Week 3 Perfusion Lecture Flashcards
What is the most common health problem seen in primary care?
HTN
What BP indicates hypertensive crisis?
> 200 systolic or >150 diastolic
If someone is in hypertensive crisis, we check Neuro, Respiratory and Kidney symptoms. Why are each of these indicated?
Neuro - spasms in cerebral vessels
Lungs- increased pressure = pulmonary edema
Renal- high BP can damage kidneys. Bringing down BP too fast can damage kidneys
What IV meds do we give for hypertensive crisis?
- Nitroprusside- powerful vasodilator
- Labetolol - BB
Which two acute illnesses do we only lower BP quickly?
Acute MI
ischemic stroke (tPA- related)
What are the 7 main symptoms of hyptertensive crisis?
- Dizzy
- Severe headache
- Blurred vision
- Epitaxis
- SOB
- Decrease urine out put
- severe anxiety
How long does chronic stable Angina last?
3-5 min - goes away with rest
What are the 7 main symptoms of Acute coronary syndrome?
1 Chest pain
2 Nausea and vomiting
3 Diaphoresis
4 Dyspnea
5 Anxiety
6 Fatigue
7 Palpitations
When someone complains of chest pain, how many min after do we need a 12 lead EKG in place?
10 min
If someone is experiencing acute coronary syndrome, what is our O2 % sat min. goal?
> 90%
What’s the prefered way to manage ACS?
coronary angioplasty first
fibrinolytic therapy second
What are the 4 non-surgical interventions for ACS?
- manage pain
- Restore perfusion
- Manage dysrhythmias
- monitor and manage HF
How do we manage ACS pain?
Assess pain
Vital signs
IV access
Medication
How do we restore perfusion with ACS?
meds:
ASA
Beta-blockers
ACE inhibitors
Statins
How do we manage dysrhythmias with ACS?
Cardiac monitoring
Evaluate hemodynamics (CO=SV X HR), (BP= CO x SVR)
What is a common complication of ACS?
Heart failure
How do we monitor and manage HF with ACS?
Common complication after MI
Assess for signs
What two interventions are for STEMI only?
-coronary angioplasty (open up & place stent)
- Fibrinolytic therapy (tPA)
What are the most important interventions during and after tPA?
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
What is PCI?
coronary angioplasty with stent - first choice
Is tPA indicated in STEMI or NSTEMI?
STEMI
how many minutes do we want to have done a PCI after STEMI Dx?
within 90 min
What medication is given during a PCI?
high dose IV heparin
What two med therapies are often used with PCI?
Anti-platelet
1. ASA
2. Platelet inhibitor
BB, ACE or ARB
What 5 things do we monitor for with PCI?
Acute closure of vessel - d/t clot
Bleeding from insertion site
Reaction to contrast medium
Vital signs (BP, dysrhythmias)
Low potassium
Risk of stroke
What does CABG stand for?
Coronary Artery Bypass Graft
What does a CABG do?
surgical procedure to graft a healthy artery around a blocked coronary artery
What do we watch for and tell the patient when they have a TR band?
- compartment syndrome
- Bleeding
- Hematoma formation (when band is decreasing air)
- tell patient to treat it like it’s broken - to avoid hematoma
- Assess kidney for AKI - d/t dye
- BP- hypotension
- Dysrhythmias - antidysrhymic meds d/t irritation to artery
- K+ levels - we want balance
What do we monitor for patients after CABG in ICU?
Initially: intubated, large chest tubes, pacemaker wires, invasive hemodynamic monitoring
dysrhythmias,
fluid and electrolyte imbalance,
hypo/hypertension,
hypothermia,
bleeding,
decreased LOC,
anginal pain
What do we monitor in patients after CABG on the ward?
DB+C
Supervised ambulation
Monitor for: decreased CO,
pain,
dysrhythmias,
decreased O2 sats,
S+S of infection,
monitor donor site/neurovascular status
What is the most common cardiac dysrhythmia seen in practice?
AFIB
Is AFIB regular or irregular?
irregular
What is the arterial rate in AFIB?
> 350 bpm or fib waves
Is the ventricular rate greater or lesser than arterial rate in AFIB?
lesser
how long is the QRS complex in AFIB?
</= .1 seconds
What is AV conduction like in AFIB?
variable
What are 4 causes of AFIB?
