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Nursing > U5 Cardiac/Shock > Flashcards

U5 Cardiac/Shock Flashcards

1
Q

Angina pectoris

A

Chest pain when ability to supply oxygen is not enough to meet cardiac muscle’s demand

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2
Q

Ischemia with angina pectoris

A

Does not cause permanent damage to the heart

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3
Q

Chronic stable angina

A

Predictable following exercise

Relieved by nitroglycerine or rest

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4
Q

Unstable angina EKG changes

A

Depressed ST
Inverted T-wave
Changes resolve when pain resolves

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5
Q

Unstable angina

A

Occurs at rest or with exertion
May last >15 min
Not relieved with rest or nitros
NO changes in troponin or CK levels

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6
Q

Variant (Prinzmetal’s) angina

A

Coronary spasm
Elevated ST; resolves when pain resolves
Usually responds to nitrates

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7
Q

New onset angina

A

1st angina symptoms felt during increased exertion

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8
Q

Pre-infarction angina

A

Occurs in days or weeks before an MI

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9
Q

Subendocardial

A

Not all the way through the muscle
Less effect on wall motion of the heart
More likely to extend later
Non-STEMI

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10
Q

Transmural

A

Affects all layers of the muscle

STEMI

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11
Q

STEMI EKG

A

ST elevation in 2 contiguous leads

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12
Q

Zone of necrosis

A

Area around the initial area of infarction
Abnormal Q
Too late to reverse

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13
Q

Zone of injury

A

Tissue that is injured, but not necrotic
ST elevation
Can be reverse, but requires immediate treatment

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14
Q

Zone of ischemia

A

Tissue that is oxygen deprived
T-wave inversion
Can be prevented with treatment

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15
Q

STEMI causes

A

Atherosclerosis
Plaque rupture
Coronary thrombi
Occlusion of coronary artery

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16
Q

Physical changes in MI

A 
Obvious changes don't occur until 6 hrs after MI
Infarcted area is blue & swollen
After 48 hrs, gray with yellow streaks
8-10 days granulation tissue forms
2-3 months scar tissue
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17
Q

Ventricular remodeling

A

Scar tissue permanently change size & shape of the ventricle

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18
Q

Anterior (septal) MI

A

Caused by left anterior descending artery obstruction
ST elevation in V1-V4
Tachycardia
2nd & 3rd degree heart blocks

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19
Q

Posterior (lateral) MI

A

Caused by circumflex artery obstruction
ST elevation in V5 & V6
Sinus arrhythmias

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20
Q

Inferior MI

A 
Obstruction of right coronary artery
1/2 of pts have obstruction of RCA that causes damage to R ventricle
ST elevation in 2, 3, & aVF
Sinus bradycardia
Heart blocks--usually temporary
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21
Q

