle

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11
Q

pre load

what is it
end

A

volume coming into ventricles

end diastolic pressure

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12
Q

afterload

what os it

A

resistance left ventricle must overcome to circulate blood

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13
Q

What will happen if preload is increased?

heart needs
it will

A

heart needs stronger contractions

it will increase the stroke volume

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14
Q

What about increased after load?

hard
so there
unless

A

–harder to pump

so there is less blood going out

unless contractions are increased

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15
Q

How about decreased contractility? –
decreased

A

decreased stroke volume

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16
Q

What happens when the heart is in optimal condition?

low
low
normal

A

low heart rate

a low contractility

normal cardiac output

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17
Q

Ejection fraction

what is it
what normal

A

% of blood that is pumped out of ventricles during systole

Normal is 50-70

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18
Q

what is it influenced by x3

Ejection fraction

A

after load,

preload

contractility.

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19
Q

how to measure ejection fraction

looks at

A

Measure with echocardiogram.

Looks at left ventricle

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20
Q

CXR-
what looking at

A

size and basic deformities of the heart

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21
Q

pre Stress tests-

make sure
dress
mo
only

A

make sure pt is npo

dressed conformable,

no caffeine

only meds that they can take are the meds that they are told they can take

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22
Q

stress test

do what
looking for

A

Walk/run on treadmill-

look for chest pain/ dyspnea with exertion

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23
Q

MRI-
identify

A

identify ischemic tissue

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24
Q

CT-
observe

A

observe for calcium deposits

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25
Q

PEt
look

A

look at myocardial perfusion

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26
Q

Echocardiogram

checks-
looks at(w/c/v)

A

checks motion of the heart

Looks at wall thickness, chamber size and velocity of blood flow

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27
Q

Ejection fraction-

what means issue
means what
also means
what’s significant problem

Echocardiogram

A

when less then 55% there’s an issue

Means a low cardiac output

Means decreased tissue perfusion

When less then 30% it’s a significant problem

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28
Q

Trans esophageal echocardiogram (TEE)-

what happens
looks for

A

camera down pts esophagus to look at heart-

looks for cardiac strictures and valves

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29
Q

Pericardiocentesis

does what

A

remove fluids from pericaridum

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30
Q

Cardiac catheterization- post cath

check
can go
apply
check
keep

A

check for bleeding

can go radial or femoral

apply direct pressure

check for distal pulses

keep the limb straight

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31
Q

if went through radial-
do what for how long

cardiac cath

A

pressure for 2-4 hrs after

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32
Q

if femoral- cardiac cath

held
on what-how ling -with what
use
needs

A

held straight

on bed rest /2-4 hrs/with hob flat-

use urinal and bedpan only

need fluids

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33
Q

Evaluating Cardiac Risk

genetic
health assessment
physical assessment

A

Genetic- hx of disease

Health assessment-, hyperlipeidemia, diet , smoking, exercise, drugs-follw up on dypnea, chest pain

Physical assessment- listen for sounds, gallops,

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34
Q

Cardiovascular disease-
any
leading

heart disease

A

any disorder of heart or blood vessel

leading cause of death and disability

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35
Q

Coronary artery disease
is what
can have

heart disease

A
  • impaired blood flow to heart

Can have symptoms or be asymptomatic

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36
Q

Atherosclerosis-
progressive
correlated

heart disease

A

progressive plaque accumulation and narrowing

Correlated with elevated blood lipid levels

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37
Q

LDL-

A

deposits of cholesterol in vessels

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38
Q

HDL

A
  • transports to liver for excretion
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39
Q

Triglycerides-

A

excess fat

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40
Q

what age men/women
what gender
what for women
what race
what plays a role

non modifiable -Risk Factors for Cardiac Disease

A

Age –men 45+ women 55+

Gender-men

Women have increased risk in increased menstrual cycles

Genetics/ family history

black

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41
Q

Hyperlipidemia-
what is it
what’s not bad
what is bad

modifiable Risk factors for Cardiac Disease

A

increased lipids,

LDH A- not so bad

, LDH B proven to oxidize and build up plaque.

