medsurg test 2 Flashcards
the purpose of a lipid panel
to take cholesterol level or early detection of heart disease
fasting for a lipid panel
12-14 hours per ATI (which is wrong but whatever)
cholesterol (total) expected range
less than 200 mg/dL
LDL expected range
less than 130 mg/dL (bad cholesterol. the loser kind)
HDL expected range
female: greater than 55 mg/dL
male: greater than 45 mg/dL
(good cholesterol. the happy kind)
triglycerides expected range
female: 35-135 mg/dL
male: 40-160 mg/dL
creatine kinase MB isoenzyme expected range
0% of total CK (30-170 units/L)
troponin T expected range
less than 0.1 ng/mL
troponin T expected duration of elevated levels
10-14 days. T stands for up to twice as long
troponin I expected range
less than 0.3 ng/mL
troponin I expected duration of elevated levels
7-10 days. I stands for idk less than the other one thats for sure
transthoracic echocardiography
the non-invasive kind. used to diagnose valve disorders and cardiomyopathy. can evaluate size, shape, and motion of the heart. CAN MEASURE EJECTION FRACTURE
transesophageal echocardiography
provides clearer ultrasonic images by sticking the fucking probe down your throat to look at your heart from the back
medications used for pharmacological stress testing
dipyridamole, adenosine, regadenoson, dobutamine
hemodynamic monitoring involves
indwelling catheters that provide information about blood volume, perfusion, fluid status and how well the heart is pumping
where are atrial lines placed
radial (most common), brachial or femoral arteries
pulmonary artery catheters
inserted into a large vein and threaded through the right atria and ventricle into a branch of the pulmonary artery
angiography, also called cardiac catheterization
an invasive procedure used to evaluate the presence and degree of coronary artery blockage. uses contrast so hold metformin
nontunneled percutaneous central venous catheter (CVC)
or central line for those of us who speak english
inserted into subclavian vein, jugular vein.
indicated for blood transfusion, long term chemo, antibiotics and total parenteral nutrition
SHORT TERM USE
peripherally inserted central catheter (PICC)
inserted into basilic or cephalic vein
indicated for blood transfusion, long term chemo, antibiotics and total parenteral nutrition
LONG TERM USE
defibrillation
delivery of an unsynchronized, direct countershock to the heart. it stops all electrical activity of the heart, allowing the SA node to take over and do its job right this time.
Indications for defibrillation
V-Fib or pulseless ventricular tachycardia
indications for cardioversion
atrial dysrhythmias, supraventricular tachycardia, and ventricular tachycardia with a pulse. its the treatment of choice and can be elective
indications for defibrillation
v-fib
cardioversion therapy preparation
when the duration is unknown they must be on anticoagulants for 4-6 months prior so there is no throwing clots around
treatment for bradycardia
medication: atropine, dopamine, epinephrine
electrical: pacemaker
treatment for A-Fib, supraventricular tachycardia and ventricular tachycardia with a pulse
medication: amiodarone, adenosine, and verapamil
electrical: synchronized cardioversion
treatment for ventricular tachycardia without a pulse or v-fib
medication: amiodarone, lidocaine and epinephrine
electrical: d-fib
cardioversion documentation
preprocedural rhythm, number of attempts, energy settings, time and response, patient’s LOC post procedure, and skin condition under the electrodes
external (transcutaneous) pacemaker
temporary. delivered through the thoracic musculature to the heart via two electrode patches. takes a lot of electricity so its painful af.
used when a symptomatic bradycardia patient is unresponsive to medications
epicardial pacemaker
temporary. when the pacemaker leads are attached directly to the heart during open heart surgery. used during and immediately after surgery
endocardial (transvenous) pacemaker
temporary. when the pacing wires are passed through a large central vein and lodged into the right ventricle, right atrium or both chambers
pacemaker mode: fixed rate (asynchronous)
fires at a constant rate, does not give a fuck about the heart’s own electrical activity
pacemaker mode: demand mode (synchronous)
it detects the heart’s electrical impulses and fires only if it is below a certain level
can be inhibited: does not fire
or triggered: fires
pacemaker mode: tachydysrhythmia function
can overpace a tachydysrhythmia and/or deliver an electric shock
implantable cardioverter/defibrillator indications
for survivors of sudden cardiac death syndrome, risk for sudden cardiac death and spontaneous or symptomatic ventricular dysrhythmias
pacemaker indications
symptomatic bradycardia, complete heart block, sick sinus syndrome, sinus attack, asystole, and atrial tachydysrhythmias
ICD indications
ventricular tachydysrthythmias, MI with left ventricular dysfunction
special care for a temporary pacemaker includes
don’t fuck with it’s settings and keep it dry (do not shower)
permanent pacemaker battery life
about 10 years
ICD battery life
about 9 years
permanent pacemaker post procedure care includes
chest x-ray to asses for pneumothorax, hemothorax or pleural effusion
minimize shoulder movement so the leads can anchor
assess for hiccups (can be that its pacing the diaphragm)
inspect for thermal burns
what do patients need to report after permanent pacemaker placement?
dizziness, fainting, fatigue, weakness, chest pain, hiccupping, palpitations, difficulty breathing or weight gain
is the shock of an ICD device harmful to people touching the patient?