- heart disease
- electrolyte imbalance
- Stress
- Caffeine
What are 2 priority problems for patients with AFIB?
- potential for embolus formation (blood pooling)
- potential for HF d/t altered conduction pattern
What are the 2 treatments to prevent embolus formation in a patient with AFIB?
- correct and control rate of rhythm
- Amiodarone or Metoprolol - Anticoagulation
- warfarin or apixaban
What are the 2 treatments for potential HF d/t altered conduction patterns for patients with AFIB?
- drug therapy
- non-surgical
- electrical cardioversion
- ablation
- pacing
What is Cardioversion?
- a sync’d countershock on the R wave of QRS to restore normal conduction
- sedation before procedure
- vitals monitored throughout
- patient shocked
What is ablation ?
Radiofrequency energy burns/ ablates area of conduction system that is a problem.
Definitive treatment of tachydysrhythmias
What is the most effective way to terminate V FIB and Pulseless VT?
defibrillation
Is someone responsive in VFIB?
no. no BP, pulse, breathing, heart sounds, and unresponsive
What is the priority in VFIB?
defibrillate the patient (CPR first till defib available)
Call code blue - ACLS guidelines
What are reversable causes of VFIB?
Hypovolemia
Hypoxemia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
Do we defibrillate someone in ASYSTOLE?
no - flat line
in Asystole, where is there no rhythm, ventricular or atrial?
ventricular
What is another word for Asystole?
flat line - dead
What are the 2 interventions for asystole?
- CPR
- epinephrine
What does acute HF usually manifest as?
Pulmonary edema
What is one symptom that Lt sided and Rt sided HF have in common?
Peeing issues at night
Lt- nocturia
Rt - polyuria
What identifies Pulmonary Edema from other cough productive respiratory issues like PN?
pink, frothy sputum
How do we treat pulmonary edema?
- Nitro SL
- IV line
- Lasix IV
QUESTION IV FLUID INTAKE
How often do we monitor VS for pulmonary edema?
q 30-60 min
What pain med can we give for pulmonary edmea?
IV morphine if BP is goochie
What are 6 things to teach a patient with HF?
- Weigh daily a.m. b/f breakkie
- Fluid restrict 1500-2000 mL/day (6-8 glasses)
- Meds - take regularily as per doctor
- Food - decrease or no salt
- Activity/rest balance
what weight change is a warning in HF?
> 4 lbs in 2 days (2kg)
5lbs in 1 week (2.5kg)
what are cardiomyopathies often caused by?
- etoh abuse
- chemo
- infection
- inflammation
- poor nutrition
- unknown
What are 3 types of cardiomyopathies?
- Dilated
- Hypertrophic
- Restrictive
What is Dilated cardiomyopathy?
HF
Dysrhythmias
Emboli
SCD
What is hypertrophic cardiomyopathy?
HF
Dysrhythmias
Emboli Angina
Syncope
SCD
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.
decrease preload and afterload
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.
ventricular filling
What is ICD?
cardioverter defibrillator
When is Afib conversion indicated?
High ventricular HR
Low BP
What is PVC?
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
What is V TACH?
Ventricular tachycardia
repetitive firing >100 bpm
Looks like mountains - QRS very wide
What lytes are low in PVC?
K+- low
Mag - low
When does V Tach become life threatening?
> 15 seconds
what are the 5 most common causes of V tach?
heart disease,
valve disease,
post MI,
electrolyte issues,
cocaine use
What are 2 ways we get patients out of V tach- if they have a pulse?
- Amiodarone - antiarrhythmics
- Synchronized cardioversion
What do we do if someone is V-tach without a pulse?
- call a code
- CPR till defibrillator comes
What is V-fib?
Ventricular fibrillation - fluttering
firing from all over the ventricles
No MI contraction, no pulse, hemodynamic collapse
What rhythm is most fatal?
V-fib
How do we treat v-fib?
defibrillation
- gets the heart back in rhythm
When is cardioversion used and when is defibrillation used?
Cardioversion- A fib, V-tach (with a pulse)
Defibrillation - V fib, V-tach (pulseless),
If someone is in V-Fib what are the reversible causes?
Hs and Ts
Hypovolemia
Hypoxemia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
What is asystole?
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
Does electrical shock help in asystole?
no b/c no electrical impulses in ventricles so there’s nothing to shock back into rhythm.
Give CPR & epinephrine
how many litres is normal CO / day?
4-6 L
