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Med surg > week 3 lecture > Flashcards

week 3 lecture Flashcards

1
Q

what is a syndrome

A

multiple diseases occurring together

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2
Q

what is acute coronary syndrome

A
  1. HTN
  2. Athlerosclerosis
  3. unstable angina
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3
Q

normal lipid panels

A

LDL below 100
HDL greater then 40
triglycerides less then 150
cholesterol less then 200

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4
Q

what is prinzmetal angina

A

angina caused due to coronary artery spasm

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5
Q

what is the first action if someone with stable angina is complaining of chest pain

A

give stress test

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6
Q

what is the recommended exercise per week

A

3 days 30-45 mins of moderate to intense

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7
Q

what is the priority intervention if lipid panel is to high

A

life style changes then do statins

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8
Q

Nitro protocol

A

take one and call 911 right away, if chest pain doesnt go away within 5 mins take another one

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9
Q

why do older people have a higher chance of surviving an MI

A

collateral circulation

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10
Q

how long does ischemia have to last before injury to myocardium occurs? Necrosis?

A

injury occurs after 20 mins

Necrosis after 4 hours

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11
Q

what is an MI

A

total occlusion of one of the coronary arteries

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12
Q

complications of MI

A
  1. HF
  2. dysrhythmias
    - Vfib
    - Vtach
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13
Q

drugs for health promotion for MI patients

A

Statins and aspirin(81mg) (325mg during MI)

-omega 3 fatty acids

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14
Q

Statins major concern

A

Rhabdomylolysis

-monitor for muscle pain

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15
Q

Why do patients have to take clopidogrel after an MI. How is it dosed?

A

to keep the stents open. loading dose is 300 mg in the cath lab then 75 mg daily until MD decides to stop

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16
Q

what is another antiplatelet that can be used in place of clopidogrel

A

effient

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17
Q

why is nitro used with vasopressors

A

to shunt blood to the heart

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18
Q

What does nitro work on.

what is the main problem with nitro

A

coronary arteries and peripheral veins.

Nitro builds tolerance very quickly

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19
Q

Sodium nitroprusside

A

Nipride

  1. dilates coronary and peripheral arteries
  2. super powerful
  3. photosensitive
  4. max 48 hour admin b/c of cyanide poisoning
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20
Q

what can ECKO be used for

A

checking ejection fraction 55-70%

checking structure and size

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21
Q

what is valve prolapse

A

valve does not fully close causing reguritation

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22
Q

MI prioritizes

A

MONA

O2 is first

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23
Q

Contraindications of trombolytics

A
  1. bleeding
  2. active stroke
  3. recent surgery
  4. 6 hours post stroke
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24
Q

TPA interventions

A
  1. check for shellfish allergy and give benadryl if they have it
  2. give alot of NS after b/c contrast is nephrotoxic
  3. if patient is ESKF call dialysis before contrast is in
  4. the contrast will make you flush and have a warm feeling you will also have the urge to urinate
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25
Q

PCI intevention

A
  1. keep entire body straight for a couple of hours to lower the pressure on the femoral artery
  2. keep assessing pedal pulses, usually will have to use doppler. If you dont hear it with doppler call doctor STAT
  3. Ask patient to move their toes if they’re awake
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26
Q

what percentage of a coronary artery has to be occluded before chest pain is felt

A

70%

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27
Q

what does ischemia on EKG show up as

A

ST depression

T inversion

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28
Q

What does myocardial injury look like on ECG

A

ST elevation

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29
Q

what do we do for patients with chest pain who do not have ST elevation

A
  1. admit and monitor for 24 hours.
  2. Do cardiac enzymes Q8H and
  3. have them on continous cardiac monitoring
30
Q

Peak times of
Myoglobins
Troponin (tells you how bad the MI is)
CK-MB

A

1-2 hours
6-8 hours
12 hours

31
Q

what is another name for CK-MB

A

creatinine phosphokinase

32
Q

what is a pathologic Q wave and what does it indicate

A

it is a Q wave which is “deeper” then normal

indicates old MI

33
Q

how do you know TPA has worked

A

ST elevation goes away therefore you know the coronaries have opened

34
Q

why are diabetics at high risk of mortality from MI

A

they may not feel chest pain due to neuropathy

35
Q

what is the maximum number of stents you can place at one time

A

2 max after that you gotta do CABG

36
Q

what do they supply
RCA
LAD
circumflex

A

inferior wall
anterior wallwhat do
posterior wall

37
Q

post CABG teaching

A
  1. no heavy lifting (how long)
  2. you ARE allowed to bend
  3. no driving for about 3 months
  4. restrict crazy sex for about 3 months
38
Q

normal rates of
SA node
AV node
Purkinjee

A

60-100
40-60
20-40

39
Q

priority intervention for tachy arrhthmias

A

check pulse

40
Q

how many large boxes are there in a 6 second strip
what time interval does a large box represent
what time interval does a small box represent

