week 3 CVS part 1 Flashcards
learn CHF, dysrhythmias, MI
My patient has CHF. what one thing do I want to consider to avoid flash pulmonary edema
do they have continuous iv fluids?
what is the ABCDD acronym for in cardiac treatment
Ace inhibitors
Beta blockers
Calcium channel blockers
Digoxin
Diuretics
pressure ventricle must overcome to push blood through artery
afterload
patient has systolic bp of 200, c/o headache and blurred vision. seems anxious. what am I worried about?
hypertensive crisis
why is hypertensive crisis an emergency?
to save brain, eyes, lungs and kidneys
what symptoms will I monitor for if patient is in hypertensive crisis?
cerebral edema symptoms: seizures, stroke.
Respiratory symptoms: pulmonary edema
Renal symptoms:
changes in urine output (could also be cause of crisis)
what is my plan of care for hypertensive crisis?
(something to monitor, something to administer, some comfort measures, complications to look for, goals)
frequent vs (q30 to start), IV nitroprusside and labetolol, semi-fowlers and O2 if indicated, monitor for stroke, seizures, urine output. goal is to lower BP gradually (5-10% in first 2 hours)
female 60yo presents with nausea and vomiting, diaphoresis, dyspnea, anxiety, fatigue and palpitations. describes throbbing in chest. what are my priority actions?
OPQRSTU of symptom(s), obtain VS, obtain 12 lead ECG asap, MONA, troponins, remain with pt
ecg shows inverted T wave, what is likely going on?
NSTEMI
what are my non-surgical actions for acute coronary syndrome?
immediate: assess pain, vs++, obtain IV/keep patent, nitro, asa, morphine, O2.
preventative: ASA, beta-blocers, ace-inhibs, statins, prevent dysrhythmias, manage heart failure
if i see a change in a patients rhythm on their telemetry strip, what should I do before notifying provider?
get vitals, espeically BP. I’d also add talk to pt and assess LOC and symptoms
a patient who just had a PCI is complaining of chest pain and becoming sweaty. What am I worried about?
acute closure of vessel, aka the vessel that was opened has become occluded by a clot again
what would I monitor for 2-5 days after PCI?
allergic reaction to dye
a patient post-CABG complains of pain in chest. Whats my next move?
assess if pain is position dependant, check vital signs, look at incision site, consider if pain management has been adequate, and OPQRSTU. Sternotomy chest pain is expected, anginal pain is not. let provider know any findings
which are the two most common dysrhythmias seen in practice?
Afib and atrial flutter
how do i know if a-fib is controlled or not?
controlled has ventricular rate of >100
what are the priority problems for a patients with AFIB?
potential for embolus formations, potential for heart failure due to altered conduction pattern
jeopardy: A synchronized countershock that may be performed to restore normal conduction
what is synchronised cardioversion
what am I monitoring throughout a synchronized cardioversoin?
vital signs
when would a patient need a pacemaker after an ablation?
if its the AV node that’s up to no good and needs to be ablated, theyll need a pacemaker after.
my patient’s telemetry strip shows a PVC, what should I do?
talk to them, maybe check their lites and adjust as needed, and if I see it happen increasingly often, i should escalate my concern
if i see a sustained Vtach, what should I do?
talk to patient, ask about symtoms/assess LOC, take vitals and PALPATE PULSE! (no pulse? CODE)
which dysrhythmia is an immediate code (for an ACP-R pt)?
Vfib
What is the process for a patient in asystole?
if ACP R, call a code, start CPR, and code team will rotate through medications like epinephrine. My job might be to make sure IV line is patent/inserted. D-fib is ineffective when there is no conduction.
what might i hear when auscultating the heart of a heart failure pt? (if i’m amazing)
S3/S4 gallop
which two organs might be enlarged on a pt with right sided heart failure?
liver and spleen
my pt with heart failure was on room air when I left clinical on wednesday. When I return tuesday, they are using 4L O2 to prevent dyspnea, even at rest. The chart says their O2 demands increased gradually over the week. What might I want to do?
