Week 5: Cardiovascular System Flashcards
Heart disease
Disease that affects the heart’s structure and function (heart’s vessels, valves, and muscles)
Co-morbidities: MI, CAD, PAD, CHF, HTN, aneurysm, congenital heart disease, stroke, arrhythmia, cardiac arrest, atherosclerosis
Cardiovascular disease
Diseases that involve the heart AND circulatory system (blood vessels)
Lifestyle and risk factors
Lifestyle: Unhealthy diet/poor nutrition, lack of exercise, obesity, smoking, drug abuse, excessive alcohol use, uncontrolled stress/anger
Risk factors: Age, sex, race, hypercholesterolemia, DM, HTN, FHX
S/S
CHF: SOB, fatigue, weakness, B/L extremity edema, weight gain, tachycardia, dysrhythmia, persistent cough/wheezing
Arrhythmia: Fluttering in chest, tachy/bradycardia, angina, SOB, dizziness, fainting
Stroke: Numbness, difficulties with balance, speech and understanding, blurred vision, facial drooping, dysphagia, change in LOC
MI: Angina, numbness/pain in left arm, jaw or back
Cardiac arrest: Can occur without warning (CPR, AED, 911)
HTN: HA, fatigue, vision problems, angina, dyspnea, dysrhythmia
Cardiac drugs
Cardiac glycosides (increase cardiac contractility, decrease HR)
Antihypertensives (decrease BP)
Vasopressors/ADH (increase BP)
Antiarrythmics (regulate heart rhythm)
Nitrates (relieve angina)
Antilipids (decrease cholesterol levels)
Diuretics (reduce fluid volume; decrease BP)
Anticoagulants (decrease potential for clot formation)
Cardiac tests/treatments
EKG
Telemetry
Duplex ultrasound
Angiogram
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Coronary artery stent
Stress test
Echocardiogram
CABG
EKG electrode placement
Precordial leads: V1: 4th ICS, right of sternum V2: 4th ICS, left of sternum *V3: between V2 and V4 V4: 5th ICS, midclavicular *V5: between V4 and V5 V6: 5th ICS, midaxillary
Limb leads (4 total): paced bilaterally on extremities
Basic cardiac rhythm
Normal sinus rhythm (60-100 bpm):
P-wave: atrial depolarization
QRS complex: ventricular depolarization
ST segment: complete ventricular depolarization
T-wave: ventricular repolarization
EKG
A 12-view snapshot that requires 6 precordial and 4 limb electrodes
Paper grid: Small square (1 mm.) = 0.04 sec.
Large square (5 mm.) = 0.2 sec. (five small squares)
Five large squares = 1 sec.
Telemetry
Continuous monitoring that requires 5 electrodes (RA, RL, V1, LA, LL)
Nursing intervention
EKG (10 view snapshot)
Telemetry (monitors continuous rhythm)
Assist with leg exercises, positioning, SCDs/TEDS
Medicate: Anticoagulation prophylaxis (clot prevention; heparin SQ 5,000 units bid/tid and is generally 1cc), diuretics, I&O
Assessment
Education
Duplex ultrasound test
Combines traditional ultrasound (solid objects) and doppler (moving objects) to see how blood moves through arteries and veins
No preparation (NPO, etc.) is needed
Angiography/angiogram
Use of radiopaque dye to outline vessels for blockage or narrowing
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Minimally invasive procedure, monitored with fluoroscopy, to open blocked coronary arteries; catheter is placed intravenously, in neck, arm or groin
Ballon catheter tip inflates/deflates to compress blockage; possible stent placement
Coronary artery stent
Placed with balloon catheter; locks in position when inflated
Post-op.: Monitor for dysrhythmias, administer anticoagulant meds.
Return from angiography/PTCA
Check peripheral pulses and VS
Assess pain
Assess bleeding or hematoma formation at insertion; if bleeding, apply pressure dressing and NHO
Maintain pressure dressing, immobilize limb for 6 hr.