MI in women

A

Post-menopause incidence is equal to men

Usually have NSTEMI

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22
Q

LDL level

A

<100mg/dL in pts with no known CAD risk factors

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23
Q

HDL level

A

> 40mg/L

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24
Q

Triglycerides level

A

<150mg/dL in men

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25
Alternative lipid-lowering therapy
Omega-3 fatty acids (fish oil) Flaxseed Canola oil Lovaza (omega 3)
26
Metabolic syndrome risk factors
``` HTN Decreased HDL High LDL & triglycerides Increased blood sugar Large waist-->40 men; >35 women ```
27
Angina vs MI
Angina might be relieved with rest, nitros MI does not go away with rest & nitro MI has high troponin & CK
28
MI assessment
``` BP & pulse EKGs Distal pulses & skin temp Heart sounds--S3 Resp rate & breath sounds Increased temp ```
29
Creatinine kinase levels
Female--30-135 u/L Male--55-170 u/L Elevations--brain, myocardial, & skeletal muscle injury
30
Cardiac catheterization
Done to determine extent & exact location of coronary artery extremity Dr decides if pt is candidate for PCTA or stent placement Watch for cold extremities
31
Emergency care of pt with chest pain
``` ABCs EKG within 10 min Pt's description of pain Vitals 02 therapy Pain relief & aspirin ```
32
Code Heart
``` EKG within 10 min Aspirin 324 mg Troponin stat Thrombolytic decision within 30 min 90 min to cath lab Echo done before discharge (ejection fraction) Beta blocker on discharge ```
33
Managing acute pain (MONA)
Morphine sulfate--small doses; watch for resp depression; can lower BP O2--2-4L nasal cannula Nitrates Aspirin
34
Glycoprotein 2b/3a inhibitors
Unstable angina or NSTEMI | Given before & during PCTA to maintain patency of artery
35
Beta blockers
Decrease size of infarct Slow heart rate & decrease force of contraction Increase perfusion while reducing force of contraction
36
A/E beta blockers
``` Bradycardia Hypotension Decreased LOC Chest discomfort Crackles Hypoglycemia ```
37
Angiotensin II Recptor Blockers (ARBs)
Prevent ventricular remodeling & heart failure post MI
38
ARBs assessment
Watch for decreased UO Hypotension Cough Changes in K, BUN, & creatinine
39
Calcium channel blockers
Not used for post MI pts Promotes vasodilation for pts with angina HTN not controlled with beta blockers
40
Calcium channel blockers assessment
Hypotension | Peripheral edema
41
Reperfusion therapy
Thrombolytics Used to reopen occluded coronary arteries Given within 30 min in ER for STEMI
42
C/I reperfusion therapy
``` Recent abdominal surgery Previous intracranial hemorrhage Vascular lesion Malignant neoplasm Stroke within 3 months Significant head injury or facial trauma within 3 months ```
43
Indication a clot has been dissolved
Abrupt cessation of pain Sudden onset of ventricular dysrhythmias Resolution of ST changes & T wave inversion
44
Heart failure
Common post MI Results from L or R ventricular dysfunction Rupture of intraventricular septum Papillary muscle rupture with valve dysfunction
45
Normal R atrial pressure
1-8 mmHg Low indicates hypovolemia High indicates R ventricular failure
46
Normal pulmonary artery pressure
15-26 mmHg systolic | 5-15 mmHg diastolic
47
Normal pulmonary artery wedge pressure
4-12 mmHg | Elevated indicates L ventricular failure
48
Killip Class I heart failure
Absent crackles S3 IV nitrates & diuretics
49
Killip Class II & III heart failure
Afterload reduction Beta blocker once/day ACE inhibitors & ARBs to prevent ventricular remodeling
50
Killip Class IV heart failure
Cardiogenic shock 40% L ventricle is necrosed Stuttering chest pain
51
S/S cardiogenic shock
``` Tachycardia Hypotension BP <30/hr Cold, clammy skin Restlessness Tachypnea ```
52
Cardiogenic shock drug therapy
Morphine--relieve pain O2--decrease oxygen requirements Hemodynamic monitoring--direct drug therapy Vasopressors--increase cardiac output
53
Cardiogenic shock tx
Intra-aortic balloon pump--when pt not responding to drug therapy
54
Intra-aortic balloon pump
Invasive procedure Balloon inflates during diastole Increases blood flow to the arteries
55
Post-PTCA complications
Closure of vessel--chest pain Bleeding from insertion site Reaction to contrast media Hypotension, hypokalemia, dysrhythmias
56
CABG
Occluded artery bypassed with pt's own venous or arterial blood vessel For pts who don't respond to drug therapy
57
CABG candidates
Angina with >50% occlusion of left main that can't be stented Acute MI with cardiogenic shock Valvular disease
58
CABG complications | F/E imbalance
Edema is common Monitor BP, wedge pressure, RA pressure, CO2, Cl, & UO Watch Ca, Mg, & K
59
CABG complications | Hypotension
May result in collapse of graft | Vasopressors may be given
60
CABG complications | Hypothermia
Institute rewarming procedures if temp is t rewarm too quickly--increases O2 consumption Stop rewarming when pt reaches 98.6
61
CABG complications | Hypertension
Systolic >140-150 mmHg | Give afterload reducers--nitroprusside--tubing must be covered in aluminum foil & protected from light
62
CABG postop
Monitor mediastinal drainage hourly | Report drainage >180ml/hr to dr
63
S/S cardiac tamponade
``` Sudden cessation of mediastinal drainage JVD Clear lung sounds Pulsus paradoxus Cardiovascular collapse ```
64
CABG postop assessment
Monitor neurological status q30 min until pt has awakened from anesthesia Then check q2-4 hrs
65
Mediastinitis
Sternal wound infection--between 5 days to several wks postop Fever beyond 4th day Unstable sternum Redness, swelling, or drainage from suture sites Increased WBC
66
Minimally invasive direct coronary artery bypass
Indicated for pt with lesion of L anterior descending coronary artery 2 in incision made & 4th rib removed
67
Home care assessment
Recurrence of chest pain Indications of heart failure--weight gain, crackles, cough Dysrhythmias
68
