Week 6 THURS Flashcards
Adult Cardiac
What equipment should you call to get for someone who is slumped on the floor?
AED
What medication is the drug of choice for sinus bradycardia?
Atropine
Pt reports fatigue, shoulder blade discomfort, and SOB. What can the nurse suspect off of theses symptoms?
Myocardial infarction
Pt has angina pectoris, what does the nurse include for managing this condition?
- balance rest w/ activity
- stop smoking
- carry nitro at all times
A pt is receiving nitroglycerin, what statement indicates therapeutic effect?
“My chest pain is decreasing”
The nurse knows a pt is having an MI after what lab result?
elevated troponin level
What assessment findings indicate possible bleeding or recurrent dissection?
Low BP and high HR
- BP: 82/40 and HR: 125bpm
Cardiac marker diagnostic labs
- CK
- troponin
- CRP> inflammation marker
- BNP> heart failure marker
Noninvasive cardiac diagnostic procedures
- ECG
- chest x-ray
- echocardiogram
- stress testing
- CT
Invasive diagnostic procedures
Transesphageal echocardiogram(TEE)
- ultrasound down throat
Cardiac Cath
- balloon and stent
What does an echo show? and what is projected ejection fraction supposed to be?
- blood flow in the heart
- above 60% E.F.
Narrowing of an opening
Stenosis
What does stenosis cause?
- creates partail obstruction which increases pressure and decreases forward blood flow and back up occurs
the narrowing of the mitral valve orifice that obstructs blood flow from the left atrium into the left ventricle
Mitral valve stenosis
What is mitral valve stenosis predominantly caused by?
- rheumatic fever> complication of untreated strep or scarlet fever
The more severe mitral valve stenosis get what decreases?
- cardiac output decreases
- causing hypertrophy of the valve
- causes dyspnea on exercition
What is an urgent concern of mitral stenosis
- sudden increase in heart rate
- decreased cardiac output
Atrial enlargement increases the risk for……
Atrial fibulation
A condition in which aortic valve is narrowed and blood flow obstructed from LV into aorta during systole
Aortic valve stenosis
Clinical manifestations of aortic stenosis
- syncope
- angina
- dyspnea
- orthopnea
- paroxysmal noctural dyspnea
insufficient or incompetent valves that do not close completely and allows blood through he valve and backs up into where the blood just left
regurgitant
blood regurgitates back into the atrium vs being ejected through the aortic valve, decreasing forward cardiac output
mitral regurgitation
Blood flows back into the LV from the aorta during diastole leading to diminished cardiac output and LV pressure and volume increases
- Leads to left ventricular hypertrophy
Aortic valve regurgitation
Mitral cusps bulge up into the left atrium during ventricular systole
- floppy valve
valvular prolapse
Microbial infection, begins to damage endothelium of a valve
Infective endocarditis
groups at risk for infective endocarditis
- preexisting heart disease
- iv drug users
- children> rheumatic fever or CHD
- elderly
- HIV
- cardiac surgical pts
- hemodialysis
How do you treat Infective endocarditis
- timely and agressive administration of antibiotics
- possible valve replacement\
- prophylaxis antibiotics
How to manage valvular disorders
- sodium restriction
- lifestyle changes
- monitor with yearly echocardiograms
- prophylactic antibiotics
T or F with a mechanical valve replacement pts need to be on a long term anti- coagulation
True!
- makes platelets less sticky and doesn’t stick to valve
An abnormal localized dilation of an artery that results from a weakened arterial wall
Aortic Aneurysm
nursing priorities for pts with valvular diseases include
- assess/ maintain cardiac output
- manage side effects
- prevent complications
- provide pt education
- administer pharmocogic therapies
Where can aneurysms be located?
Can be located all along the aorta, from the ascending thoracic aorta through the trunk of the abdominal aorta
What is the most common location for an aneurysm?
- abdomen!
T or F aneurysms are usually a complication of long-standing atherosclerosis
True!!
