- Used in the early management of MI - Morphine - O2 - Nitrates - Aspirin

- Goals are to: minimize myocardial damage, preserver myocardial fxn, and prevent complications - Thrombolytics (streptokinase, tPA) - Dobutamine to decrease SVR - Diuretics/vasodilators (Nitro) decrease preload and afterload in order to decrease O2 demand

- "Pump failure" - Decreased CO causes inadequate tissue perfusion - High mortality rate of 50-75% - Treat cause

- Common in elderly - "Systolic murmur", high-pitched, blowing

- "Leaky valve" - P-P interval is widened - Diastolic murmur

- P-P interval narrowed - Low-pitched systolic murmur

- Assess for: JVD, dysrhythmias - S/S: Flu-like symptoms, ST depression, gallop rhythm

Unit 3 B Flashcards by Blake McNeill

Stable Angina

Predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin

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Unstable Angina

Symptoms increase in frequency and severity; may not be relieved with rest and/or nitroglycerin

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Variant Angina

Pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm

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Silent Ischemia

Objective evidence of ischemia (ECG changes during stress test), but pt reports no pain

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Angina Pectoris: Meds

Nitroglycerin: Decreases preload, dilates coronary arteries, decreases afterload
CCBs: Dilate coronary arteries, decrease HR, decrease contractility
Beta-Blockers: Decrease HR, decrease afterload, decrease contractility
Anti-platelet: prevent platelet aggregation, prevents formation of thrombi/plaques

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Nitroglycerin: Pt Teaching

Moisten mouth before taking
Carry at all times
Keep in original bottle
Renew supply every 6 months
Record time to pain relief
Sit down when taking
S/E: HA, hypoTN, tachycardia, flushing

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MONA

Used in the early management of MI
Morphine
O2
Nitrates
Aspirin

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Management of MI

Goals are to: minimize myocardial damage, preserver myocardial fxn, and prevent complications
Thrombolytics (streptokinase, tPA)
Dobutamine to decrease SVR
Diuretics/vasodilators (Nitro) decrease preload and afterload in order to decrease O2 demand

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MI: Door to Balloon Time

90 minutes

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PCI: Post-procedure Care

Assess for back pain
Check pulses (15 min for 2 hrs, then Q1-2 hrs)
HOB less than 30 degrees while sheath in place
Leg straight for several hours
Direct pressure for 15-30 minutes after removal of sheath

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Coronary Bypass: Number One Complication

Pneumonia

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Coronary Bypass: Post-procedure Assessment

-Asses for: Decreased CO, fluid volume and electrolyte imbalances, impaired gas exchange, impaired cerebral circulation

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Cardiogenic Shock

“Pump failure”
Decreased CO causes inadequate tissue perfusion
High mortality rate of 50-75%
Treat cause

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Cardiogenic Shock S/S

Cerebral hypoxia (restlessness, confusion, agitation), Decreased BP, rapid/weak pulse, cold/clammy skin, tachypnea, crackles

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Sudden Cardiac Arrest: Management

Maintain open airway
Provide artificial ventilation
Promote artificial circulation
Defibrillate

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Mitral Regurgitation

*Common in elderly

- “Systolic murmur”, high-pitched, blowing

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Aortic Regurgitation

“Leaky valve”
P-P interval is widened
Diastolic murmur

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Aortic Stenosis

P-P interval narrowed

- Low-pitched systolic murmur

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Infective Endocarditis

S/S: Petichiae, Osler nodes , Janeway lesions, Splinter hemorrhage
Tx: Abx or valve replacement

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Myocarditis

Assess for: JVD, dysrhythmias

- S/S: Flu-like symptoms, ST depression, gallop rhythm

Pericarditis

*Post-op
Assess for: Cardiac Tamponade
S/S Positional pain, friction rub

Left Heart Failure: S/S

*Blood backs up in lungs
Tachypnea
Tacycardia
Cough
Crackles
Hemoptysis
Pulmonary edema
Fatigue
Orthopnea

Right Heart Failure: S/S

*Blood backs up in bodily vasculature
Peripheral edema
Hepatomegaly
Splenomegaly
Hepatojugular reflex
Ascities
JVD
Pulmonary HTN
Weakness
Anorexia
Indigestion
Mental changes

Left Heart Failure: Management

O2 therapy
Morphine
Diuretics
IV Meds (decrease preload and afterload, increase stroke volume): Dobutamine, Nesiritide, Milrinone

Right Heart Failure Management

- Meds: ACE inhibitors, B-Blockers, Diuretics, Digitalis - Nutritional therapy - Additional therapy: O2, ICD

Triponin Markers

-Rise in 3-12 hours, peak in 24-48 hours

Pulse Scale

- 0 Absent - 1 weak/thready - 2 Diminished - 3 Easy to palpate/full - 4 Strong/bounding

Role of Nurse in OR

Safety!

Pre-op Fasting Guidelines

- Clear liquids: 2 hrs - Light meal: 6 hrs - Reg/heavy meal: 8 hrs - Infants: breast milk 4 hrs, non-human milk 6 hrs

Why don't you mark surgical site on neonate?

Can leave a permanent mark on skin

Hypothermia (OR): Risk Factors

Skinny and elderly

Malignant Hyperthermia

- Higher risk: bulky muscle, hx of muscle cramps/weakness - Genetic link - S/S: *Lock-jaw, initial tachycardia, generalized muscle rigidity - Tx: *Dantrolene (reversal), hyperventilation (100% O2), Iced NS, monitor body temp and liver fxn

Sedation Depth Guidelines

- *Document pt rxn to anesthesia - Ativan and Valium: Minimal sedation - Propofol: Moderate sedation, depressed consciousness - Do NOT leave pt unattended

Stages of Anesthesia

- Stage 1: Beginning (shaking/shivering) - Stage2: Excitement (aggressive behavior) - Stage 3: Surgical anesthesia (unconsciousness) - Stage 4: Medullary depression (watch respirations)

Laryngeal Mask Airway (LMA): Contraindications

Pregnancy, full stomach, intestinal obstruction

Reversal Agents: Opiates and Benzo's

- Opiates: Narcan | - Benzo's: Romazicon

Laryngospasm: Tx

- Raise HOB, hyperextend neck, O2 | - Prevention: suction before extubation

DKA: S/S

- Type I | - Hyperglycemia (300-800), profound dehydration, acidosis

HHS: S/S

- Type II - HypoTN, profound dehydration, tachycardia, neuro status changes, Hyperglycemia (600-1200), normal pH - Often caused by infection

HHS Tx

- Fluid replacement - Correct electrolyte imbalances - K is added to fluids once UO is adequate

DKA Tx

- Replace fluids at 5 units/hr or 0.1 units/kg/hr - Hourly glucose checks (reduce by 10% per hour) - Only regular insulin can be given IV - Monitor EKG, UO, precipitating factors

Calculating Cardiac Output

- Stroke volume X HR | - (4 to 8 L/min is expected)

Phlebostatic Axis

- Intersection of midaxillary line and 4th intercostal space - If below axis, gives high readings - If above, gives low readings

Water Seal Chamber (2nd chamber)

- Bubbling indicates air leak - Should see tidaling: Fluid level rises during inspiration, and falls during expiration (Mech vent pt will be backwards)

Suction Chamber

-Bubbling is normal here

Chest Tube

- Sudden increase in bloody drainage (more than 200 ml) could be hemorrhage - Sudden decrease could be clogged tube, or occluded by pt laying on it (turn pt first)

Removing Chest Tube

Ask pt to take a deep breath in and bear down

Suctioning a Trach

- *Set suction no higher than 120 | - Sterile procedure if open system