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42
Q

HTN—->
what numbers
whats best

modifiable Risk factors for Cardiac Disease

A

140/90,

diastolic <80 is best.

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43
Q

Diabetes—-
why a risk factor

modifiable Risk factors for Cardiac Disease

A

2-4 times more likely to have heart disease or a stroke.

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44
Q

. Smoking-
what does carbon monoxide do

waht does nicotine cause

modifiable Risk factors for Cardiac Disease

A

carbon monoxide damages blood vessels- leads to plaque build up.

Nicotine causes-tachycardia, vasoconstriction.

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45
Q

Obesity causes- x3

considered with what///what size in men and women

modifiable Risk factors for Cardiac Disease

A

HTN,DMII,Hyperlipidemia

considered with waist circumference >40 for men, >35 for women

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46
Q

Lack of exercise- what does exercise do

modifiable Risk factors for Cardiac Disease

A

exercise does strengthens heart, decreases cardiac workload, lowers BP, lowers wt. Lowers lipids

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47
Q
  1. Diet-
    what diet are we promoting

high
low

modifiable Risk factors for Cardiac Disease

A

eat high fiber,

low fat, simple carbs and Na+

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48
Q

How do I decrease my risk for heart disease

5/7 of these
1-no
2-what bmi
3-how much exercise
4-what diet
5-what cholesterol
6-waht bp
7-what fasting glucose

A

1.No smoking

  1. Bmi less then 25
  2. 150 minutes per week of excercise
  3. Healthy diet
  4. Total cholesterol less then 200
  5. Bp less then 120/80
  6. Fasting glucose less then 100
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49
Q

