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Nursing 283 > Week 5 and 6 Acute Coronary Syndromes > Flashcards

Week 5 and 6 Acute Coronary Syndromes Flashcards

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1
Q

What is infarction?

A

necrosis or cell death, causes irreversible damage

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2
Q

What causes infarction?

A

Prolonged severe ischemia and decreased perfusion

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3
Q

How to differentiate unstable angina from an MI (lab)

A

Will have ST changes on ECK but no elevation in CK or triponin

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4
Q

3 categories of MI

A

ST elevation MY(STEMI)
Non-ST elevation (NSTEMI)- most common in women
Unstable angina

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5
Q

Primary factor in development of MI

A

atherosclerosis

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6
Q

Major risk factor for heart disease

A

Metabolic syndrome

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7
Q

Metabolic syndrome

A

3 of the following risk factors: HTN, triglycerides, fasting blood glucose >110, waist > 40 M > 35 F, increased C reactive protein, increased blood clotting factors

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8
Q

Use of thallium scan

A

identify “cold spots” that indicate ischemia or infarction

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9
Q

Priority main medication in MI

A

morphine

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10
Q

Medications post MI

A

Beta blocker within 2 hours
ACE or ARB within 48 hours
Possible Ca+ blocker

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11
Q

Function of ACE or ARB order

A

prevent ventricular remodeling and development of heart failure

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12
Q

Class I HF

A

pts often respond well to reduction in preload with IV nitrates and diuretics, no crackles or S3

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13
Q

Class II HF

A

may need diuretics, IV nitroglycerin, need beta blockers, ACE and ARBs, crackles in the lower half of the lungs and possible S3

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14
Q

Class III HF

A

may need diuretics, IV nitroglycerin, need beta blockers, ACE and ARBs, crackles more than halfway up the lungs and frequent pulmonary edema

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15
Q

Class IV HF

A

Necrosis of more than 40% of the L ventricle occurs, stuttering pattern of chest pain, monitor for cardiogenic shock

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16
Q

Sx of cardiogenic shock

A

Tachycardia, hypotension, BP less than 90 or 30 from baseline, urine output less than 30!!, cold clammy skin and poor peripheral pulses, agitation restlessness confusion, pulmonary congestion, tachypnea, continuing chest discomfort

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17
Q

Myocardial O2 requirements during an MI

A

Increased O2 demand and tissue is already O2 deprived. This can cause ventricular dysrhythmias

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18
Q

When is tx of MI needed

A

within 4-6 hours, physical changes to the heart occur after 6 hours

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19
Q

ventricular remodeling

A

when scar tissue permanently changes the heart, can cause dysrhythmias

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20
Q

CK-MB lab

A

most specific test for MI but doesn’t peak until 24 hours after

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21
Q

Priority problems for Pts with CAD

A

Acute pain (r/t < myocardial O2), inadequate tissue perfusion, activity intolerance, ineffective coping

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22
Q

Additional potential problems for a Pt having an MI

A

Potential for dysrhythmias
Potential for HF
Potential for recurrent symptoms and extension of injury

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23
Q

New onset a-fib

A

May signal MI in patients with DM and CAD, they may not experience chest pain or pressure because of neuropathy.

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24
Q

Drugs given in acute MI

A

ASA, Nitro, morphine, O2

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25
Q

Reperfusion therapy

A

uses thrombolytics to restore blood flow, best used within 6 hours of onset

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26
Q

percutaneous transluminal coronary angioplasty (PTCA)

A

Stent placement to re-open the clotted artery, should be done within 2-3 hours

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27
Q

Signs the clot was lysed and the artery reperfused

A

Abrupt cessation of pain, Sudden onset of ventricular dysrhythmias, Resolution of ST-segment depression/elevation or T-wave inversion, A peak at 12 hours of markers of myocardial damage

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28
Q

Complication after clot lysis

A

vessel reocclusion due to high thrombin release into the blood

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29
Q

S/Sx of left ventricular failure and pulmonary edema

A

crackles, wheezing, tachypnea, and frothy sputum

Listen for S3 sound

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30
Q

S/Sx of inadequate organ perfusion

A

change in mental status, Urine output less than 30mL/hr, Cool clammy extremities with decreased or absent pulses, Unusual fatigue or recurrent chest pain

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31
Q

Medications to reduce preload

A

diuretics and nitroglycerin

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32
Q

S/Sx of Rt ventricular failure

A

Decreased cardiac output with a paradoxical pulse, clear lungs, and JVD

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33
Q

ST segment elevation indicates what?

