week 3 <3 Flashcards
amiodorone
administered when heart is in a-fib to help prevent clots
formula & amount of normal cardiac output
CO= HR x SV
*4-8 L per minute
formula of cardiac index
CI= cardiac output / body surface area
*normal = 2.8 to 4.2
formula for mean arterial pressure
MAP = SBP + 2DBP / 3
in patients with heart failure, their pulse pressure
decreases
in relation to the heart…chemicals associated with the sympathetic nervous system are
epinephrine & norepinephrine
- INCREASE contractility, HR, & vasoCONSTRICTION
In relation to the heart… (a) chemical associated with the parasympathetic nervous system are
acetylcholine
*DECREASES– contractility, HR, & vasoDILATION
baroreceptors
found in carotid sinus & aortic arch & function to MAINTAIN NORMAL BLOOD PRESSURE
chemoreceptors
MAINTAIN ABG’S - cardiorespiratory hemostasis
2 locations =
(1) BRAIN - stimulated by pH and PCO2 (arterial co2)
(2) peripheral in carotid & aortic bodies - stimulated by pH & PO2
** hyperventilation stimulates them
testing for orthostatic hypotension includes
- BP while lying down
- sit-up & wait 5 min then take BP
- stand and take BP
8 sites for palpating arteries
- carotid
- brachial
- radial
- ulnar
- femoral
- popliteal
- posterior tibial
- dorsalis pedis
3 types of drugs for a slow heart
***these drugs help speed it up
- Beta Blockers = -lol
- Calcium channel blockers = -zem
- digoxin = -digitalis
atropine
anticholinergic drug used to elevate heart rate bradycardia
used only when symptoms are present
atroPINE = PINE on top of the tree = ELEVATE
3 cardiac biomarkers
Troponin ( 7 days)
Creatinine kinase (up to 3 days)
Myoglobin (within 24 hrs)
normal cholesterol levels
< 200 mg/dL
c-reactive protein range
< 0.3 mg/dL
EKG 5 step interpretations
- # of R peaks x 10 = bpm
- rhythm = space between R peaks
- presence of P wave next to QRS
- PR interval less than 5 mini boxes
- QRS wave (present, upright, & tight)
V-fib on an EKG looks like & is treated by:
*flopping squiggly line
- use DEFIB
- admin drugs LAP
(L) lidocaine
(A) amiodorone
(P) praocainamide
**caused by v-tach. post MI, & electorlyte imbalances
V-tach on an EKG looks like
*TOMBSTONES
*no pulse = d-fib
pulse = cardioversion
*caused by LOW K+ & MG, & MI
a-fib on an EKG
no p wave (starting hill) fibrillation flopping
- TTE to rule out clots
- cardioversion
- digoxin
- anticoagulants
*caused by COPD, HTN
before administering digoxin check for
A.T.P.
**digoxin DIGS for deeper contraction
A = apical pulse is 60 +
T = toxicity (<2,0, n/v, green halos)
P = potassium less than 3.5
NO ANTACIDS
atrial flutter
*saw TOOTH w/ 2 T’s
treated same as a-fib
- TTE to rule out clots
- cardioversion
- digoxin
- anticoagulants
treatment for supraventricular tachycardia
** super fast — hr
synchronized cardioversion = priority if HR & RR is elevated & Bp is low
- pt to bear down or ice cold stimulation
- rapid push of adenosine
torsades de pointes on EKG
*wavy tornado
caused by low MG, MI, & hypoxia
treated w magnesium sulfate
magnesiums role on heart muscles
magnesium MELLOWS out the heart muscles
if low = overactive heart
p-wave depicts
atrial fibrillation
ORS Wave depicts
ventricular rhythm
“lack of QRS complexes”
patient is in asystole
“wide bizarre QRS complexes”
patient is in v-tach
“chaotic or unorganized”
describes fibrillation
“chaotic rhythm w no P waves”
atrial fibrillation
“chaotic rhythm with no QRS complexes”
ventricular fibrillation
antidote for epinephrine, norepinephrine, and dopamine
Phentolamine
cardiac catheterization complications
affects kidneys
cardiac tamponade (fluid in heart)
hematoma
artery dissection
restenosis
retroperitoneal bleeding
4 stages of coronary artery disease
- endothelial damage
- fatty streak
- fibrous plaque
- complicated lesion
metabolic syndrome
increased - blood pressure, blood sugar, obesity, insulin resistence and abnormal cholesterol levels
statins & adverse effects
*atorvastatin, simvastatin, lovastatin
adv effects = hepatotoxicity & myopathy
cholesterol absorption inhibitors
**ezetimbe
risk of hepatotoxicity & myopathy when taken with statins
Fibrates nursing instructions & adverse effects
*gemfibrozil
take 30 min BEFORE breakfast & dinner
adv = gallbladder disease, myopathy, hepatotoxicity, & bleeding
4 stages of hypertension
- pre-hypertension = 120- 129
- Stage 1 = 130-139 / 80-89
- stage 2 = > 140/90
- hypertensive crisis > 180 / 120
DASH meal plan
high in fruits vegetables, nuts, seeds, and beans
low in dairy, animal meat, saturated fats, and sweets.