Increased what levels

what helps lower

other risk factors of heart disease

A

Increased homocysteine levels

b vitamins- folate, b6 and b12

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50
Q

Metabolic syndrome-

other risk factors of heart disease

A

abdominal obesity- waist circumference of over 40 in men and over 35 in women///

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51
Q

Metabolic syndrome-

serum triglyceride
HDL- men/women

other risk factors of heart disease

A

serum triglyceride of 150 or above,

hdl 40 or lower in men or 50 or more in women

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52
Q

Metabolic syndrome-BP

other risk factors of heart disease

A

bp 130/85 or greater

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53
Q

Metabolic syndrome- fasting glucose

other risk factors of heart disease

A

fasting glucose of over 100

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54
Q

Premature menopause
causes

Risk factors unique to women

what hdl
what ldl

A

low hdl,

high ldl

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55
Q

Oral contraceptives-
bp
what risk

Risk factors unique to women

A

increase bp

clotting risk

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56
Q

Hormone replacement therapy-

increases
metabolized where
leads to

Risk factors unique to women

A

increase cad,

metalbozed in liver

leads to formation of clots

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57
Q

Cholesterol- what’s normal

total
ldl
hdl
triglycerides

Diagnostic Tests

A

total less then 200

ldl less then120

, hdl greater then 35

triglycerides less then 150

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58
Q

C-reactive protein-
see what

Diagnostic Tests

A

inflammation on patient

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59
Q

Exercise ECG-
look for
signs of

Diagnostic Tests heart disease

A

look for st depression

signs of ischemia

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60
Q

what smoking

how much exercise/how often

Risk management-heart disease

A

Smoking- quit

Exercise- 30 mins- 5-6 times a week

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61
Q

Diet-
add
have
high
low

Risk management-heart disease

A

add vitamin b,

have alcohol in moderation,

eat high fiber,

low fat, simple carbs and Na

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62
Q

how to lower HTN

decrease
increase
decrease

Risk management-heart disease

A

decrease sodium

, increase exercise

, decrease stress

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63
Q

manage what

daily aspirin-only when-does what

risk management heart disease

A

Diabetes- manage appropriately

Daily aspirin- only if prescribed- decreased inflammation and prevent clots

64
Q

Statins-
most
does what
monitor what lab
watch for what

Medications to Lower Lipids

A

most common-

reduces total and ldl-

monitor LFT liver function

watch for rhabdomyolosys

65
Q

why avoid green tea and grapefruit juice in statins

A

increase level of medication

increase diabetes risk in women

66
Q

OTHERS-Medications to Lower Lipids

A

Bile acid sequesters-Questran, prevaide

Nicotinic acid-

Fibric acid derivatives-

67
Q

d/e
what helps

Complementary Therapies heart disease/lipids

A

Diet exercise

Stress management can help

68
Q

give what 3 vitamins

take what -3gs

3g of what

Complementary Therapies heart disease/lipids

A

Give vitamins- c, e , b6

Take garlic, gingko, green tea

3 g daily of omega acids

69
Q

Ischemia-

A

tissues that are starved for oxygen

70
Q

Infarction

A
  • dead tissue
71
Q

Myocardial ischemia-
what is it

A

insufficient oxygen to meet hearts metabolic needs

72
Q

what is myocardial ischemia influenced by

c
m
b

A

coronary artery perfusion

myocardial workload

blood oxygen concertation

73
Q

Coronary perfusion
is what

can be decreased by(p/c/h/v)

Myocardial Ischemia

A

how much blood the vessels get

can be decreased by plaque, clots , hypotension, vasospasm,

74
Q

Myocardial workload-
made up from
h
p
a

Myocardial Ischemia

A

hr contractility,

preload

afterload

75
Q

Blood oxygen concentration- can be reduced in

high
in
a

Myocardial Ischemia

A

high altitudes

in impaired gas exchange

anemia

76
Q

Angina Pectoris

what is it
what happens if over 30 mins

A

Chest pain due to imbalance between blood supply and demand

Blood flow lasting greater then 30 minutes leads to infarction

77
Q

Decreased blood flow to tissues causing
I
low
low
what metabolism
what buildup

angina pectoris

A

Ischemia,

low blood flow

, low oxygen

Anerobic metabolism,

lactic acid buildup

78
Q

Stable-
most
what pain/with

Types of Angina

A

most common,

predictable pain with increased workload of the heart

79
Q

Stable-happen due to x3

Types of Angina

A

cold, stress or exercise//

80
Q

Stable-treat w

Types of Angina

A

rest and nitrogylcerin

81
Q

Prinzmetals or atypical-
un
un
happens when
caused by

Types of Angina

A

unpredicatbale

unrealated to activity

happens at night

, caused by coronary artery spasms

82
Q

Unstable-

increasing in
pain is/can be

Types of Angina

A

increasing in frequency, severity, duration

pain is unpredictable and can be at rest.

83
Q

unstable angina

risk for

what troponin/what impaired

A

High risk for mi

chest pain with normal troponin but impaired cardiac output

84
Q

S/S of Angina

what pain
what pressure
can be
increased
increased
f
women may have

A

Chest pain

Tight squeezing pressure

Can be sob

Increased hr

Increased anxiety

Fear

Women may have nausea and vomiting

85
Q

how long does angina last

what Relieved it

A

Lasts for 2-3 minutes

Relieved with rest and nitroglycerin

86
Q

ECG
stress ECG

Diagnostic Tests- angina

A

ECG- normal, or st depression if long term ischmeia

Stress ECG- exercise may bring on angina

87
Q

Radionuclide testing-

shows what

Diagnostic Tests- angina

A

shows ischemic cells that light up on x ray

88
Q

Echocardiogram-
evaluates what

Diagnostic Tests- angina

A

evaluate structures and function of the heart

89
Q

Coronary angiography-
looks for
end up with
that does

Diagnostic Tests- angina

A

looks for arterial stenosis-

will end up with implanted caridioverter debrifilater-

shock out of arrythmia,

90
Q

Nitrates-

keep where
where give
acts how fast
decreases what

Medications to Relieve Angina

A

keep in dark

, give sublingual

acts in 1-2 minutes

will decrease preload/after load and oxygen demand

91
Q

nitrates-
what before/after
taken before what
free how ling before stress test
cannot take

