Unit 2: Planning Care (concepts related to ACS)

Question 1

• apply oxygen only if needed.
• obtain EKG immediately ( less than 10 minutes) ** STEMI?
• obtain full set of vital signs (stability)
• administer ASA upon arrival (decrease the coagulation) **
• establish IV access (for medications and fluids)
• obtain labs: cardiac workup (diagnostics)
• give nitro: 1 tab sublingual q5min x 3 (vasodilation of coronary arteries)
• IV fluids (increasing circulating volume)
• prepare for cardiac catherization (if indicated) (reperfusion of patient asap) ***
• beta blockers upon discharge ***

Answer 1

actions in response to ACS

Question 2

cardiovascular exercise yields ______ _______.

Answer 2

collateral circulation

Question 3

What are the four core measures?

Answer 3

EKG within 10 minutes

• ASA upon arrival
• cardiac catherization within 90 minutes or fibrolytic administration
• beta blockers upon discharge

Question 4

secondary vessels branch off of coronary arteries

Answer 4

collateral circulation

Question 5

• most common form of cardiomyopathy
• pathophysiology: characterized by dilated heart chambers. myofibril damage. weakened heart muscle causing stretching and thinning of chamber walls.
• ineffective pumping leads to decreased CO
• causes: most often an unknown cause (idiopathic), inherited, alcohol abuse, chemotherapy, infection/inflammation, complications of pregnancy.

Answer 5

dilated cardiomyopathy

Question 6

• may be asymptomatic
• sudden onset of symptoms of left sided heart failure (dyspnea on exertion, orthopnea, fatigue, activity intolerance, palpitations, dysrhythmias

Answer 6

signs and symptoms of dilated cardiomyopathy

Question 7

• thickened heart walls and septum
• enlargement and disorganization of myocardial fibers
• stiffened walls and small chambers
• obstruction of ventricular flow
• leads to decreased stroke volume (SV) and CO
• causes: inherited and chronic hypertension

Answer 7

hypertropic cardiomyopathy

Question 8

signs and syptoms:

• often asymptomatic
• chest pain at rest (not relieved by nitrates)
• dyspnea
• syncope
• dizziness
• fatigue
• ventricular dysrhythmias
• common in athletes
• heart is working harder

Answer 8

signs and symptoms of hypertropic cardiomyopathy

Question 9

• most rare from of cardiomyopathy
• stiff ventricles
• scar tissue replaces muscle tissue
• restricted ventricular filling pattern
• causes: sarcoidosis, amyloidosis, connective tissue diseases.
• signs and symptoms: right and left sided heart failure>

Answer 9

restrictive cardiomyopathy

Question 10

• replacement of myocardial tissue with fibrous and fatty tissue.
• interruption of the heart’s electrical signal
• hard brick like material
• causes: inherited
• signs and symptoms: may be asymptomatic
  sudden cardiac death palpitations, dysrhythmias, syncope

Answer 10

arrhythogenic right ventricular cardiomyopathy

Question 11

• removal of the toxin
• close monitoring
• management of dysrhythmias
• symptom control (pacemakers)
• lifestyle modifications

Answer 11

non surgical treatment

Question 12

for dilated and restrictive cardiomyopahty what medications are used to treat?

Answer 12

diuretics, vasodilators, cardiac glycosides, beta blockers

Question 13

for hypertropic cardiomyopathy what medications do you treat with ?

Answer 13

beta-adrenergic blockers, calcium antagonists. REMEMBER that the medications used to treat dilated cardiomyopathy are contraindicated.

Question 14

• implantable cardioverter defibrillator
• ventriculomyomectomy
• percutaneous alcohol septal ablation
• radio frequency catheter ablation
• heart transplant

Answer 14

surgical treatment for cardiomyopathy

Question 15

• reasons to call the physician (chest pain, shob, palpitations)
• fluid status
• daily weights (no more than 5 pounds/week)
• dietary restrictions
• activity restrictions
• medication management and compliance
• genetic counseling
• substance abuse counseling

Answer 15

patient education

Question 16

• dilated cardiomyopathy
• restrictive cardiomyopathy
• end stage heart disease caused by CAD, valvular disease or congenital heart disease (heart didn’t develop properly)

Answer 16

indications for transplant

Question 17

they will not transplant a heart into someone that is greater than ___ years old.

Answer 17

65

Question 18

- donor and recipient matching
less than 55 years old 
HLA typing
blood type
comparable body weight
transplanted no more than 6 hours after harvesting

Answer 18

transplant donor selection

Question 19

• bleeding in the pericardial sac (cardiac tamponade)
• new heart is denervated (unresponsive to vagal stimulation, orthostatic hypotension, pacemaker)
• immunosuppressants to prevent organ rejection (life long and increased risk for infection)

Answer 19

post-transplant nursing considerations

Question 20

what are the signs and symptoms of organ rejection?

Answer 20

fatigue
weakness
ShoB

Question 21

symptoms after transplant: fever, nauseated, ShoB, doesn’t feel good, vomiting up meds, fatigue, GI symptoms

Answer 21

call the physician for any of these symptoms

Question 22

medication adherence is critical. Medication should be taken at the ____ time every day.

• encourage regular exercise
• eating a heart healthy diet
• recipient doesn’t initially get to know the donor/family ( 1 year time frame) assume that they will never know

Answer 22

same

Question 23

denervated heart =

Answer 23

no chest pain