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Complex Exam One > Week Two > Flashcards

Week Two Flashcards

1
Q

Acute Coronary Syndrome (ACS) includes….

A

unstable angina
NSTEMI
STEMI

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2
Q

NON Modifiable Risk Factors for CAD

A

age
gender
ethnicity
family history
genetic predisposition

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3
Q

Modifiable RF for CAD

A

HTN
smoking
exercise (lack thereof)
obesity
diabetes
metabolic syndrome
psychologic state (stress)
homocysteine level
substance abuse

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4
Q

Stable (chronic, exertional) Angina

A

blockage of coronary artery
predictable
relieved by rest
ST depression or T wave inversion
TREATMENT: rest and NTG

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5
Q

Prinzmetal’s Angina (Variant)

A

different things cause the chest pain
vasospasm of a coronary artery
smoking, alcohol, caffeine
transient ST elevation during pain episodes
cardiac cath
TREATMENT: CCB (relax coronary artery)

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6
Q

Silent Ischemia

A

ischemia without the patient reporting pain
diabetes- neuropathy
elderly
woman (present different)

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7
Q

Women Presentation with angina

A

unusual fatigue
sleep disturbances
SOB
weakness
cold sweat
lightheadness
Nausea
dizziness
indigestion

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8
Q

Unstable (crescendo) Angina

A

atherosclerotic plaque instability and possible thrombus formation
ST depression or T wave inversion
unpredictable
TREATMENT: rest, NTG, drugs affecting platelets, re-vascularization (stents and bypass)

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9
Q

Acute Myocardial Infarction (AMI)

A

ischemia with myocardial cell death (necrosis) r/t disruption or deficiency of blood supply to coronary arteries
imbalance of O2 supply and demand

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10
Q

CM of ACS

A

chest pain
diaphoretic
skin (pale/ashen, cool and clammy)
syncope
N/V
dysrhythmias
fever in the 1st 24 hours
Initially increase in HR and BP but then BP drops because of decreased CO
crackles
JVD
S3 or S4 heard
new murmur

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11
Q

how to classify an MI

A

ECG changes
depth of heart damage
location of the area of the heart affected

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12
Q

progression of an AMI

A

ischemia (lack of O2)
- ST depression, T wave inversion, tall peaked T wave

injury (occlusion with ischemia)
- ST elevation

infarction (death)
- pathological Q wave - ain’t getting fixes

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13
Q

Transmural

A

full-thickness damage of the heart
endocardium, myocardium, epicardium
pathological Q wave from scarring

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14
Q

Non Transmural

A

limited damage of the myocardium (middle layer of heart)

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15
Q

most frequent site of MI

A

left ventricle

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16
Q

most frequent coronary artery of a MI

A

left vein coronary artery (widow maker)

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17
Q

Anterior MI

A

left anterior descending
V3-V4

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18
Q

septal

A

left anterior descending
V1-V2

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19
Q

lateral

A

left circumflex
1, aVL, V5-V6

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20
Q

inferior MI

A

right coronary artery
2, 3, aVF

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21
Q

posterior MI

A

left circumflex
V1- V3

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22
Q

MI healing

A

within 24 hours, leukocytes infiltrate the area of cell death
neutrophils and macrophages remove necrotic tissue by 4th day (there is a thin wall)
10-14 days scar tissue is still weak
very vulnerable to stress
by 6 weeks, scar tissue replaced
normally, the heart will hypertrophy and dilate in an attempt to compensate for dead tissue

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23
Q

management of AMI

A

O2 supply
decrease myocardial demand (MONA)
M: morphine
O: o2
N: NTG
A: aspirin
IN THIS ORDER: ONAM

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24
Q

medical management of AMI

A

Call 911
O2
coags
decrease HR (increase ventricular filling time)
decrease preload
decrease afterload
decrease myocardial oxygen
lipid-lowering agents
thrombolytics
intensive glucose therapy

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25
Q

CORE MEASURES OF AMI

A

start ecg
ASA on arrival (and prescribed at discharge)
ACEI or ARB for LVSD (EF> 40)
smoking cessation
Beta-blockers at discharge
TBA (fibrinolytic therapy within 30 min of getting to hospital)
90 min from door to balloon
statin at dischage

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26
Q

nursing management of AMI

A

pain control
cont monitoring (ECG, ST segments, Heart and breathe sounds, VS, Pulse ox, I&O)
rest and comfort
anxiety reduction
emotional support
pt teaching
cardiac rehab

for chest pain:
- semi fowler’s
-O2
-assess VS
- 12 lead ECG
- NTG followed by opioid analgesic
- auscultate heart and breath sounds