Medications to Relieve Angina

A

check bp and pulse before/ after doses

can be taken before exercise to prevent angina

pts need to be nitrate free for 8-10 hrs before a stress test

cannot take male performance drugs

92
Q

Long acting nitroglycerin. -available in
sife effects

Medications to Relieve Angina

A

patches, capsules

side effects – headache, low bp

93
Q

Beta blockers proproanolol, Metoprolol

do what
dint give to who
cause cause

Medications to Relieve Angina

A

decrease workload-

don’t give to hf, low bp,hr

Can cause low hr and sometimes hf

94
Q

Calcium channel blockers-
increase
increase
decrease and
used for

Medications to Relieve Angina

A

increase blood flow to heart ,

increases 02 supply,

decreases bp and vasodilates–

used for Prins metals angina

95
Q

Calcium channel blockers-first class

what med
works where
good for

Medications to Relieve Angina

A

verapamil-

works only on heart

good for angina

96
Q

Calcium channel blockers-second class

what med
does what
good for x3

Medications to Relieve Angina

A

dilitiazem-

dilates vessels,

good for angina, hypertension and a fib

97
Q

Calcium channel blockers- third class

what med
good for x2

Medications to Relieve Angina

A

amlopdine-

good for hypertension and angina

98
Q

what med also works for angina

A

aspirin

99
Q

nitro-keep where
oxygen -how much
activities-
education-
exercise-
quitting-

neffective Tissue Perfusion-angina

A

Nitro- keep with pt, dark, cool, dry

Oxygen- 4-6 L NC

Activities- rest, pace themselves

Education- medications and risk factors for MI

Exercise- progressive

Smoking

100
Q

denial-
asses
provide
give

Risk for ineffective therapeutic regimen management

A

Denial- forgetting medications, aggressive behavior when educating about the disease

Asses Knowledge level

provide Education

give Referrals

101
Q

Acute Coronary Syndrome- ACS

untable
acute

A

Unstable angina

acute myocardial ischemia

102
Q

precipitated by one or more processes
__plaque
spasms
I
increased
decreased

Acute Coronary syndrome

A

rupture/ erosion of plaque,

spasms of coronary arteries,

inflammation,

increased oxygen demand.

Decreased supply of oxygen from blood loss

103
Q

S/S of ACS

what pain
d
d
p
hr
bp

A

Substernal/ Epigastric Chest pain-

Dyspnea,

Diaphoresis

Pallor

Increased hr

hypotension

104
Q

Substernal/ Epigastric Chest pain ACS

can
occurs
longer
more

A
  • can radiate

occurs at rest

longer then 10—20 minutes

more severe then angina

105
Q

Unstable angina- ACS

ecg/ cardiac enzyme

A

does not see ecg or cardiac enzyme changes

106
Q

myocardial infarction- ACS

ecg/ cardiac enzyme

A

enzyme changes

some st elevation or t wave inversion.

