Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing > U5 Cardiac/Shock > Flashcards

U5 Cardiac/Shock Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Mental Health flashcards Nursing Management of Care flashcards NCLEX-PN® flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Pediatrics flashcards Nursing Safety & Infection flashcards Nursing Pharmacology flashcards Nursing Maternity flashcards Family Nurse Practitioner (FNP) flashcards
1
Q

Angina pectoris

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ischemia with angina pectoris

A

Does not cause permanent damage to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic stable angina

A

Predictable following exercise

Relieved by nitroglycerine or rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Unstable angina EKG changes

A

Depressed ST
Inverted T-wave
Changes resolve when pain resolves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Variant (Prinzmetal’s) angina

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

New onset angina

A

1st angina symptoms felt during increased exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pre-infarction angina

A

Occurs in days or weeks before an MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Transmural

A

Affects all layers of the muscle

STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

STEMI EKG

A

ST elevation in 2 contiguous leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Zone of necrosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Zone of injury

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Zone of ischemia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

STEMI causes

A

Atherosclerosis
Plaque rupture
Coronary thrombi
Occlusion of coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ventricular remodeling

A

Scar tissue permanently change size & shape of the ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Anterior (septal) MI

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Posterior (lateral) MI

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MI in women

A

Post-menopause incidence is equal to men

Usually have NSTEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

LDL level

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HDL level

A

> 40mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Triglycerides level

A

<150mg/dL in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Alternative lipid-lowering therapy

A

Omega-3 fatty acids (fish oil)
Flaxseed
Canola oil
Lovaza (omega 3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Metabolic syndrome risk factors

A 
HTN
Decreased HDL
High LDL & triglycerides
Increased blood sugar
Large waist-->40 men; >35 women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Angina vs MI

A

Angina might be relieved with rest, nitros
MI does not go away with rest & nitro
MI has high troponin & CK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MI assessment

A 
BP & pulse
EKGs
Distal pulses & skin temp
Heart sounds--S3
Resp rate & breath sounds
Increased temp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Creatinine kinase levels

A

Female–30-135 u/L
Male–55-170 u/L
Elevations–brain, myocardial, & skeletal muscle injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Cardiac catheterization

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Emergency care of pt with chest pain

A 
ABCs
EKG within 10 min
Pt's description of pain
Vitals
02 therapy
Pain relief & aspirin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Code Heart

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Managing acute pain (MONA)

A

Morphine sulfate–small doses; watch for resp depression; can lower BP
O2–2-4L nasal cannula
Nitrates
Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Glycoprotein 2b/3a inhibitors

A

Unstable angina or NSTEMI

Given before & during PCTA to maintain patency of artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Beta blockers

A

Decrease size of infarct
Slow heart rate & decrease force of contraction
Increase perfusion while reducing force of contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

A/E beta blockers

A 
Bradycardia
Hypotension
Decreased LOC
Chest discomfort
Crackles
Hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Angiotensin II Recptor Blockers (ARBs)

A

Prevent ventricular remodeling & heart failure post MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

ARBs assessment

A

Watch for decreased UO
Hypotension
Cough
Changes in K, BUN, & creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Calcium channel blockers

A

Not used for post MI pts
Promotes vasodilation for pts with angina
HTN not controlled with beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Calcium channel blockers assessment

A

Hypotension

Peripheral edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Reperfusion therapy

A

Thrombolytics
Used to reopen occluded coronary arteries
Given within 30 min in ER for STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

C/I reperfusion therapy

A 
Recent abdominal surgery
Previous intracranial hemorrhage
Vascular lesion
Malignant neoplasm
Stroke within 3 months
Significant head injury or facial trauma within 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Indication a clot has been dissolved

A

Abrupt cessation of pain
Sudden onset of ventricular dysrhythmias
Resolution of ST changes & T wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Heart failure

A

Common post MI
Results from L or R ventricular dysfunction
Rupture of intraventricular septum
Papillary muscle rupture with valve dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Normal R atrial pressure

A

1-8 mmHg
Low indicates hypovolemia
High indicates R ventricular failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Normal pulmonary artery pressure

A

15-26 mmHg systolic

5-15 mmHg diastolic

47
Q

Normal pulmonary artery wedge pressure

A

4-12 mmHg

Elevated indicates L ventricular failure

48
Q

Killip Class I heart failure

A

Absent crackles
S3
IV nitrates & diuretics

49
Q

Killip Class II & III heart failure

A

Afterload reduction
Beta blocker once/day
ACE inhibitors & ARBs to prevent ventricular remodeling