Physical activity post-MI
1st wk--light housework 2nd wk--work part time 3rd wk--lift no more than 15 lbs for 6-8 wks Monitor pulse before, halfway, & after exercise
69
Initial Stage of Shock
MAP decreased by <10 Lactic acid produced, but metabolism is still aerobic Vascular constriction Increased heart rate
70
Non-progressive Stage of Shock | Compensatory Shock
``` MAP decreased by 10-15 Acidosis & hyperkalemia--metabolism is anaerobic Thirst Anxiety/restlessness Tachycardia/ increased respiratory rate Decreased UO Narrowing pulse pressure Cool extremities ```
71
Progressive Stage of Shock | Intermediate Shock
``` Sustained decrease in MAP of >20 Compensatory mechanisms no longer deliver oxygen sufficiently Feeling of impending doom Confusion Rapid, weak pulse Hypotension Anuria Low blood pH ```
72
Intermediate Shock implications
Vital organs can only tolerate for short time before permanent damage Must be corrected within 1 hr or less to save pt's life
73
Irreversible Stage of Shock | Refractory Stage
``` Too much cell damage has occurred Therapy can't save pt's life even if cause of shock is corrected Non-palpable pulse Cold, dusky extremities Unmeasureable O2 sats ```
74
Vasoconstrictors
Improve blood flow by increasing peripheral resistance | Increases venous return to the heart & improves heart contractility
75
Dopamine infusion | Nursing interventions
Assess for chest pain | Monitor UO hourly
76
Norepinephrine (Levophed) | Nursing interventions
Assess BP q15min | Assess for headache
77
Phenylephrine HCL | Nursing interventions
Assess q30min for extravasation Check extremities for color & perfusion Assess for chest pain
78
Inotropic agents
Improve heart muscle cell contraction
79
Dobutamine | Nursing interventions
Assess for chest pain
80
Milrinone | Nursing interventions
Assess BP q15min
81
Agents enhancing myocardial perfusion
Improves blood flow to the heart by dilating coronary arteries
82
Sodium nitroprusside | Nursing interventions
Protect drug from light | Assess BP q15min
83
Hypovolemic shock
Loss of blood volume from vascular space Loss of circulating RBCs--low oxygen Reduced MAP
84
Causes of hypovolemic shock
Hemorrhage | Dehydration
85
Hypovolemic shock lab assessment
``` Decreased PaO2 Increased PaCO2 Increased lactic acid Decreased H&H Increased potassium ```
86
Hypovolemic shock | Nursing interventions
ABCs Elevate pt's ft & keep HOB no greater than 30* Restore fluid with colloids Blood & blood products
87
Hypovolemic shock | Drug therapy--dopamine, levophed
Cause vasoconstriction of blood vessels, decrease venous pooling, increase MAP & O2
88
Hypovolemic shock | Drug therapy--dobutamine, milrinone
Improve heart muscle cell contraction
89
Hypovolemic shock | Drug therapy--nipride, nitroglycerine
Dilate coronary blood vessels to improve cardiac contraction & aerobic metabolism in the heart
90
Drug therapy parameters
``` Assess q15min Pulse BP RR Skin color O2 sat Mental status UO ```
91
Distributive shock
No loss of blood volume, but is not effectively circulated
92
Causes of distributive shock
Loss of sympathetic tone Blood vessel dilation Pooling of blood in venous & capillary beds Increased capillary leak
93
Neurogenic shock
Loss of MAP Decreased sympathetic nerve impulses Smooth muscles relax causing vasodilation
94
Causes of neurogenic shock
``` Pain Anesthesia Stress Spinal cord injury Head trauma ```
95
S/S neurogenic shock
Flushed skin Diaphoresis Can persist 1-6 wks
96
Chemical induced distributive shock | Anaphylaxis
Seconds to minutes after exposure to antigen | Causes widespread loss of blood vessel tone & decreased cardiac output
97
Capillary leak syndrome
Fluid shifts from blood vessels into interstitial tissues
98
Causes of capillary leak syndrome
``` Severe burns/wounds Liver disorders Ascites Paralytic ileus Malnutrition Hyperglycemia ```
99
Obstructive shock
Heart remains normal but factors outside the heart prevent adequate filling & adequate contraction of the heart
100
Sepsis
Infectious organisms have entered the blood stream | Begins with bacterial or fungal infection & progresses to a dangerous condition over a period of days
101
Septic Inflammatory Response Syndrome (SIRS)
Increase in organisms that escape local control & trigger inflammatory response
102
SIRS criteria
Temp >100.4 or 20 or PaCO2 12,000 or <4,000
103
Sepsis criteria
``` 2 or more present Hypotension UO less than intake Positive fluid balance Decreased cap refill Hyperglycemia >120 Change in LOC Increased creatinine ```
104
Severe sepsis
``` All tissues involved & hypoxic to some extent Widespread microthrombi formation Anaerobic metabolism Hyperglycemia Increased HR ```
105
S/S severe sepsis
Low O2 sat Rapid resp rate Decreased to absent UO Change in mental status
106
Common organisms leading to sepsis
``` E-coli Klebsiella Pseudomonas Staph Strep ```
107
Sepsis interventions
``` O2 therapy IV antibiotics Low dose cortisone for adrenal insufficiency Insulin to manage blood sugar Heparin therapy for microthrombi ```
108
Adult Respiratory Distress Syndrome (ARDs)
Common in sepsis | Makes air exchange difficult
109
S/S that suggest ARDs cause is sepsis
``` Productive cough Fever >100.9 Pleuritic pain Pulse >90 Tachypnea Altered LOC Elevated or low WBCs Hypotension High lactate ```
110
Disseminated Intravascular Coagulopathy (DIC)
Widespread intravascular activation of coagulation system caused by disruption in homeostasis Can occur with septic shock
111
DIC lab tests
D-dime--indicates formation & breakdown of fibrin clots PT PTT Fibrinogen level
112
DIC presentation
Oozing from bodily orifices Hemorrhaging Bruising, petechiae Oozing from IV sites, puncture sites,wounds
113
DIC tx
Replacement of platelets & clotting factors | Control of initiating disease process
114
Troponin levels
Rises first & quickly Troponin T--<0.03 ng/ml Elevation--myocardial damage

Nursing (9 decks)

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