Monitor for urination (Normal: within 6 hr.; dye can affect kidneys)
Administer fluids, I&O
Document
CABG
Using another vessel to bypass a blocked or damaged coronary artery
Vessels:
1. Left Internal Mammary Artery (LIMA): preferred vessel for CABG (it is a “live vessel” that is moved over)
- Left Anterior Descending (LAD) coronary artery (“widow maker”; common place for coronary blockages)
- Greater saphenous vein: less ideal for CABG (can handle less pressure, has valves, and needs to be removed)
Stress test
Connected to EKG/telemetry rhythm strip to record continuous CV responsiveness to increased activity
Echocardiogram
Uses ultrasonic waves to detect structural defects
Can be done at bedside
DNR/DNI/MOLST
DNR: do not resuscitate
DNI: do not intubate
MOLST: Maryland Order for Life-Sustaining Treatment
Peripheral Intravascular device (PIV)
Short-term peripheral device inserted by nurses/techs
Also called “medlock”/”heplock”/”salinelock”
Multi-lumen CVAD
SHORT-term CVAD, placed at bedside, into the internal jugular and terminates into the SVC, above the RA; confirmed by XRAY before use
Risk for pneumothorax or air embolism
Requires each lumen (single/dual/triple) to be flushed individually to prevent mixing and crystallization of incompatible meds (lumens empty in different places)
Hickman
LONG-term tunneled CVAD (“tunnels” under the skin through subcutaneous tissue), placed in the OR, that terminates into the SVC, above the RA; confirmed by XRAY before use
Dacron sheath: skin tissue creates an anchor and protective barrier
Infuses fluids, meds., draw blood, transfusions
Peripherally Inserted Central Catheter (PICC)
LONG-term CVAD, small in diameter and placed at bedside; inserted in a peripheral vein and terminates in the subclavian or SVC
Inserted using ultrasound; confirmed by XRAY
Fewer chances for complications (pneumothorax, air embolus) because it is started in the arm
Mediport
LONG-term CVAD, placed in the OR, that terminates in the SVC, above the RA
Self-sealing port; in the subcutaneous tissue
Huber needle: non-coring, 90-degree angle needle used to accesses mediport
Code blue team
First responder
Bedside nurse
Charge nurse
Team/code leader (physician)
Recorder (time of compression/meds./etc.; records legal document)
Runner
Respiratory/anesthesia (manage airway/intubation)
Code cart nurse
Nursing supervisor
Security
Rapid Response Team (RRT)
Alert criteria:
1. HR <45 or >130
- RR <8 or >30
- SBP <85 or >200
- O2 sat. <90% (despite >60% FiO2)
- Significant mental status change, especially persistent lethargy or unresponsiveness
- New seizure or prolonged seizure with apnea
- General concern about the pt (“something is not right”)
Automated External Defibrillator (AED)
Can self diagnose life-threatening cardiac arrhythmias and deliver an electrical shock as needed
Crash cart
Emergency meds
Defibrillator
Blood drawing supplies
Central line kit
Backboard
Laryngoscope
Oropharyngeal airway
Ventricular dysrhythmias
Life-threatening conditions d/t MI, scarring, cardiomyopathy, etc.
Caused by:
- Abnormal stimulation of ectopic foci in walls of ventricles
- Decreased CO
- Intrinsic ventricular rate (without atrial depolarization) is only 20-40 bpm
*Atrial dysrhythmias can be managed with medication
Premature Ventricular Contraction (PVC)
Extra heartbeats that begin in the ventricles and DISRUPTS regular heart rhythm; S/S: Fluttering, skipped beat in chest
It is a beat, NOT a rhythm
Caused by: Drinking coffee, stress; concerning if frequent, in groups
Ventricular tachycardia
Foci in ventricles take over and heart beats too fast to count
Dangerous, life-threatening complication
Treatment: Cardioversion, CPR (code team); long-term: antiarrhythmic drugs, ICD
Ventricular fibrillation
Rapid, CHAOTIC depolarization of ventricles; no coordination of ventricular and atrial contractions (no palpable pulse)
Treatment: Defibrillation, CPR; long-term: ICD
Pulseless electrical activity (PEA)
Electrical activity is present, but NO muscular contraction
There is no pulse, no CO, and no tissue perfusion (death); it is non-shockable
Treatment: CPR to establish a viable, shockable rhythm
Asystole
No electrical activity, no pulse
Immediate loss of oxygen supply to brain, heart, and tissue; it is non-shockable
Treatment: CPR, drugs
Holter monitor
Records activity of heart in daily activities; worn for 1-3 days
Pacemaker
Used to augment or replace the natural pacemaker of the heart; causes “pacemaker spike” on EKG
Can be used for bradycardia/tachycardia, damage to heart from MI, CHF
Implantable Cardioverter Defibrillator (ICD)
Delivers shock to treat ventricular tachycardia and ventricular fibrillation
Shock feels like a “kick in the chest”; another person touching will feel shock
