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NURS 3512 acute & chronic > Week 3 Perfusion Lecture > Flashcards

Week 3 Perfusion Lecture Flashcards

1
Q

What is the most common health problem seen in primary care?

A

HTN

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2
Q

What BP indicates hypertensive crisis?

A

> 200 systolic or >150 diastolic

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3
Q

If someone is in hypertensive crisis, we check Neuro, Respiratory and Kidney symptoms. Why are each of these indicated?

A

Neuro - spasms in cerebral vessels
Lungs- increased pressure = pulmonary edema
Renal- high BP can damage kidneys. Bringing down BP too fast can damage kidneys

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4
Q

What IV meds do we give for hypertensive crisis?

A
  1. Nitroprusside- powerful vasodilator
  2. Labetolol - BB
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5
Q

Which two acute illnesses do we only lower BP quickly?

A

Acute MI
ischemic stroke (tPA- related)

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6
Q

What are the 7 main symptoms of hyptertensive crisis?

A
  1. Dizzy
  2. Severe headache
  3. Blurred vision
  4. Epitaxis
  5. SOB
  6. Decrease urine out put
  7. severe anxiety
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7
Q

How long does chronic stable Angina last?

A

3-5 min - goes away with rest

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8
Q

What are the 7 main symptoms of Acute coronary syndrome?

A

1 Chest pain
2 Nausea and vomiting
3 Diaphoresis
4 Dyspnea
5 Anxiety
6 Fatigue
7 Palpitations

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9
Q

When someone complains of chest pain, how many min after do we need a 12 lead EKG in place?

A

10 min

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10
Q

If someone is experiencing acute coronary syndrome, what is our O2 % sat min. goal?

A

> 90%

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11
Q

What’s the prefered way to manage ACS?

A

coronary angioplasty first
fibrinolytic therapy second

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12
Q

What are the 4 non-surgical interventions for ACS?

A
  1. manage pain
  2. Restore perfusion
  3. Manage dysrhythmias
  4. monitor and manage HF
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13
Q

How do we manage ACS pain?

A

Assess pain
Vital signs
IV access
Medication

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14
Q

How do we restore perfusion with ACS?

A

meds:
ASA
Beta-blockers
ACE inhibitors
Statins

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15
Q

How do we manage dysrhythmias with ACS?

A

Cardiac monitoring
Evaluate hemodynamics (CO=SV X HR), (BP= CO x SVR)

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16
Q

What is a common complication of ACS?

A

Heart failure

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17
Q

How do we monitor and manage HF with ACS?

A

Common complication after MI
Assess for signs

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18
Q

What two interventions are for STEMI only?

A

-coronary angioplasty (open up & place stent)
- Fibrinolytic therapy (tPA)

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19
Q

What are the most important interventions during and after tPA?

A

BLEEDING
1. neuro status to get baseline and after
2. IV sites for bleeding and patency (not blocked)
3. check clotting labs - INR aPTT, PTT
4. Internal bleeding - BP, hemat. hemoglobin
5. Stool, urine, emesis - for blood
6. monitor heparin continuous infusion

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20
Q

What is PCI?

A

coronary angioplasty with stent - first choice

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21
Q

Is tPA indicated in STEMI or NSTEMI?

A

STEMI

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22
Q

how many minutes do we want to have done a PCI after STEMI Dx?

A

within 90 min

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23
Q

What medication is given during a PCI?

A

high dose IV heparin

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24
Q

What two med therapies are often used with PCI?

A

Anti-platelet
1. ASA
2. Platelet inhibitor

BB, ACE or ARB

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25
Q

What 5 things do we monitor for with PCI?

A

Acute closure of vessel - d/t clot
Bleeding from insertion site
Reaction to contrast medium
Vital signs (BP, dysrhythmias)
Low potassium
Risk of stroke

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26
Q

What does CABG stand for?

A

Coronary Artery Bypass Graft

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27
Q

What does a CABG do?

A

surgical procedure to graft a healthy artery around a blocked coronary artery

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28
Q

What do we watch for and tell the patient when they have a TR band?

A
  1. compartment syndrome
  2. Bleeding
  3. Hematoma formation (when band is decreasing air)
  4. tell patient to treat it like it’s broken - to avoid hematoma
  5. Assess kidney for AKI - d/t dye
  6. BP- hypotension
  7. Dysrhythmias - antidysrhymic meds d/t irritation to artery
  8. K+ levels - we want balance
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29
Q

What do we monitor for patients after CABG in ICU?

A

Initially: intubated, large chest tubes, pacemaker wires, invasive hemodynamic monitoring

dysrhythmias,
fluid and electrolyte imbalance,
hypo/hypertension,
hypothermia,
bleeding,
decreased LOC,
anginal pain

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30
Q

What do we monitor in patients after CABG on the ward?

A

DB+C
Supervised ambulation

Monitor for: decreased CO,
pain,
dysrhythmias,
decreased O2 sats,
S+S of infection,
monitor donor site/neurovascular status

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31
Q

What is the most common cardiac dysrhythmia seen in practice?

A

AFIB

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32
Q

Is AFIB regular or irregular?

A

irregular

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33
Q

What is the arterial rate in AFIB?

A

> 350 bpm or fib waves

34
Q

Is the ventricular rate greater or lesser than arterial rate in AFIB?

A

lesser

35
Q

how long is the QRS complex in AFIB?

A

</= .1 seconds

36
Q

What is AV conduction like in AFIB?

A

variable

37
Q

What are 4 causes of AFIB?

A
  1. heart disease
  2. electrolyte imbalance
  3. Stress
  4. Caffeine
38
Q

What are 2 priority problems for patients with AFIB?

A
  1. potential for embolus formation (blood pooling)
  2. potential for HF d/t altered conduction pattern
39
Q

What are the 2 treatments to prevent embolus formation in a patient with AFIB?