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27
Q

reperfusion strategies

A

Fibrinolytic (Thrombolytic) therapy
-6-hour window to start from the onset of symptoms
-less than 30 with admission
-TBA
-Adjuncts: heparin and glycoprotein inhibitors
-start 2-3 IVS

Cath (90 min)

PTCA

Intracoronary artery stenting

bypass grafts

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28
Q

Cath/coronary angiography

A

visualize and open blockages
- percutaneous coronary interventions (PCI)
- balloon angioplasty
-stent

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29
Q

PTCA

A

balloon cath is inflated temporarily to open vessel

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30
Q

intracoronary stent

A

tubes placed in conjunction with angioplasty to keep vessel patent
anti coag therapy

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31
Q

Pre Cath Care

A

NPO 6-12 hours
Insulin/hypoglycemics adjusted day of procedure
Benadryl if allergic to dye
ASA, Clopidogrel or platelet inhibitor may be given
PT awake during procedure

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32
Q

Post Cath Care

A

bedrest (HOB 30)
monitor for bleeding/ hematoma
immobilize arm
monitor cardiac rhythm
encourage fluid intake (get dye to filter through kidneys)
I&O
observe for reaction to dye (angiography)
assess for chest pain, back pain, SOB
antiplatelet drugs after
go home 6-8 hours after

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33
Q

Nursing Management after Cath

A

monitor ECG and serial 12 leads
VS q15min until stable
monitor O2 stat cont
monitor serial troponin and/or cardiac biomarkers
monitor PT/APTT and observe for signs of bleeding in receiving thrombolytic therapy
manage hemodynamic compromise as ordered (Dopamine, Dobutamine)
assess for signs of HF (S3, S4, rales, edema, weight gain, decreased CO, decreased UOP)

34
Q

patient education ACS

A

ambulatory and home care
cardiac rehab
pt and caregiver teaching
physical activity
- level of activity - METs or Borg scale
- monitor HR
- low-level stress test before discharge
- isometric vs. isotonic activities
resumption of sexual activities after 7-10 days or when you can climb two flights of stairs
do not take nitrates with ED meds
take a prophylactic nitrate before sex
CAD- symptoms (when do they need to seek help)
Diet is an AHA diet (reduces fat, total cholesterol <200, HDL > 40, LDL <100) reduces salt
smoking cessation
control HTN, diabetes
achieve ideal body weight
avoid Valsalva maneuver
med teaching

35
Q

Hemodynamic Monitoring

A

measurement of pressure, flow, and oxygenation within the cardiovascular system
assess heart function, fluid balance, and effects of drugs on CO

36
Q

Cardiac Output (CO)

A

volume of blood pump through heart in a min

37
Q

Cardiac Index (CI)

A

cardiac output based on patients weight

38
Q

Stroke Volume (SV)

A

amount ejected w each beat
this is effected by preload, afterload, and how healthy the heart is

39
Q

Stroke Volume Index (SVI)

A

is the volume of blood pumped by the heart with each beat divided by the body surface area

40
Q

Ejection Fraction (EF)

A

% of heart contracting (>60%)

41
Q

Systemic Vascular Resistance (SVR)

A

How the heart has to overcome each body system
how much you are starting with and how much is left

42
Q

pulmonary vascular resistance

A

what the heart has to overcome to pump through the lungs

43
Q

preload

A

volume of blood within ventricle at end of diastole
PAWP: reflects left vent
CVP: reflects right vent
(what is left for the next heart beat)

44
Q

afterload

A

forces opposing ventricular ejection
SVR and arterial pressure of left vent afterload
PVR and pulmonary pressure of right vent afterload

45
Q

SVR and PVR (resistance) reflects ……

A

afterload

46
Q

MAP

A

avg perfusion pressure
SBP + 2(DBP) divided by 3

> 60 mmHg

47
Q

Intra-arterial Pressure monitoring

A

cont BP readings

48
Q

components of pressure monitoring system

A

invasive cath
pressure tubing
transducer - level with phelbostatic axix
3 way stopcocks
pressure bag
flush solution
monitor and pressure cable

49
Q

principles of invasive pressure monitoring

A

zeroing: calibrated to atmospheric pressure
leveling: transducer so zero reference point at level of atria of heart (phlebostatic axis)

50
Q

what test do you do before entering a material pressure monitor?

A

allen’s test

51
Q

how many mL do you flush an hour with APM?