A

Infarction

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34
Q

ST segment depression indicates what?

A

Ischemia

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35
Q

When does the S3 heart sound occur?

A

during the rapid ventricular filling of diastole; low pitched; use bell

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36
Q

When does the S4 heart sound occur?

A

linked to resistance in ventricular filling or a vibration caused by atrial contraction; low- pitched; use bell

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37
Q

Contraindications of reperfusion therapy

A

any hx of bleeding disorders, anticoagulation therapy or HTN > 180/110

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38
Q

How to calculate CO and average CO

A

SV X HR

averages 4-8 L

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39
Q

Preload

A

amount of stretch on myocardial muscle fibers at end diastole determined by amount of blood in the ventricles

40
Q

Afterload

A

Sum of all forces against which the ventricle muscle must contract to eject blood into the pulmonary and systemic circulation

41
Q

SVR`

A

measures afterload

42
Q

Factors that affect afterload

A

heart size, qty of resistance overcome by heart muscle to eject blood, qty of disease

43
Q

When is preload increased?

A

hypervolemia, valvular regurgitation

44
Q

When is afterload increased?

A

HTN, vasoconstriction

45
Q

HR at which CO declines

A

160 BPM

46
Q

Normal ejection fraction

A

55-70%

47
Q

Acute coronary syndrome

A

refers to unstable angina, Non STEMI or STEMI MI

48
Q

CO changes in sepsis

A

in earlier stages your CO will rise because of vasodilation and more fluids moving in, in the later stages, your CO drops

49
Q

Do beta blockers reduce preload or afterload?

A

Afterload because they dilate the arterial beds

50
Q

Are ACE and ARB preload or afterload reducers

A

Afterload

51
Q

Does aldoactone reduce preload or afterload

A

proload because it will help move fluid out of the body

52
Q

Ways to measure SVR (systemic vascular resistance)

A

Crudest is BP

Pulmonary artery catheter

53
Q

How does the size of the heart affect afterload

A

The larger your heart gets, the more it increases the arterial resistance

54
Q

What happens to myocardial O2 demand with increased afterload?

A

O2 demand goes up

55
Q

What drugs depress cardiac contractility?

A

Beta Blockers (mild negative inotrope)

56
Q

Test to measure ejection fraction

A

Echo

Cardiac cath

57
Q

S/Sx seen in low EF %

A

Dyspnea, cool skin, edema, JVD, low BP, crackles

58
Q

What reading can be obtained from the cardiac cath?

A

pulmonary artery pressure, Rt atrial pressure, central venous pressure, HR, BP
Wedge pressure only when balloon is inflated

59
Q

Average arterial BP

A

Systolic 90-140

Diastolic 60-90

60
Q

Mean arterial BP range

A

70-11 mmHg

61
Q

Rt arterial pressure range

A

2-6 mmHg

Measures preload

62
Q

Pulmonary artery pressure range

A

25/10
a quarter over a dime
Systolic range 15-25
Diastolic range 8-15

63
Q

Neurohormonal factors for preload

A

1st- SNS

2nd- RAAS

64
Q

Factors effecting preload levels

A

blood volume, decreased fluid excretion by kidneys, SV, contractility, HR

65
Q

Steps of management in HF

A

1st- Preload
2nd- Afterload
3rd- Contractility

66
Q

Correlation to high BP to afterload

A

afterload will be high

very high BP = increased SVR

67
Q

Interventions in the home to decrease proload

A

lower legs, restrict fluid, give diuretic

68
Q

Interventions to reduce afterload

A

vasodilator/antihypertensive (ACE, Nitro, etc.)