107
Q

ACS

if ecg changes then what

A

STEMI

108
Q

ACS

if no ecg changes and cardiac markers raised then what

A

NSTEMI

109
Q

ACS

no ecg changes and no cardiac markers raised

A

unstable angina

110
Q

ECG-

Diagnostics for ACS

A

ischemia, elevation, depression or blocks

111
Q

Cardiac muscle troponins-

Diagnostics for ACS

A

normal unless mi

112
Q

Creatinine kinase-

Diagnostics for ACS

A

beirfly elevated

113
Q

Medications for ACS

anti-
n-
b-
pain relief-

A

Anti platelets- aspirin or clopidogrel

Nitrates- nitroglycerin

Beta blockers- metorpolol

Pain relief- morphine- decreases anxiety, pain and 02 consumption

114
Q

When patient is having mi
M
O
N
A

A

M- morphine

O- oxygen-FISRT priority

N- nitro

A- aspirin

115
Q

Percutaneous coronary revascularization-
restores
with

Revascularization-Treatment Measures for ACS

A

restores blood flow

with a balloon angioplasty

116
Q

Percutanious translumenal coronary angioplasty-

placement of

Revascularization Treatment Measures for ACS

A

stent placement

117
Q

cut
harvest
what machine
will bypass
watch for

Treatment Measures for ACS CABG

A

cut sternum,

harvest saphenous vein,

heart-lung bypass machine

Will bypass blockage by attaching vein to artery

Watch for Infection, bleeding

118
Q

Post op care- CABG

want them
watch for
can return to normal sexual activity when

A

want them up and moving,

watch for urine output, vs,

can return to normal sexual activity when they can climb 2 flights of stairs without being winded

119
Q

MI
death
can be
condition based

A

Death of myocardial cells

Can be due to blockage from clots and vasoconstriction

Condition based on location of infarction

120
Q

s/s of mi

what pain
not releived by
what skin
n
v
a
t

A

Severe sudden, crushing burning and radiating chest pain

not releived by rest/nitro

Cold clammy skin

Nausea,

vomiting

Anxiety

tachycardic

121
Q

MI in women

chest
s
what pain
flush
sweat
n
s
unusal

A

chest sensations

SOB

shoulder blade pain

hot flush

cold sweat

nausea

dizziness

unusal fatiuge

122
Q

why dysrtyhmias

why heart failure

Complications of MI

A

Dysrhythmias- cannot conduct electricity

Heart failure- dead muscle cannot pump

123
Q

Cardiogenic shock-
what happens

Complications of MI

A

cardiac output less then 40%- high morality rate

124
Q

Infarct extension-
what happens

Complications of MI

A

rethrow a clot and infarct again

125
Q

Structural defects-
can be

Complications of MI

A

can be from damaged valves in arteries

126
Q

Pericarditis-
how long after
what happens

complications of MI

A

-2-3 days afterwards-

increased chest pain with movement and breathing

127
Q

Care of MI Patient

receive
reduce
maintain
decrease
prevent

A

Relieve pain

Reduce extent of damage

Maintain cardio stability

Decrease cardiac workload

Prevent complications

128
Q

CK- Creatinine Kinase-

CK-MB- Creatinine Kinase Myoglobin

Troponin-

CBC

Diagnostics to Detect MI

A

CK- elevated

CK-MB- - greater then 5%

Troponin- increased- greater then 0.2

CBC- elevated wbc count

129
Q

ABG

ECG

echocardiogram -what see

Diagnostics to Detect MI

A

ABGs- metabolic acidosis

ECG- st elevation and depression

Echocardiogram- infarcted tissue that doenst contract

130
Q

Aspirin-
decreases what
reduces

Medications for MI

A

decreases inflammation

reduces risk of clots

131
Q

Nitrates-
will/won’t
do what

Medications for MI

A

will decrease pain but wont take it away-

dilate vessels

132
Q

Morphine-
decreases
receives

Medications for MI

A

decreases oxygen demand

relieves pain

133
Q

Fibrinolytic therapy- TPA-

given when
do not give to

Medications for MI

A

given if onset is less the 6 hrs-

do not give to recent bleed, surgery or recent fall or trauma

134
Q

Anti dysrhythmics-
what for bradycardia
what for a fib

Medications for MI

A

atropine for bradycardia,

verapamil- afib

135
Q

Beta blockers-
decreases
limits

Medications for MI

A

decrease pain,

limits damage and cardiac remodeling

136
Q

Anticoagulants- what

Medications for MI

A

heparin

137
Q

ACE inhibitors- prils- Lisinopril

decreases risk of
can increase
decreases i
decrease what risk
decreases risk for
decreases blood