A

30

  1. 2 seconds
  2. 04 seconds
41
Q

what does PQ interval represent

A

Atrial depolarization

42
Q

what is the normal PR interval and when is it elevated

A

.12-.2

Heart block

43
Q

what does the QT interval represent

A

ventricular cycle

44
Q

white is right

A

yup

45
Q

what does vagus nerve stimulation do and how can you do it

A

activates PNS

valsalva

46
Q

interventions when D/Cing a central line

A

it stimulates the vagus nerve and can cause a vasovagal attack

47
Q

how can you save a life during a vasovagal attack

A

push 0.5 atrophine

48
Q

what does a sawtooth pattern indicate

A

atrial flutter not really dangerous in of itself but it can lead to afib

49
Q

what is a vasovagal attack

A

a sudden drop in HR and BP

50
Q

where else are there baroreceptors present that when activated lower HR and BP

A

carotid sinus but nurses arent aloud to do a carotid massage to lower HR because it may dislodge a clot in patients with athlersclerosis

51
Q

pre heart surgery intervention

A

doppler of carotids to check for plaques if plaques are present then we gotta clear them before the surgery

52
Q

pulse = QRS = mechanical contraction

A

true

53
Q

how do you count heart rate

A

count R-R intervals in 6 second strip multiple by 10
or take the #of large boxes in 1 min and divide by the # of large boxes in one R-R interval
OR take the number of small boxes in 1 min (1500) and divide by the number of small boxes in one R-R interval

54
Q

what does an artifact indicate

A

misplaced electrotrodes it looks like vfib

55
Q

why do we call a rhtyhm sinus for example sinus bradycardia. when is sinus bradycardia normal

A

if there is no P wave then we dont say sinus. it is normal during sleep and in athletes

56
Q

what are the causes of sinus tachycardia

A
  1. pain
  2. fever
  3. anxiety
57
Q

what does the word Paroxysmal mean what is Paroxysmal supraventricular tachycardia (PSVT) and what is your priority intervention

A

it starts and stops

  1. HR above 160
  2. check pulse and then look at rhythm to check if it is regular or irregular
58
Q

what are you do if you have a regular rhythm for PSVT

A
  1. Valsalva
  2. adenosine (half life 5 seconds 6 12 12)
  3. cardioversion
59
Q

Atrial fibrillation

A

1.no p waves
2.f waves (caused by focci generating conduction)
can be controlled (HR less then 100) or uncontrolled (HR greater then 100)

60
Q

what is your priorities when dealing with Afib

A
  1. Heparin
  2. Amiordarone (Amio) give loading dose 300 mg over 10 min then 1 mg/kg per min for 6 hours then 0.5 mg/kg per min over 18 hours
  3. digoxin (lower HR and increase contractility, decrease workload)
  4. cardioversion
61
Q

Heart blocks

A

1st degree =prolonged PR
2nd degree
-Mobits 1= Gradual prlongation of PR with some dropped beats (no QRS)
-Mobits 2=PR might be normal but you have dropped beats
3rd degree-Atrium and ventricles go rogue

62
Q

how do you manage the different heart blocks

A

just monitor or give atropine for 1st degree and mobits 1

for mobits 2 and 3rd degree you have to put a pacemaker

63
Q

why are premature ventricular contractions bad

A

can cause vtach

64
Q

what is bigeminty what is trigeminity which one is worse

A

bi-1 normal beat 1 PVC
tri-2 normal beats 1 PVC

Bi is worse

65
Q

what is a cardiac ablation

A

Cauterization of focci

66
Q

how do you know you have PVC

A

weird feeling in your chest right before bed

67
Q

Vtach priorities

A

check pulse if present then check vitals if not call code

68
Q

what are the types of transvenous pacemakers

A

atrail
ventricular
both/dual

69
Q

what does failure to capture mean and how do you know this is the case

A

power is to low to cause contraction. You will see a spike on ECG

70
Q

what is failure to sense and how do you fix it

A

the pacer cannot sense the HR. Increase sensitivity

71
Q

what is an Aneurysm and how do you manage it

A

it is a buldging vessel you gotta keep the BP low

72
Q

when do you hear reguritation vs stenosis

A

If a valve is opening and makes a sounds it is stenosis if it is closing and makes a murmur it is reguritation.

Med surg (35 decks)

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