69
Q

Interventions in acidosis and decreased CO

A

must fix acidosis 1st or drugs won’t work
Acidosis is detrimental to contractility
Can give insulin

70
Q

Functions of echocardiogram

A

gives EF
Diagnose valve disorders
Diagnose cardiac tamponade

71
Q

Normal pulmonary capillary wedge pressure

A

4-12 mmHg

72
Q

What is the significance of PCWP (pulmonary artery wedge pressure)

A

shows L side heart function

If pressure is up, then pressure is up in the L side of the heart

73
Q

First intervention when high PA pressure is seen

A

put them on O2

then look at pre-load and address that

74
Q

SVR

A

represents arterial bed constriction

75
Q

What 3 symptoms seen together should be reported together for ACS?

A

Increased HR
No HTN
Pulmonary congestion

76
Q

Heart sound heard with exces fluid

A

S3

Common w/ previous MI or HTN

77
Q

What condition is indicated with S3 and S4 heart sounds

A

severe HF

78
Q

Priority interventions with suspected cardiac issues

A 
1. VS and cardiac monitoring/12 lead
2 Labs
3 IV (saline lock)
4 Physical exam and chest x-ray
Give MONA when 12 lead is positive
79
Q

What is the biggest risk for CV issues

A

DM (type I or II)

80
Q

Classic clinical manifestations of cardiac disease

A

Chest, jaw, left arm pain (esp. men), N/V, diaphoretic, cool, clammy, temp (mild)

81
Q

Common sx of MI in women

A

SOB (biggie for women), extreme fatigue, pain/discomfort centered low in chest or upper abdomen, shoulder blade/back pain, pain/discomfort in left arm, shoulder, jaw (like men), weakness, nausea, hot, flushed, dizziness, syncope

82
Q

3 inflammatory markers to test for

A

Homocystiene, lipoprotein and C-reactive protein (#1, high is 3)

83
Q

Causes of increased imflammation (which increases CV risk)

A

poor nutrition, sugar, sedentary lifestyle, psoriasis, migraines, sleep apnea, gum disease

84
Q

Labs to get when MI is possible

A

cardiac markers, comprehensive metabolic panel, CBC, coags, C-RP, Mg+, cholesterol

85
Q

When to give morphine for an MI

A

after 3 doses of nitro have not relieved pain

86
Q

What does ST depression indicate?

A

Ischemia, possibly some myocardial death but ischemia may be reversed

87
Q

What does ST elevation indicate

A

Infarction (MI)

must be significant in 2 leads

88
Q

What does an inverted/flattened T wave indicate?

A

ischemia

89
Q

When to gove TpA

A

within 12 hours of onset
if not going to cath lab/delayed
if no bleeding risk (injury/trauma, CPR, recent surgery or stroke)

90
Q

Time frame and what is needed in the H&P for cardiac injury

A

10 minutes

onset?, syncope?, CV Hx? DM? renal disease? smoking and diet?

91
Q

Where is the PMI and how do you palpate?

A

Left MCL 5th intercostal

palpate with palm

92
Q

S1 sound

A

Tricuspid and mitral valve close

heard best at 5th intercostal MCL

93
Q

S2 sound

A

aortic and pulmonic closure

heard best at 2nd ICS rt of sternum

94
Q

S3

A

Occurs during rapid ventricular filling, use bell

= fluid overload/ HF

95
Q

S4

A

resistance to ventricular filling or vibration from atrial contraction, use bell
= HF and aortic stenosis

96
Q

Where to best hear murmurs

A

3rd ICS on L side (erbs point)

97
Q

Best Pt position to hear heart sounds

A

Pt sit up and lean forward (to the left a little too maybe)

If have to lie down, lay on left side (left lying probably best, but often having trouble breathing, etc so sit up)

Nursing 283 (10 decks)

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