A

3-6 mL
maintains line patency
limits thrombus formation

52
Q

Pulmonary Artery Pressure Monitoring

A

guides pt with complicated cardiopulmonary problems
Pa diastolic (PAD) pressure and PAWP = cardiac function and fluid volume status
allows for precise manipulation of preload

53
Q

Swan- Ganz

A

PA flow-directed cath
Balloon inflated to measure PAWP

54
Q

Pulmonary Artery Pressure Monitoring - Insertion

A

trendelenberg or supine w/ towel b/w shoulder blades
sedation
inserted deflated balloon, selected inflation to float cath into PA
waveform changes as cath progression
check for proper wedging for PWP or PAOP
sheath
chest x ray

55
Q

When are pulmonary artery pressure measurements obtained?

A

PA: at the end of expiration
PAWP: slowly inflate balloon with air until PA waveform changes to PAWP waveform
do not inflate for more than 4 RR cycles or 8-15 sec

56
Q

Pulmonary Artery Pressure monitoring - nursing management

A

level transducer and zero arterial systems
utilize proximal lumen to measure RAP, infuse IV fluids, blood samples, and infusion of IV
distal lumen used to measure PA pressures. lumen not used for IV fluids, only irrigation fluids
balloon lumen left deflated and locked
monitor RR and Cardiac status
monitor for complications (pneumothorax, infection, sepsis, air embolus, PA infarction, or PA rupture, ventricular dysrhythmias)

57
Q

Measurement parameters of PAC

A

PA systolic: 20-30
PA diastolic: 4-12
PA mean: 10-15
PWP/PAOP: 6-12

58
Q

intermittent bolus thermodilution (TDCO)

A

continuous cardiac output (CCO)
inject saline or D5W into proximal lumen of PA cath
thermistor sensor detects differences in blood tempt and calculates CO
uses average of three measurements

59
Q

Increase SVR

A

vasoconstriction (more pressure to push through)

60
Q

decreases SVR

A

vasodilation (less pressure lower BP)

61
Q

Venous Oxygen Saturation

A

SvO2/ScvO2 reflect balance b/w oxygenation of arterial blood, tissue perfusion, and tissue oxygen consumption
assess hemodynamic status and response to treatment/activity
normal-70%

62
Q

decrease SvO2/ ScvO2

A

decreased arterial oxygenation
low CO
low hemoglobin level
increased oxygen consumption or extraction

63
Q

increased SvO2/ ScvO2

A

may indicate improvement
or sepsis

64
Q

CO values

A

4-8 L/min

65
Q

SV values

A

60-150 mL

66
Q

Cardiac Index

A

2.2-4.0 L/min/m^2

67
Q

Systemic Vascular resistance (SVR)

A

left side afterload indicator
800-1200 dynes/sec/cm^5/m5

68
Q

Pulmonary Vascular Resistance (PVR)

A

right side afterload indicator
160-380 dynes/sec/cm^5/ m2

69
Q

pulmonary artery wedge pressure (PAWP)

A

left side
6-12 mmHg

70
Q

central venous pressure (CVP)

A

right side
2-8 mmHg

71
Q

PA systolic (PAS)

A

20-30 mmHg

72
Q

PA diastolic (PAD)

A

4-12 mmHG

73
Q

Mean Arterial Pressure

A

overall measure of tissue perfusion
70-105 mmHg (at least 60 mmHg to prevent metabolism in the peripheral tissue)

Formula: 2(DBP) + systolic BP (SBP) / 3

74
Q

Cardiac Index is

A

cardiac output adjusted for body size

75
Q

Stroke volume is

A

amount blood ejected by the ventricle with each heartbeat

76
Q

SvO2 monitoring is

A

oxygen saturation of the hemoglobin in the venous return

77
Q

purpose of SvO2 monitoring

A

early warning of an imbalance b/w oxygen supply and demand to the tissues and tissue use of oxygen (NORMAL: supply and demand match)

78
Q

method of SvO2

A

a cath is placed in the pulmonary artery (mixed venous blood pumped out from the right ventricle) measures the amount of light reflected off the hemoglobin to determine how saturated they are with oxygen

79
Q

normal SvO2 values

A

70%

80
Q

low SvO2 means

A

seen in conditions that decrease O2 supple (low CO, low Hgb, and low SaO2)
or
increase in oxygen consumption (Vo2, sepsis, MODS, burns, shivering)

81
Q

high SvO2

A

seen in conditions with low oxygen consumption such as anesthesia

Complex Exam One (3 decks)

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