PE And Cardiomyopathies Flashcards
What is the most frequent cause of a pulmonary embolism?
DVT that develop in the venous system or right side of the heart.
What is a pulmonary embolism?
Obstruction of blood flow in part of the pulmonary vascular system by an embolus.
What is the most common nonthrombotic pulmonary emboli?
Fat emboli
What arethe risk factors for PE?
Stasis of Venous blood, vessel wall damage and altered blood coagulation. Prolonged immobility Trauma Surgery MI and HF Women who use oral contraceptives Smoking
Is the nurse is unable to prevent, what is the plan of care?
Support
Oxygen
Analgesics
Pulmonary artery and wedge pressures are monitored
What are the common clinical manifestations of PE?
Dyspnea and SOB Chest pain Anxiety and apprehension Cough Tachycardia and tachypnea Crackles Low grade fever (inflammation)
What are less common clinical manifestations of PE?
Diaphoresis Hemoptysis Syncope Cyanosis S3 and S4 gallop
What is the primary goal in treating PE?
Prevention because DVT may not be recognized until the actual PE occurs
What does a plasma D-dimmer monitor for?
The presence of a thrombus. D-dimmer is a fragment of fibrin formed during a lysis of a blood clot. Elevated blood levels indicate a thrombus
What does a chest CT indicate?
Principle test used to diagnose a PE.
What does a lung scan indicate?
Radio tagged albumin is injected intravenously, the area in the lung in which the isotope cannot be detected is suggestive of occluded blood flow and PE.
What does a pulmonary angiography indicate?
Definitive test when other less invasive tests are in conclusive. They are used to detect very very small emboli
What is the ECG indicated for?
To rule out an MI.
What does an ABG indicate!
Shows hypoxemia and often respiratory alkalosis.
What does an ETCO2 indicate?
A measurement of the co2 exhaled.
What therapy is used to prevent PE?
Anticoagulant therapy
What is the dosage of heparin for a patient with a PE?
IV bonus of 5,000 to 10,000 units followed by a continuous infusion at a rate of 1,000 to 1,500 units/hr.
How long do we continue heparin therapy?
We take heparin and Coumadin and the same time for 5 days and then discontinue the heparin and just take Coumadin.
What is fibrinolytic therapy?
Treats a massive PE and hypotension,
What are examples of Fibrinolytics?
Tpa, streptokinase, and alteplase
What is the use of fibrinolytics contraindicated in?
Intracranial disease, recent stroke, active bleeding disorder, severe hypertension, trauma, surgery, or any invasive procedures.
What is dilated cardiomyopathy?
Dilation of the heart chamber impairs ventricular contraction.
What is the most common cardiomyopathy?
Dilated
What does dilated cardiomyopathy commonly cause?
HF
What causes dilated cardiomyopathy?
Usually idiopathic, may be secondary to chronic alcoholism or myocarditis.
What are the clinical manifestations of dilated cardiomyopathy?
HF Cardiomegaly S3 and S4 gallop Dyspnea, angina, and syncope Fibrosis and necrotic myocardial cells
What is the management for dilated cardiomyopathy?
Surgery (cardiac transplantation)
ICD
What is hypertrophic cardiomyopathy?
Left ventricular hypertrophy and decreased compliance. Septal hypertrophy
What is the cause of hypertrophic cardiomyopathy?
Hereditary, may be secondary to chronic hypertension
What are the clinical manifestations of hypertrophic cardiomyopathy?
Left ventricular hypertrophy, Dysthymias, loud S4, sudden death.
How do you manage hypertrophic cardiomyopathy?
Beta blockers Antidysrhytmics Calcium channel blockers ICD Surgical excision of part of septum
What is restrictive cardiomyopathy?
Rigid ventricular walls that impair diastolic filling.
What causes restrictive cardiomyopathy?
Secondary to amyloidosis, radiation, or myocardial fibrosis.
What are the clinical manifestations of restrictive cardiomyopathy?
Dyspnea, fatigue, right sided heart failure, Cardiomegaly, S3 and S4, mitral regurgitation murmur.
How do you manage restrictive cardiomyopathy?
Management if HF
Exercise restriction.
What are the diagnostic tests for Cardiomyopathies?
ECCHO ECG Chest x ray Hemodynamics studies Radionuclear scans Myocardial biopsy Cardiac catheterization and coronary angiography
What drugs are used for restrictive and dilated?
ACEI, vasodilators, and digitalis.
