Week 1 recorded Cardio Vascular part 1 and learning outcome

Question 1

Electrocardiogram (ECG)

Answer 1

► Recording the electrical signals from your heart.

Question 2

If your patient is having a cardiac event,
what three potential rhythms might you
see?

Answer 2

Inverted T-Wave
NSTEMI ( ST depression)
STEMI

Question 3

What laboratory tests would
you ensure happen quickly?

Answer 3

Serum Cardiac Biomarkers

Question 4

Serum Cardiac Biomarkers test types

Answer 4

Cardiac-Specific Troponin:
►Troponin T (cTnt): <0.1 ng/mL (>2.3 + cardiac injury)
►Troponin I (cTnI): <0.5 ng/mL
►Creatine Kinase MB (CK-MB): < 4%-6% total CK
►Myoglobin: 11.1 mcg/L – 91.2 mcg/L

-most importantly for identify cardiac shock we take Trioinin T-test

Question 5

Which result is the most important?►Why?

Answer 5

►Troponin T (cTnt)

Question 6

How do you differentiate between Unstable Angina (UA) and Non-Stemi (NSTEMI)?

Answer 6

►ECG
►Serum Cardiac Biomarkers

Question 7

What are your priority nursing interventions?

Answer 7

► Medications: Continue O2, Administer Nitroglycerin
and Aspirin
► Monitor: Continually assess patient: Airway,
breathing efforts, hemodynamic status, cardiac
arrhythmias
► Prepare for percutaneous coronary intervention (PCI).
► Would you wait for laboratory results prior to sending
patient to the cardiac catheterization lab? Why or
why not? no because time is a tissue

Question 8

Cardiac Catheterization Lab:

Answer 8

► Arterial Access: Radial or Femoral
► Percutaneous Coronary Intervention (PCI): An
endovascular procedure that is minimally invasive
where a small incision is made into a vessel using a
needle puncture, guidewire and sheath to provide
access to diagnose/treat.
► Percutaneous Transluminal Coronary Angioplasty
(PTCA): Locate and assess blockage and determine
extent of collateral circulation along with left
ventricular function.
► Balloon Angioplasty: Widening of blocked or narrowed
vessel by balloon catheter.
► Stent Placement: Bare Metal or Drug-Eluting

Question 9

What medications are used
during a cardiac catheterization?

Answer 9

►Midazolam
►For Sedation
►Fentanyl
►For Pain Control

Question 10

what are the benefits
of PCI over
Coronary Artery Bypass Graft (CABG)?

Answer 10

►Minimally Invasive
►Low Risk
►Quick Recovery

Question 11

What is the goal of PCI?

Answer 11

►Quickly open up blocked
arteries to allow oxygen-rich
blood to circulate to the entire
heart muscle with minimal risk
and recovery

Question 12

What are your expectations s/p
reperfusion? -aka- What will you
frequently assess?

Answer 12

►No Chest Pain
►Normal ECG
►Normal Vital Signs
►Normal Neuro Status
►Normal Heart and Lung Sounds
►No Bleeding (External or Internal)

Question 13

How often will you draw serum cardiac
biomarkers post PCI?

Answer 13

► Q 6 hours x 3
► What will happen to serum cardiac biomarkers s/p
reperfusion therapy?
► Early and rapid rise within three hours of reperfusion
therapy.
► Peaking within 12 hours.
► Why do these levels increase?
►Necrotic heart cells release proteins into circulation
after perfusion is restored to the area.

Question 14

What are some PCI complications that can
lead to an emergent Coronary Artery Bypass
Graft (CABG).

Answer 14

► Dissection
► Rupture
► Acute Stent Thrombosis
► Restenosis (Reocclusion)
► Coronary Spasm
► Bleeding
► Stroke
► Infection

Question 15

When would a patient receive a thrombolytic?

Answer 15

►No Cardiac Catheter Lab
►Thrombolytic Requirements:
►Chest Pain < 12 hours
►STEMI only
►No contraindications

Question 16

What is the goal of Thrombolytic Therapy?

Answer 16

►Limit Infarction Size
►Get Patient to Cardiac Cath Lab ASAP
►Thrombolytic Therapy Risks?
►Bleeding
►Reocclusion of Artery

Question 17

Absolute Contraindications:

Answer 17

► Intracranial Hemorrhage History
► Known Abnormalities
► Recent Stroke
► Recent Trauma
► Intracranial Cancer
► Severe Uncontrolled Hypertension
► Active Internal Bleeding
► Suspected Aortic Dissection
► Prior Treatment (Streptokinase)
► Recent Intracranial/Spinal Surgery

Question 18

ACS Medications: Why do we give them?

Answer 18

►Dual Antiplatelet Therapy
►Nitroglycerin
►Morphine
►Beta Blocker
►Lipid-Lowering Drugs
►ACE/ARB
►Antidysrhythmics
►Stool Softeners

Question 19

► Dual Antiplatelet Therapy:

Answer 19

Antiplatelets stop platelets from clumping
together and forming blood clots. Dual antiplatelet therapy (DAPT) is
defined as the use of a P2Y12 receptor inhibitor (clopidogrel,
ticagrelor, and prasugrel) and aspirin. (Clopidogrel, Aspirin)

Question 20

► Nitroglycerin:

Answer 20

A nitrate resulting in vasodilation to relieve angina
occurring when the heart muscle is deprived of blood/oxygen.

Question 21

► Morphine:

Answer 21

A potent opioid providing analgesia along with vasodilation
and decreasing cardiac workload (decreases heart rate, blood
pressure and venous return). As a result, myocardial oxygen demand
is decreased.

Question 22

► Beta Blocker:

Answer 22

Used to manage abnormal heart rhythms and for
patients with acute MI, beta blocker therapy reduces infarct size and
early mortality when started early and lowers the risk of death when
continued long term. (Atenolol, Metoprolol)

Question 23

► Lipid-Lowering Drugs:

Answer 23

Decrease the levels of fats in the blood.
Lowering cholesterol levels that are too high lessens the risk for
developing heart disease and reduces the chance of a heart attack or
dying of heart disease, even if the patient already has it.ACE/ARB
(Atorvastatin, Simvastatin)

Question 24

► Antidysrhythmics:

Answer 24

Used to reduce mortality in post MI patients with
ventricular ectopic activity which has an adverse effect on prognosis
post MI. (Amiodarone)

Question 25

► Stool Softener:

Answer 25

Used to prevent straining during a bowel movement
which should be avoided after an MI or surgery. Straining can trigger
a vasovagal response where the vagus nerve sends a message to the
brain causing a sudden drop in blood pressure and heart rate which
can trigger a cardiovascular event, such as arrhythmia. (Docusate)