Listen for crackles in chest! check weights and ins and outs, consider if they ahve been on continuous fluids! There are some ominous signs of flash pulmonary edema.
would I bother to ask a heart failure pt gi/gu questions like if they are nauseated or have had vomiting/diarrhea?
yes! this can be a sign of fluid overload if it has lasted more than 2 days (happens in the “yellow” zone)
which of the cardiomyopathies can result in sudden cardiac death?
both (dilated and hypertrophic)
what causes cardiomyopathies?
alcohol overuse, chemo, infection, inflammation, poor nutrition
what treatments are available for cardiomyopathies?
an ICD (implantable cardioverter defib), drug therapy (all the usual suspects, diuretics, dig, amiodarone, beta blockers, and morphine and nitro)
what should i teach patients with dilated cardiomyopathy?
to report any palpitations, dizziness, or fainting, or if their ICD shocks them more frequently they should be admitted
Name two examples of CHDs that affect pediatric pts
ventricular Septal Defect and Tetralogy of Fallot
what are the symptoms of pediatric heart defects/diseases? (two broad categories)
cyanosis and heart failure
what are three abnormalities in vital signs that are a result of pediatric heart issues?
tachycardia, weak pulses, decreased BP
what are four signs of decreased perfusion in pediatric clients?
anorexia, decreased U/O, inappropriate sweating, weakness/fatigue
which five respiratory symptoms occur in pediatric heart disease?
tachypnea, dyspnea, flaring nares, wheezing, grunting
symptoms related to fluid retention in pediatric heart disease (4)
weight gain, peripheral edema (esp. periorbital), neck vein distension, ascites
why would MRI not be an ideal diagnostic test for babies and toddlers?
it takes over 30 minutes and its difficult for them to stay still
what are “tet” spells?
hypercyanotic spells (tet refers to tetrology of fallot) which can occur during procedures in children with heart disease.
how to intervene in a “tet” spell?
place infant in knee-chcest position, administer 100% o2, give morphine
medication for pediatric CHD (name 3)
digoxin,
ace inhibitors
beta blockers
what should I be thinking about for in a pediatric client taking cardiac meds?
-accurate dose calculation
- assessing vitals pre and post med admin
-monitor for dig toxicity
what would I teach a parent about dig toxicity for their child with CHD?
symptoms are Nausea and vomiting, bradycardia, dysrhythmias
what three ways do we treat fluid overload in pediatric heart failure?
diuretics, fluid restriction (though rarely needed b.c feeding is difficult), sodium restriction (again, not really relevant for babies)
is assessment for heart failure and diuretic use different for pediatrics?
no, we still monitor ins and outs and weight and VS, but need to consider good dose calculation
what are the 3 main goals of care for ped CHD?
decrease cardiac demands, increase tissue oxygenation, maintain nutritional status
how do we decrease cardiac demands for peds? (name 5)
-keep temp normal,
-catch infections early and treat promptly,
- reduce breathing effort (semi-fowlers),
- sedate irritable child (no tantrums, too much demand on heart!)
-provide restful environment
where are the two main areas of aortic aneurysm?
thoracic and abdominal
what are signs of abdominal aortic aneurysm?
pulsatile mass in periumbilical area left of midline with audible bruits
difficulty wtih bowels or epigastric pain
what are signs/symptoms of thoracic aneurysm?
diffuse chest pain, might interfere with swallowing
which type of aneurysm rupture has a better prognosis?
posterior as the organs in the back of the peritoneal cavity tamponade the aorta
how to manage a small asymptomatic aortic aneurysm
monitor growth,
maintain BP in normal limits
patient has sudden severe onset of excruciating chest pain described as “ripping, tearing” that migrates. what is this pointing to?
aortic dissection
how would i know if an aortic dissection is occuring in the aortic arch or the descending aorta?
aortic arch would have CNS symptoms and weak carotid and temporal pulses, descending would have pain to back of abdomen and legs would ahve decreased perfusion
what are three complications of aortic dissection
cardiac tamponade, aortic rupture, occlusion of blood supply to organs
which type of aortic dissection is always an emergency and requires immediate invasive treatment?
ascending aortic