- build-up of plaque leads to obstruction and backup of blood causing an aneurysm
risk factors for aneurysms
- HTN
- smoking
- age
- male gender
- hyperlipidemia
- hx of PAD
Clinical manifestations of aneurysms
- often asymptomatic or cause only minimal symptoms
- back/ flank pain, epigastric discomfort, altered bowel elimation
primary diagnostic for aneurysms
Diagnostic imaging is the primary tool for diagnosing aortic aneurysms
interventions for aneurysms
- open surgical repair> high risk
- endovascular Aortic Repair> less invasive, more patients qualify
T or F with an aortic rupture there is a slow onset of severe symptoms
FALSE
- there is rapid onset
- shock goes through he body very fast!
Heart tissue is not getting enough perfusion (heart itself)
Acute coronary syncdrome
What does Acute coronary syndrome encompass
- unstable angina
- NSTEMI
- STEMI
What lab test is the big indicator of an MI
troponin
Post op considerations for pts after a valve replacement
- check pulses
- I and O
- s/s infection
- assess physical health
- monitor vs
inital collaborative management for Acute coronary syndrome
- relieve chest pain
- reduce myocardial oxygen demand
- ECG obtained
- aspirin administered
- nitro given
- morphine give
- education to pt and family
MONA
- morphine
- oxygen
- nitroglycerin
- aspirin
sustained ischemia, causing irreversible myocardial cell death
Myocardial Infarction
clinical manifestations of MI
- chest pain lasting longer than 20 min
- crushing/ gripping pain
- chest heaviness and doom feeling
- jaw pain, shoulder, epigastric pain, fatigue, nausea, worsening sob
Complications of MI
- dysrhythmias
- premature contractions
- life threatening> death
- HF
- cardiogenic shock
- ventricular aneurysm
- pericarditis
Nursing considerations when giving morphine and nitro
- decreased oxygen sats
- low blood pressure
- low pulse
- severe headaches
- too many vasodilators can cause issues too!
- ask about viagra/ other vasodilators
Anticoag medications to help with Acute coronary syndrome> MI/ angina
- heparin
- aspirin
- plavix
Do all pts qualify for thrombolytic therapy?
NO
- only used in pts experiencing acute STEMI
- contradicted in pts w/ active bleeds and potential aneurysm
1 goal intervention to restore perfusion
- reperfuse the heart asap
nursing care for pre-procedure (PCI)
- perform baseline assessment
- medication administration
- patient and family education
- pre op care
- assess allergies> iodine!! Seafood!!
post op nursing care for PCI
- moniotr VS frequently
- ECG
- assess access site for pain, swelling, bleeding
- bruising may be present> mark circumference
- bloodwork
- pt should remain flat and no ambulation for 4-6hrs
what is the #1 nursing care post-procedure for PCI
- monitor and stop bleeding!
CABG is what?
coronary artery bypass graph
- takes vein from leg and put in in heart and bypasses a block
early pharmaceutical treatment for post MI, PCI, CABG
- beta blockers
- Antiplates> aspirin, plavix
- ACE inhibitors> prils
- ARBs> artan’s
- Calcium channel blockers
- digoxin
client education for beta blockers
- check pulses daily
- teach pts how to check pulse
- < 60 hold med
- know when to call provider; light-headedness, increasing fatigue, impotence, low pulse, low bp
Stop taking antiplatelets if pt is experiencing…
- frequent nosebleeds that won’t stop
- rash
- gi upset
- bleeding
- abdominal pain
- blood in stool
ACE inhibitors are used especially in pts who ….
- recovering from STEMI
- Heart Failure
- EF < 40%
- HTN
What is a major side effect of ACE inhibitors?
- angioedema
- maculopapular rash
ARBs do what
block the binding of angiotensin II to muscles on blood vessels
Avoid antiarrhythmics (calcium channel blockers) in pts w/
- Heart failure
- hypotension
- sinus node dysfunction
What medication is Positive inotropes strengthen the hearts contractions, so it can pump more blood w/ fewer heartbeats
Digoxin
- strengthen the force of the heartbeat, so every heartbeat counts
Digoxin toxicity s/s
- usually get when first taking this medication
- confusion
- irregular pulse
- less appetite
- n/v/diarrhea
- fast heartbeat
- vision changes
right side of heart holds what blood??
deoxygenated
left side of heart holds what blood??
oxygenated
Left side of heart pumps oxygenated blood where?
throughout the body!