no. they might feel the impulse but it is not harmful
items that can fuck with a pacemaker generator
garage door opener, burglar alarms, strong magnets, generators and other powerful transmitters, large stereo speakers
atherectomy
breaks up and remove plaque within the cardiac vessels
stent
placement of a mesh wire device that contains no medication to hold an artery open and prevent restenosis
percutaneous transluminal coronary angioplasty (or just angioplasty)
involves inflating a balloon to dialate the arterial lumen and the adhering plaque, thus widening the arterial lumen. can include a stent placement while they’re up in there
percutaneous coronary intervention (PCI) is usually performed
4-6 hours after a N-STEMI
or within 60-90 minutes after a STEMI
artery dissection
perforation of an artery by the catheter might cause cardiac tamponade or require emergency bypass surgery.
s/s severe hypotension and tachycardia
cardiac tamponade - what is it and s/s
can happen from fluid accumulation in the pericardial sac
s/s: hypotension, jugular vein distention, muffled heart sounds, and paradoxical pulse
paradoxical pulse
variance of 10 mm Hg or more in systolic blood pressure between expiration and inspiration
cardiac tamponade nursing implications
IV fluids for hypotension, x-ray/echo, prepare the patient for pericardiocentesis
retroperitoneal bleeding
bleeding in that space (abdominal cavity behind the peritoneum) can occur due to femoral artery puncture
assess for flank pain and hypotension
retroperitoneal bleeding education
apply pressure to the site, keep legs straight, report chest pain, SOB, and cardiac symptoms
coronary artery bypass grafts
invasive surgical procedure to restore vascularization of the myocardium. most effective when the patient’s ejection fracture is greater than 50%
peripheral bypass grafts
aims to restore blood flow to the areas affected by peripheral artery disease like coronary artery bypass grafts but for the rest of the body
potential complications of peripheral bypass grafts
graft occlusion, compartment syndrome, infection
potential complications of coronary artery bypass grafts
atelectasis, pneumonia, pulmonary edema, hypothermia, decreased cardiac output, cardiac tamponade, hypovolemia, left sided heart failure, electrolyte disturbances, neurologic deficits
ischemia vs infacrtion
ischemia is reversible while infarction is permanent damage
stable (exertional) angina
occurs with exercise or emotional stress and is relieved by rest or nitroglycerine
unstable (periinfarction) angina
occurs with exercise of at rest, but increases in occurrence, severity and duration over time
variant (prinzmetal’s) angina
is due to a coronary artery spasm, often occurring during periods of rest
angina and MI expected findings
anxiety, chest pain (may radiate), nausea, dizziness, pallor, cool and clammy skin, tachycardia, palpitations, tachypnea, SOB, diaphoresis, vomiting, decreased LOC
what should hourly urine output be greater than?
30 mL/hr why do I always forget this
special skills of beta blockers
alongside being antihypertensive, it is also an antidysrhythmic and can reduce afterload and slow the heart rate
thrombolytic agent examples
alteplaase and reteplase. used to break up blood clots
new york heart association’s heart failure scale
class i: no manifestations with activity
class ii: manifestations with ordinary exertion
class iii: manifestations with minimal exertion
class iv: manifestations at rest
left sided heart failure symptoms
dyspnea, orthopnea (sob while lying down), fatigue, displaced apical pulse, s3 heart sound, pulmonary congestion, frothy sputum, altered mental status, manifestations of organ failure, nocturia
right sided heart failure symptoms
jugular vein distention, ascending dependent edema, abdominal distention, fatigue, nausea, anorexia, polyuria at rest, liver enlargement and tenderness, weight gain
hBNP
less than 300 pg/mL indicates no heart failure
300 indicates mild HF
600 indicates moderate HF
900 severe HF
ventricular assist device (VAD)
a mechanical pump that assists a heart that is too weak to pump blood through the body. used for patients waiting for a heart transplant or those who are not candidates for one
valvular heart disease: stenosis
narrowed opening impedes blood moving forward
valvular heart disease: insufficiency/improper closure
some blood flows backward (regurgitation)
congenital valvular heart disease
can affect all four valves and cause either stenosis or insufficiency
acquired degenerative valvular heart disease
due to damage over time from mechanical stress, atherosclerosis and hypertension
rheumatic valvular heart disease
acquired. gradual fibrotic changes with calcification of valve cusps
ineffective endocarditis valvular heart disease
infectious organisms destroy the valve. streptococcal infections are the cause
patient education for valvular heart disease
prophylactic antibiotics for dental work, notify doctor of 3lb weight gain, avoid caffeine, alcohol and epinephrine, preserve energy
pericarditis
inflammation of the pericardium, commonly follows a respiratory infection, but can be due to MI or acute exacerbation of a systemic connective tissue disease
pericarditis expected findings
chest pressure/pain made worse with breathing, coughing and swallowing
pericardial friction rub, SOB, relief of pain when sitting and leaning forward
myocarditis
inflammation of the myocardium can be due to viral, fungal, or bacterial infection or a systematic inflammatory response
myocarditis expected findings
tachycardia, murmur, friction rub, cardiomegaly, chest pin and dysrhythmias
rheumatic endocarditis
infection of the endocardium due to a complication of rheumatic fever preceded by streptococcal pharyngitis. produces lesions in the heart
rheumatic endocarditis expected findings
fever, chest pain, joint pain, tachycardia, SOB, rash on trunk and extremities, friction rub, murmur, muscle spasms
infective endocarditis
infection of the endocardium. most common in patients with cardiac malformations, cardiac implants (pacemaker or prosthetics), or IV drug use
infective endocarditis expected findings
fever, flu like manifestations, murmur, petechiae, positive blood cultures, splinter hemorrhages (red streaks under fingernails)
beta blockers and hypoglycemia
they can mask some manifestations such as tachycardia. you have to look at other indications