Medications for MI

A

Decreases risk of diabetes comlications

Can increase potassium

Decreases inflammation

decreases clotting risk

Decreases risk for remodeling

Decreases blood glucose

138
Q

MI Ace inhibitors

Se-

A

cough,

orthostatic hypotension,

life threatening angioedema

139
Q

Treatment for MI

close
bed
o
revascualrizion-within/examples

A

Close monitoring

Bed rest

Oxygen

Revascularization within 90 minutes- angioplasty, place a stent, cabg, intraaortic ballon pump

140
Q

three phases- first Inpatient-

do what

Cardiac Rehab

A

ambulation and ADLs

141
Q

three phases- second Immediately post discharge-

do what

Cardiac Rehab

A

gradually increase activity and cardiac rehab

142
Q

third stage to cardiac rehab

do what

Cardiac Rehab

A

Transition to independence

143
Q

Assessment of Client With MI

hx
what pain
is there
what is
do they
e

A

Hx in them or fam?

Crushing, stabbing type pain?

Is there other symptoms like nausea, vomiting, anxiety, dyspnea?

What is medical hx- HTN, CAD, diabetes, angina, lipids

Do they use drugs- meds, cocaine

ECG

144
Q

Acute pain-
what is high priority

what decreases workload

how much of what

Nursing Diagnoses and Interventions in mi

A

Pain relief is high priority// morphine and nitro

rest decreases workload

oxygen- 2-6 liters decreases ischemia and pain

145
Q

Ineffective Tissue Perfusion-

assess for/1st
monitor what
anti
serial
plan for

Nursing Diagnoses and Interventions

A

Assess- for change in mental status-1st sign of decreased tissue
perfusion, no O2 to brain

Monitor- watch the urine output, skin color and temp

Anti dysrhythmics

Serial enzymes

Plan for invasive hemodynamic monitoring

146
Q

Fear of death and disability

I
a
e
m
reduce

A

Identify

Acknowledge

Encourage

Medications

Stress reduction

147
Q

Women and MIs

what is leading cause of death

more likely to have

more likely to have

A

CAD is leading cause of death in women

More likely to have atypical symptoms

more likely to have NSTEMI

148
Q

WOMEN and mi

increased risk w/

what med
early
what therapy

A

oral contraceptives,

early menopause

, hormone replacement therapy

149
Q

Elderly with MIs
Usually have atypical symptoms:

s
c/d
d
what pain
what mi

A

SOB

Confusion and disorientation- new abrupt onset

Dizziness

Abdominal pain

Silent MIs

150
Q

PVCs/PACs-

is what
reduce

Arrythmias

A

irregular heart rhythm-

reduce caffeine intake

151
Q

1st degree Heart block/BBB –

can signify

Arrythmias

A

can signify issues- will investigate if new

152
Q

2nd Degree Block-

not always
but get

Arrythmias

A

not always emergency

, but gets workup and heart cath

153
Q

3rd degree block

very
may need

Arrythmias

A
  • very slow hr,

may need pacemaker

154
Q

Atrial fib/flutter-
try to
if chronic give

Arrythmias

A

try to convert with med or cardioversion with really fast rate

if chronic give rate controller and blood thinners

155
Q

V tach-
check
start
if pulse->
continued
if cardioversion->might

Arrythmias

A

check for pulse,

start cpr if no pulse,

if pulse try to convert with meds or cardioversion,

continued assessment for a pulse

, if cardioversion- might sedate so monitor airway and vitals and 02

156
Q

V fib-
make sure
what rhythm
start

Arrythmias

A

make sure monitor is correct,

shockable rhythm,

start cpr,

3-Third semester (13 decks)

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