A
  1. correct and control rate of rhythm
    - Amiodarone or Metoprolol
  2. Anticoagulation
    - warfarin or apixaban
40
Q

What are the 2 treatments for potential HF d/t altered conduction patterns for patients with AFIB?

A
  1. drug therapy
  2. non-surgical
    - electrical cardioversion
    - ablation
    - pacing
41
Q

What is Cardioversion?

A
  1. a sync’d countershock on the R wave of QRS to restore normal conduction
  2. sedation before procedure
  3. vitals monitored throughout
  4. patient shocked
42
Q

What is ablation ?

A

Radiofrequency energy burns/ ablates area of conduction system that is a problem.
Definitive treatment of tachydysrhythmias

43
Q

What is the most effective way to terminate V FIB and Pulseless VT?

A

defibrillation

44
Q

Is someone responsive in VFIB?

A

no. no BP, pulse, breathing, heart sounds, and unresponsive

45
Q

What is the priority in VFIB?

A

defibrillate the patient (CPR first till defib available)

Call code blue - ACLS guidelines

46
Q

What are reversable causes of VFIB?

A

Hypovolemia
Hypoxemia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary

47
Q

Do we defibrillate someone in ASYSTOLE?

A

no - flat line

48
Q

in Asystole, where is there no rhythm, ventricular or atrial?

A

ventricular

49
Q

What is another word for Asystole?

A

flat line - dead

50
Q

What are the 2 interventions for asystole?

A
  1. CPR
  2. epinephrine
51
Q

What does acute HF usually manifest as?

A

Pulmonary edema

52
Q

What is one symptom that Lt sided and Rt sided HF have in common?

A

Peeing issues at night
Lt- nocturia
Rt - polyuria

53
Q

What identifies Pulmonary Edema from other cough productive respiratory issues like PN?

A

pink, frothy sputum

54
Q

How do we treat pulmonary edema?

A
  1. Nitro SL
  2. IV line
  3. Lasix IV
    QUESTION IV FLUID INTAKE
55
Q

How often do we monitor VS for pulmonary edema?

A

q 30-60 min

56
Q

What pain med can we give for pulmonary edmea?

A

IV morphine if BP is goochie

57
Q

What are 6 things to teach a patient with HF?

A
  1. Weigh daily a.m. b/f breakkie
  2. Fluid restrict 1500-2000 mL/day (6-8 glasses)
  3. Meds - take regularily as per doctor
  4. Food - decrease or no salt
  5. Activity/rest balance
58
Q

what weight change is a warning in HF?

A

> 4 lbs in 2 days (2kg)
5lbs in 1 week (2.5kg)

59
Q

what are cardiomyopathies often caused by?

A
  1. etoh abuse
  2. chemo
  3. infection
  4. inflammation
  5. poor nutrition
  6. unknown
60
Q

What are 3 types of cardiomyopathies?

A
  1. Dilated
  2. Hypertrophic
  3. Restrictive
61
Q

What is Dilated cardiomyopathy?

A

HF
Dysrhythmias
Emboli
SCD

62
Q

What is hypertrophic cardiomyopathy?

A

HF
Dysrhythmias
Emboli Angina
Syncope
SCD

63
Q

When a patient has dilated cardiomyopathy, the drugs that are used help with which part of heart function? preload, afterload, contractility, HR, filling of certain chambers, etc.

A

decrease preload and afterload

64
Q

When a patient has hypertrophic cardiomyopathy, the drugs that are used help with which part of heart function? preload, afterload, contractility, HR, filling of certain chambers, etc.

A

ventricular filling

65
Q

What is ICD?

A

cardioverter defibrillator

66
Q

When is Afib conversion indicated?

A

High ventricular HR
Low BP

67
Q

What is PVC?

A

pre ventricular contraction (early stage)
- Ventricles fire off abnormally
- if it happens too many times in a row then you have CO and perfusion issues

68
Q

What is V TACH?

A

Ventricular tachycardia
repetitive firing >100 bpm
Looks like mountains - QRS very wide

69
Q

What lytes are low in PVC?

A

K+- low
Mag - low

70
Q

When does V Tach become life threatening?

A

> 15 seconds

71
Q

what are the 5 most common causes of V tach?

A

heart disease,
valve disease,
post MI,
electrolyte issues,
cocaine use

72
Q

What are 2 ways we get patients out of V tach- if they have a pulse?

A
  1. Amiodarone - antiarrhythmics
  2. Synchronized cardioversion
73
Q

What do we do if someone is V-tach without a pulse?

A
  1. call a code
  2. CPR till defibrillator comes
74
Q

What is V-fib?

A

Ventricular fibrillation - fluttering
firing from all over the ventricles
No MI contraction, no pulse, hemodynamic collapse

75
Q

What rhythm is most fatal?

A

V-fib

76
Q

How do we treat v-fib?

A

defibrillation
- gets the heart back in rhythm

77
Q

When is cardioversion used and when is defibrillation used?

A

Cardioversion- A fib, V-tach (with a pulse)
Defibrillation - V fib, V-tach (pulseless),

78
Q

If someone is in V-Fib what are the reversible causes?

A

Hs and Ts

Hypovolemia
Hypoxemia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary

79
Q

What is asystole?

A

Complete absence of any ventricular rhythm. No electrical impulses in the ventricles and therefore NO ventricular depolarization, no QRS, no contraction, no CO, and no perfusion to rest of body

80
Q

Does electrical shock help in asystole?

A

no b/c no electrical impulses in ventricles so there’s nothing to shock back into rhythm.
Give CPR & epinephrine

81
Q

how many litres is normal CO / day?

A

4-6 L

NURS 3512 acute & chronic (29 decks)

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