50
Q

Killip Class IV heart failure

A

Cardiogenic shock
40% L ventricle is necrosed
Stuttering chest pain

51
Q

S/S cardiogenic shock

A 
Tachycardia
Hypotension
BP <30/hr
Cold, clammy skin
Restlessness
Tachypnea
52
Q

Cardiogenic shock drug therapy

A

Morphine–relieve pain
O2–decrease oxygen requirements
Hemodynamic monitoring–direct drug therapy
Vasopressors–increase cardiac output

53
Q

Cardiogenic shock tx

A

Intra-aortic balloon pump–when pt not responding to drug therapy

54
Q

Intra-aortic balloon pump

A

Invasive procedure
Balloon inflates during diastole
Increases blood flow to the arteries

55
Q

Post-PTCA complications

A

Closure of vessel–chest pain
Bleeding from insertion site
Reaction to contrast media
Hypotension, hypokalemia, dysrhythmias

56
Q

CABG

A

Occluded artery bypassed with pt’s own venous or arterial blood vessel
For pts who don’t respond to drug therapy

57
Q

CABG candidates

A

Angina with >50% occlusion of left main that can’t be stented
Acute MI with cardiogenic shock
Valvular disease

58
Q

CABG complications

F/E imbalance

A

Edema is common
Monitor BP, wedge pressure, RA pressure, CO2, Cl, & UO
Watch Ca, Mg, & K

59
Q

CABG complications

Hypotension

A

May result in collapse of graft

Vasopressors may be given

60
Q

CABG complications

Hypothermia

A

Institute rewarming procedures if temp is t rewarm too quickly–increases O2 consumption
Stop rewarming when pt reaches 98.6

61
Q

CABG complications

Hypertension

A

Systolic >140-150 mmHg

Give afterload reducers–nitroprusside–tubing must be covered in aluminum foil & protected from light

62
Q

CABG postop

A

Monitor mediastinal drainage hourly

Report drainage >180ml/hr to dr

63
Q

S/S cardiac tamponade

A 
Sudden cessation of mediastinal drainage
JVD
Clear lung sounds
Pulsus paradoxus
Cardiovascular collapse
64
Q

CABG postop assessment

A

Monitor neurological status q30 min until pt has awakened from anesthesia
Then check q2-4 hrs

65
Q

Mediastinitis

A

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
Q

Minimally invasive direct coronary artery bypass

A

Indicated for pt with lesion of L anterior descending coronary artery
2 in incision made & 4th rib removed

67
Q

Home care assessment

A

Recurrence of chest pain
Indications of heart failure–weight gain, crackles, cough
Dysrhythmias

68
Q

Physical activity post-MI

A

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
Q

Initial Stage of Shock

A

MAP decreased by <10
Lactic acid produced, but metabolism is still aerobic
Vascular constriction
Increased heart rate

70
Q

Non-progressive Stage of Shock

Compensatory Shock

A 
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
Q

Progressive Stage of Shock

Intermediate Shock

A 
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
Q

Intermediate Shock implications

A

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
Q

Irreversible Stage of Shock

Refractory Stage

A 
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
Q

Vasoconstrictors

A

Improve blood flow by increasing peripheral resistance

Increases venous return to the heart & improves heart contractility

75
Q

Dopamine infusion

Nursing interventions

A

Assess for chest pain

Monitor UO hourly

76
Q

Norepinephrine (Levophed)

Nursing interventions

A

Assess BP q15min

Assess for headache

77
Q

Phenylephrine HCL

Nursing interventions

A

Assess q30min for extravasation
Check extremities for color & perfusion
Assess for chest pain

78
Q

Inotropic agents

A

Improve heart muscle cell contraction

79
Q

Dobutamine

Nursing interventions

A

Assess for chest pain

80
Q

Milrinone

Nursing interventions

A

Assess BP q15min

81
Q

Agents enhancing myocardial perfusion

A

Improves blood flow to the heart by dilating coronary arteries

82
Q

Sodium nitroprusside

Nursing interventions

A

Protect drug from light

Assess BP q15min

83
Q

Hypovolemic shock

A

Loss of blood volume from vascular space
Loss of circulating RBCs–low oxygen
Reduced MAP

