Quiz 3 Flashcards
Describe how acute coronary syndrome starts
start with:
atherosclerosis
stable angina
unstable angina
heart attack (NSTEMI and STEMI)
What is stable angina?
chest pain with exercise or stress, but chest pain goes away with rest
What is unstable angina? What is the treatment?
chest pain with exercise or at rest, but increases with occurrence, severity, and duration
tx: nitroglycerin every 5 minutes for 3 doses
What is NSTEMI?
non-ST-segment elevation MI
least dangerous
no changes in EKG
decreased cardiac tissue, won’t see damage
decreased cardiac output (HR shows)
What is STEMI?
ST-segment elevation MI
emergency
EKG changes - ST elevation
What are the causes of acute coronary syndrome?
SODDA
S - stress, smoking, stims
O - obesity (BMI >25)
D - diabetes / HTN
D - diet (high cholest)
A - african male/ age (over50)
What are the clinical manifestations of acute coronary syndrome?
Pain - jaw, back, shoulder, heartburn, substernal “crushing”
SOB
N/V
Diaphoresis
Pale cool skin
Anxiety
starts w/ brady then goes to tachy
HTN
Who experiences silent MIs?
older white females
What are the diagnostic studies for acute coronary syndrome?
Troponin
CK-MB, myoglobin
Stress test
Echocardiogram
Coronary angiogram
Troponin
I or T : any + value indicates damage to cardiac tissue
High sensitivity cardiac troponin (HSCT) : important to measure during heart attack
What are the two types of stress test?
- exercise - treadmill
- pharmacologic - Lexiscan
Describe the pharmacologic stress test
radionuclide myocardial perfusion imaging
pt given Lexiscan if they are unable to run
shows which portion of the heart is having trouble perfusing
What is Lexiscan?
regadenoson
vasodilates the coronary arteries and induces cardiac hyperemia
increases cardiac output
What is an echocardiogram?
EKG
ultrasound of the heart
shows damage of heart attack and ejection fraction %
What is a coronary angiogram (cardiac catheterization)?
invasive procedure where a catheter is threaded into artery balloon inflates and stent is left = opening artery
What are people with stent given to take?
anticoagulants
- eliquis (apixaban)
- xarelto (rivaroxaban)
aspirin
What are therapeutic procedures for acute coronary syndrome?
angioplasty
stent
coronary artery bypass graft
What are the nursing interventions for a heart attack?
- morphine, oxygen, nitro, aspirin (MONA)
- semi or full-fowler
- monitor VS and EKG
- IV access
What should you ask a patient before giving nitroglycerin? Why?
if they are taking sexual enhancing drugs (sildenafil)
it can lead to shock
What medications are used after heart attacks?
- morphine (pain and slow down breathing)
- ACE inhibitors (-pril)
- anticoagulants
- antidysrhythmics
- antilipemic
- beta blockers (-lol)
- Ca channel blockers (-dipine, -zem, - amil)
- stool softener
What ACE inhibitor is given after heart attacks? Why?
What is an adverse effect when taking this? What is expected?
lisinopril (chill pril)
- first choice
- treats heart failure after attack
precaution: angioedema (STOP)
expected: cough
What antilipemic is given after heart attacks?
What is seen if the patient is taking the medication short term vs long term?
atorvastatin
decrease calcium absorption
short: joint pain, muscle pain
long: osteoporosis, decrease bone density
What beta blockers are given after heart attacks? Why?
What are precautions when taking this?
sedalol - antiarrhythmic
metoprolol - cardioselective
Lol = sLOws down HR and BP
Precautions: BBB
Bad for CHF
Bradycardia (<60)
Breathing - asthma
What calcium channel blockers are given after heart attacks? Why?
What is an adverse effect when taking this?
nifeDIPINE - declined BP and HR
diltiaZEM - zen yoga for heart
verapAMIL - chill heart
calms BP and HR from dysrhythmias after heart attack
adverse: BLE edema
What stool softener is giving after heart attacks? Why?
docusate sodium
prevents from straining because the pt can bear down which results in decreased HR (valsalva maneuver)
What are post heart attack complications?
DARTH VADER
Death
Arrhythmias (dysrhythmias)
Ruptures
Tamponade
Heart failure (Right vs Left Acute vs Chronic)
Valvular disease
Aneurysm
Dressler’s Syndrome
Embolism
Recurrence
What are examples of dysrhythmias? What do they mean?
atrial fibrillation - ventricular tachycardia - ventricular fibrillation - asystole (death)
hearts last effort to save itself
What is the treatment for ventricular fibrillation?
defibrillation
What should a nurse ask a pt who has afib?
smoking hx
What is a person at risk for who has afib?
cerebrovascular accident (CVA)
left atria can’t pump blood - clot can form - clot can cause embolic stroke
What is the treatment of heart failure?
ACE inhibitors
What is the difference between left and right sided heart failure?
HF = heart failure (heavy fluid)
Right
- ROCKS body with fluid
- peripheral edema
Left
- LUNG fluid
- pulmonary edema
What is pericarditis? What causes it?
inflammation outside the heart - heart gets compressed and can’t pump
less cardiac OUTput = less oxygen OUT
causes: HAIR
- Heart attack
- Autoimmune disorders
- Infection
- Renal failure
What are the clinical manifestations of pericarditis?
- pericardial friction rub
- pulsus paradoxus (> 10mmHg BP systolic drop while pt holds breath)
- pleuritic chest pain (rib cage)
- dyspnea
- fever (>100.4)
What diagnostic studies can be done for pericarditis?
What will the labs show?
ECG (ejection fraction)
Blood culture (infection in blood)
Throat culture (strep)
CXR, CT scan
Pericardiocentesis (drains fluid or blood in heart sac)
Labs:
- increased WBC (>10,000)
- increased troponin
- increased ESR and c-reactive protein (markers for inflammation)
What indicates that a pericardiocentesis worked?
What should be monitored after?
increase in BP = increase in cardiac output
signs of pneumothorax
What medications are used for pericarditis?
NSAIDS
Corticosteroid
Colchicine
Antibiotic
What NSAID is given for pericarditis? Why?
indomethacin
decrease inflammation
What corticosteroids are given for pericarditis? Why?
methylprednisolone
solumedrol
prednisone
treats inflammation
What is colchicine? How is it used for pericarditis? What should be monitored?
plant poison used for gout
treats inflammation
monitor N/V and diarrhea
What is endocarditis?
inflammation inside the heart, heart valves can’t fully close
infective = bacteria, mold on heart valves
noninfective = no bacteria, only inflammation
less cardiac output = less oxygen out
What are causes of endocarditis?
- dirty needles (IV drug abuse)
- heart sx (prosthetic valves or CABG) bacteria easily comes
- untreated strep throat
How is endocarditis treated?
Antibiotics (blood culture first then broad spectrum antibiotics)
Valve repair or replacement
What are the clinical manifestations for endocarditis?
fever
murmur (aortic/mitral valves)
tachycardia
Roth spots (eyes)
petechiae (capillary rupture)
splinter hemorrhages (nailbed)
Osler nodes (raised bumps fingers/toes)
Janeway lesions (bruises palms/soles)
What are the diagnostic studies for endocarditis?
What will the lab show?
Blood culture
CXR
ECG
Cardiac catheterization
Lab:
Increased WBC, ESR, C-reactive protein
What are the nursing interventions for endocarditis?
MOLD
Monitor for infection and s/s of stroke (neuro check)
Oral care
Let all providers know Hx of endocarditis
Dental tx: antibiotics prior to tx
What is cardiomyopathy? What are the 3 types?
physical change in heart muscle that leads to decreased cardiac output = uncontrolled BP
dilated
restrictive
hypertrophic
Describe dilated cardiomyopathy
distended (thinned) heart muscle
heart chamber can fill, but can’t push blood out
What are the clinical manifestations of dilated cardiomyopathy?
Low oxygen
- restlessness
- dizzy
- SOB
Left sided HF (lung fluid)
What medications are used to treat dilated cardiomyopathy?
ACE inhibitors (prils)
digoxin
Describe hypertrophic cardiomyopathy
Huge trophy like heart muscle (enlarged)
obstruction to aortic outflow
heart can push, but no blood to push
What are the clinical manifestations of hypertrophic cardiomyopathy?
Low oxygen
- restlessness
- syncope
- dyspnea
- fatigue (common)
Left sided HF (lung fluid)
What medications are used to treat hypertrophic cardiomyopathy?
Beta blockers (lol)
- lower BP and slows heart down
Calcium channel blockers
What are the nursing interventions for hypertrophic cardiomyopathy?
Syncope
avoid strenuous activity and dehydration (important!)
rest and elevate legs to improve venous return
avoid vasodilators
Describe restrictive cardiomyopathy
rock hard heart muscles, stiffen
heart can fill but can’t contract
What are the clinical manifestations of restrictive cardiomyopathy?
Low oxygen
- restlessness
- dyspnea
- syncope
- fatigue
Exercise intolerance
Left sided HF (lung fluid)
What is the treatment for restrictive cardiomyopathy?
transplant list
What should a client be educated on if they have cardiomyopathy?
DRESS
Diet (low sodium/fat)
Rest
Exercise (avoid strenuous)
Stop smoking/alc
Stress reduction