manifestations of hypertensive crisis
epistaxis
severe headache
dizziness
blurred vision
vasodilators
NITROGLYCERIN & HYDRALAZINE
decreases preload, afterload, & O2 demand
used cautiously w antihypertensives
headache = common
alpha adrenergic blockers
PRAZOSIN, DOXAZOSIN , TERAZOSIN
first dose = orthostatic hypotension
admin at night
left sided heart failure can result in
right sided heart failure
clinical manifestations for left-sided heart failure
*PULMONARY
EF normal = 55%-70%
decreased pulse ox
crackles / dyspnea
frothy sputum
nocturia
altered LOC
clinical manifestations for right-sided heart failure
*SYSTEMIC CONGESTION
EF normal = 45%-60%
edema
jugular vein distention
anorexia/ vomiting
hepatomegaly
ascites (abdominal swelling)
dietary restrictions for heart failure
limit fluid & sodium
*2-3 g sodium diet
manifestations of acute pulmonary edema
respiratory distress
crackles
tachycardia / anxiety
frothy blood-tinged sputum
nursing actions for acute pulmonary edema
NO FLUIDS
- high fowlers
- admin O2 / intubate
- IV loop diuretics
- IV morphine
- alternate rest & activity
pericardial tamponade manifestations & diagnostic studies,
- hypotension, muffled heart souds, JVD, & paradoxical pulse
- chest x ray
echocardiogram
chronic stable angina
episodic 5-15 min
provoked by exertion but relieved by nitroglycerin
caused by MI – St depression or T inversion
*atypical in women
acute coronary syndrome
caused by rupture of thickened plaque w angina > 30 min
nitroglycerin DOES NOT work
Prinzmetal’s angina
occurs primarily at REST
triggered by increased smoking, histamine, & epinephrine
Ranolazine
sodium current inhibitor that treats chronic angina
contraindications for anginal meds
erectile dysfunction meds
severe anemia
head injury
closed-angle glaucoma
alcohol
sublingual nitroglycerin
decreases demand for O2
MOST RAPID = up to 3 tabs 5 min apart
call 911 if pain is not relieved by FIRST tab, wait 5 min then take 2nd.. up to 3
dark container away from light/heat
replace every 6 mo
take acetaminophen for headache
orthostatic hypotension
nitroglycerin topical ointment
- check BP B4
- gloves
- clean & hairless area
- DO NOT MASSAGE OR RUB
nontunneled percutaneous venous catheter is for
SHORT-TERM USE ONLY
subclavian and jugular vein
tunneled percutaneous venous catheter is for
LONG term use
normal Troponin levels
less than 0.03
normal LDL levels
less than 130
nursing interventions for echocardiogram
*measures ejection fraction & heart
client lays on LEFT side
Non-invasive
1 hour
nursing interventions for a stress test
- instruct client to fast 2- 4 hrs before
- avoid alcohol, caffeine, etc
- apply 12-lead EKG
4 medications for a medical stress test
- adenosine
- dobutamine
- dipyridamole
- regadenoson
nursing considerations for cardiac cathetherization
- NPO 8 hours
- allergy to IODINE / SHELLFISH
- ask if pt. is taking METFORMIN (if they are then resume 48hrs after)
**warmth & flushing is normal
**pressure on site
**extremity kept STRAIGHT
hydrochlorothiazide nursing considerations
monitor for hyopkalemia (muscle weakness)
*in the morning
atenolol and Bp is unchanged
notify the provider
ACE & ARB’s act to
decrease
tertiary prevention
walking program
teaching how to read food labels
adhering to medication regimen
captopril nursing considerations
no salt substitutes
*ACE inhibitor = hypokalemia