84
Q

Causes of hypovolemic shock

A

Hemorrhage

Dehydration

85
Q

Hypovolemic shock lab assessment

A 
Decreased PaO2
Increased PaCO2
Increased lactic acid
Decreased H&H
Increased potassium
86
Q

Hypovolemic shock

Nursing interventions

A

ABCs
Elevate pt’s ft & keep HOB no greater than 30*
Restore fluid with colloids
Blood & blood products

87
Q

Hypovolemic shock

Drug therapy–dopamine, levophed

A

Cause vasoconstriction of blood vessels, decrease venous pooling, increase MAP & O2

88
Q

Hypovolemic shock

Drug therapy–dobutamine, milrinone

A

Improve heart muscle cell contraction

89
Q

Hypovolemic shock

Drug therapy–nipride, nitroglycerine

A

Dilate coronary blood vessels to improve cardiac contraction & aerobic metabolism in the heart

90
Q

Drug therapy parameters

A 
Assess q15min
Pulse 
BP 
RR
Skin color
O2 sat
Mental status
UO
91
Q

Distributive shock

A

No loss of blood volume, but is not effectively circulated

92
Q

Causes of distributive shock

A

Loss of sympathetic tone
Blood vessel dilation
Pooling of blood in venous & capillary beds
Increased capillary leak

93
Q

Neurogenic shock

A

Loss of MAP
Decreased sympathetic nerve impulses
Smooth muscles relax causing vasodilation

94
Q

Causes of neurogenic shock

A 
Pain
Anesthesia
Stress
Spinal cord injury
Head trauma
95
Q

S/S neurogenic shock

A

Flushed skin
Diaphoresis
Can persist 1-6 wks

96
Q

Chemical induced distributive shock

Anaphylaxis

A

Seconds to minutes after exposure to antigen

Causes widespread loss of blood vessel tone & decreased cardiac output

97
Q

Capillary leak syndrome

A

Fluid shifts from blood vessels into interstitial tissues

98
Q

Causes of capillary leak syndrome

A 
Severe burns/wounds
Liver disorders
Ascites
Paralytic ileus
Malnutrition
Hyperglycemia
99
Q

Obstructive shock

A

Heart remains normal but factors outside the heart prevent adequate filling & adequate contraction of the heart

100
Q

Sepsis

A

Infectious organisms have entered the blood stream

Begins with bacterial or fungal infection & progresses to a dangerous condition over a period of days

101
Q

Septic Inflammatory Response Syndrome (SIRS)

A

Increase in organisms that escape local control & trigger inflammatory response

102
Q

SIRS criteria

A

Temp >100.4 or 20 or PaCO2 12,000 or <4,000

103
Q

Sepsis criteria

A 
2 or more present
Hypotension
UO less than intake
Positive fluid balance
Decreased cap refill 
Hyperglycemia >120
Change in LOC
Increased creatinine
104
Q

Severe sepsis

A 
All tissues involved & hypoxic to some extent
Widespread microthrombi formation
Anaerobic metabolism
Hyperglycemia
Increased HR
105
Q

S/S severe sepsis

A

Low O2 sat
Rapid resp rate
Decreased to absent UO
Change in mental status

106
Q

Common organisms leading to sepsis

A 
E-coli
Klebsiella
Pseudomonas
Staph
Strep
107
Q

Sepsis interventions

A 
O2 therapy
IV antibiotics
Low dose cortisone for adrenal insufficiency
Insulin to manage blood sugar
Heparin therapy for microthrombi
108
Q

Adult Respiratory Distress Syndrome (ARDs)

A

Common in sepsis

Makes air exchange difficult

109
Q

S/S that suggest ARDs cause is sepsis

A 
Productive cough
Fever >100.9
Pleuritic pain
Pulse >90
Tachypnea
Altered LOC
Elevated or low WBCs
Hypotension
High lactate
110
Q

Disseminated Intravascular Coagulopathy (DIC)

A

Widespread intravascular activation of coagulation system caused by disruption in homeostasis
Can occur with septic shock

111
Q

DIC lab tests

A

D-dime–indicates formation & breakdown of fibrin clots
PT
PTT
Fibrinogen level

112
Q

DIC presentation

A

Oozing from bodily orifices
Hemorrhaging
Bruising, petechiae
Oozing from IV sites, puncture sites,wounds

113
Q

DIC tx

A

Replacement of platelets & clotting factors

Control of initiating disease process

114
Q

Troponin levels

A

Rises first & quickly
Troponin T–<0.03 ng/ml
Elevation–myocardial damage

Nursing (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions