Cardiac Flashcards
(176 cards)
1
Q
How does the blood flow through the heart in order?
A
Superior/Inferior Vena Cava
R Atrium
Tricuspid Valve
R Ventricle
Pulmonic Valve
Pulmonary artery
Lungs
Pulmonary veins
L Atrium
Mitral Valve
L Ventricle
Aortic Valve
Aorta and Aortic Arch Arteries
To the body
Repeat
2
Q
If a plaque happens in the coronary arteries, what could follow?
A
increase pressure can cause a break off and a clot can form causing an MI
3
Q
A cardiac assessment includes what stethoscope points
A
Aortic
Pulmonic
Ereb’s Point
Tricuspid
Mitral (APICAL FOR 1 MINUTES)
4
Q
The aortic valve is located at
A
R 2nd intercostal space
5
Q
The pulmonic valve is located at
A
L 2nd intercostal space
6
Q
Erb’s Point is located at
A
L 3rd intercostal space
heart murmurs can be heard best when auscultated
7
Q
The tricuspid is located at
A
L 4-5th intercostal space
8
Q
The mitral valve is located at
A
L 5th intercostal midclavicular
9
Q
The lub sound is
A
Tricuspid and Mitral valve closing
start systole
Blood exits the ventricles and into the body
10
Q
The dub sound is
A
Aortic and Pulmonic valve closing
start diastole
blood enters the ventricles
11
Q
What are the different coronary arteries of the heart?
A
L coronary artery
R coronary artery
R (acute) marginal artery
circumflex artery
L (obtuse)marginal artery
L anterior descending artery
diagonal arteries
12
Q
T/F: Auscultating a regular rhythm is hearing the same thing every time even if the extra beat is consistent.
A
True
13
Q
What are the layers of the heart from out to in?
A
Fibrous pericardium (hard and why the wond gets knocked out of you)
pariental layer of serous pericardium
Pericardial cavity (lube for the heart)
Epicardium (visceral layer of serous pericardium)
Myocardium (pushes and muscles of the heart)
Endocardium
14
Q
Right-sided Heart Failure s/s
A
generalized edema (swollen ankles)
15
Q
Left-sided Heart Failure s/s
A
low perfusion
pulmonary congestion
low cardiac output
16
Q
Preload
A
volume of blood in verticles at the end of diastole
17
Q
Afterload
A
resistance left ventricle must overcome to circulate blood
18
Q
Preload increased in
A
hypovolemia
regurgitation of cardiac valves
19
Q
Afterload increased in
A
HTN
Vasoconstriction
20
Q
If afterload is increased then
A
cardiac workload is increased
21
Q
Stroke volume
A
amount of blood put out of the ventricles
22
Q
Cardiac output
A
amount of blood into the body in 1 minute
23
Q
Coronary Artery Disease is caused by
A
T2DM
HTN
Hyperlipidemia
High Cholesterol >100 (HDL = low) (LDL = high)
heart is working overtime
24
Q
Coronary Artery Disease is
A
coronary arteries struggle to supply blood, oxygen, and nutrients to the heart muscle
- cholesterol plaques in the coronary arteries and inflammation
25
What is the nursing teaching for coronary artery disease?
Heart healthy diet
Exercise (working up to 20 minutes a day)
more fluids
Teach on what happens when you don't stop eating bad
- Be realistic (cut down on the bad food, show them reality or MI will happen)
26
Heart Healthy Diet
Low salt, low fat, low cholesterol
27
What medications could be provided for Coronary Artery Disease?
Metformin - glucose
Beta-blockers - HTN
Statin - cholesterol
28
Statin drugs should be taken when
at night
- due to face flushing
29
What is Acute Coronary Syndrome?
condition occurs when blood flow is decreased or blocked in the heart
- unstable angina
- NSTEMI
- STEMI
30
What is the main difference between unstable angina and NSTEMI/STEMI?
Unstable angina does not cause necrosis
Both STEMI and NSTEMI can cause necrosis
31
What is the difference between NSTEMI and STEMI?
STEMI has an EKG ST elevation
32
What causes the chest pain in acute coronary syndrome?
ischemia
33
What is used to differentiate NSTEMI and STEMI?
EKG - ST elevations
34
What are the 2 goals if a patient comes in with chest pain?
decrease O2 demand
increase O2 supply
35
What is the priority intervention if a patient comes in with chest pain?
apply supplemental O2 (1st thing)
- 2L NC
decrease physical activity
administer medications
36
ACS medications should do what
decrease preload
decrease afterload
dilate coronary arteries
reduce contractility
reduce HR
prevent further thrombosis
37
What medications would you administer for ACS?
Beta-blockers
Anticoagulants
Calcium Channel Blockers
Nitrates - Nitroglycerin
Opioids - Morphine
Narcan
ACE/ARB
38
Beta Blockers
block epinephrine and adrenaline
39
Before you give a Beta Blocker, check
BP
40
Anticoagulants
prevent more clots
41
Calcium channel Blockers
decrease HR
42
Nitrates type
Nitroglycerin SUBLINGUAL
43
Nitroglycerin does what
dilates arteries and lowers BP absorption
44
What medications should you HOLD if HR is lower than 60?
Beta Blockers
Calcium Channel Blockers
- check the apical pulse
45
If the patient is sent home with topical Nitroglycerin, what should the nurse teach the patient?
Wear gloves
Sit down
46
What is contraindicated with Nitroglycerin?
Viagra
- ask males after clearing the room as it can be fatal if combined
47
81 mg Aspirin is absorbed by
chewing (sublingual) causing absorption quickly into the bloodstream
48
As people get older, they are at a higher risk of what cardiac critical care illness?
increased risk of plaques due to blood vessels stiffening and tough
**increase resistance = high BP**
49
Nitroglycerin should be given how
Sublingual
wait 5 minutes
repeat up to 3 times
Move to Morphine
50
With morphine, what do you need to watch?
RR and O2Sat
- possibly can give if less than 10 in a cardiac situation
51
ACE/ARBs do what
vasodilate preload and afterload
52
ACE/ARB side effect
dry mouth
53
ACE/ARB adverse effect and need to see HCP
coughing not going away
54
What is an MI
death/necrosis of myocardial cells caused by blood flow blockage
- STEMI / NSTEMI
55
How long does the medical team have to get a NSTEMI into the cath lab?
**12**-72 hours
= if not necrosis
56
How long does the medical team have to get a STEMI into the cath lab?
90 minutes
57
NSTEMI is a
partial occlusion at a 50% rate
- enzymes up and heart damage still
58
STEMI is a
total occlusion emergency and reopen within 90 minutes in the cath lab
59
STEMI has total necrosis within
4-6 hours of the myocardium
- Hypomyokinesis
- Akinesis
60
Hypomyokinesis
61
Akinesis
62
What is the ACS/MI?
The chest pain goes away after giving Nitro and lab levels are normal.
Unstable angina
63
What is the ACS/MI?
The chest pain is constant and labs show cardiac injury.
STEMI - ST elevation
NSTEMI - no ST elevation
64
Time =
Muscle
- when the cells have died they are gone
- replaces necrotic cells with scar tissue
65
Hypoxia begins in
10 seconds
66
O2 deprivation can cause damage to occur after
20 minutes
67
STEMI is an emergent situation! Intervention within
90 minutes
68
Typical s/s of MI
**Chest pain /discomfort /pressure** - ELEPHANT
Elevated blood glucose
N/V
Diaphoresis
Increased HR/BP
S3/S4 heart sounds
Peripheral vasoconstriction
Fever
SOB
Dizziness
AMS
Dysrhythmias
Pulmonary edema
69
Atypical s/s of MI
ANY S/S NOT ACCOMPANIED BY CHEST PAIN
- "I just don't feel good"
- if they have multiple dx
70
Nitroglycerin is sensitive to
light
71
Older adults are more common to have
MI without chest pain
72
What gender is more common to have MI
women
73
Description frequently used for MI
squeezing
band-like sensation
tightness
burning/heartburn
pressure
ache
crushing
knot in the center of chest
toothache
Elephant/heavy wt
74
Description NOT frequently used for
SHARP
knife
changed with breathing
stabbing
pins and needles
75
Can a NSTEMI turn into a STEMI
YES
76
How do you know if a NSTEMI turns into a STEMI?
PULMONARY S/S
TACHYCARDIA
COOL, CLAMMY SKIN
77
What do you do when the NSTEMI goes into a STEMI
Call doc immediately
78
Diagnosis of an MI includes
elevated cardiac enzymes
typical s/s
ST Segment changes
Hx of cardiac intervention
79
What can help guide to the dx of MI?
EKG - ST elevations
Cardiac Enzymes - cardiac injury
Stress Test - follow-ups
Echo
Coronary Angiogram
80
Cardiac s/s in an MI is a sign of
late stage ischemia
81
Cardiac Enzymes show what
cardiac injury
82
Occlusion/Collateral Circulation
can be good with by helping the patient live because of plague build up blocking the path (makes an alternate detour around the plague with only slight higher pressure)
83
When does a collateral circulation become known as the widow maker?
Left Anterior Descending gets plaque (the doctor can not make it through the tiny branches to get to the clot inside becoming inoperable
84
Troponin is best known for letting the medical staff know they had an
MI
85
Troponin elevates after how many hours of injury?
4-6 hours
86
Troponin peaks at
10-24 hours
87
Troponin level normals
<0.03 (I)
<0.1 (T)
88
Troponin is found in
skeletal and cardiac muscles
89
Creatine Kinase (CK) elevates how long after injury
6 hours
90
CK peaks after
18 hours
91
Normal level of CK
30-170
92
CK returns to normal how long after injury
24-36 hours
93
CK is found
muscle (not heart specific)
94
CK shows
muscle damage
- workout to heart attack
**DOES NOT MEAN MI**
95
CK-MB (Myoglobin) elevates within
2 hours
96
CK-MB peaks at
3-15 hours
97
CK-MB normal
<90
98
CK-MB returns to normal after
12-24 hours after injury
99
CK-MB is specific to
cardiac
100
CK-MB is elevated due to to
shock and myocarditis
101
CK-MB shows
heart damage
102
**What is the correct order of interventions if a person comes in with chest pain?**
Rest
Apply supplemental O2 – NC to NRB
Place the patient on a cardiac monitor – ST Elevation
Vital signs -
EKG
Ensure adequate IV access – 2 large bore IVs for cath labs and get blood
Draw cardiac enzymes
Administer medication – Nitro to Morphine
Get patient ready for reperfusion therapy
Cath Lab
103
What can the ER instruct a patient to do if they are waiting for the ambulance to come to their house when they have chest pain?
have high-dose aspirin
104
MI Medications
Nitrates (IV/SL nitroglycerin)
Beta-blockers (Metoprolol)
Antiplatelet Agents (ASA/Clopidogrel/Eptifibatide)
Anticoagulants (Heparin/Enoxaparin)
Thrombolytic Therapy (Alteplase)
105
Antiplatelet Agents types
(ASA/Clopidogrel/Eptifibatide)
106
Thrombolytic Therapy
(Alteplase)
107
Beta blockers do what
lowers pumping allows the heart to decrease the workload
108
Anticoagulant labs therapeutic level for MI
2-3X NORMAL
109
PT/INR normal
PT 11-13.5 secs
INR 0.8-1.1
110
PT/INR normal for MI
PT 22-33 secs
INR 2.4-3.3 secs
2-3 x the therapeutic range
111
Antiplatelet agents ASA or Heparin
- which half-life is longer
antiplatelet agents
112
If the patient is going to the cath lab, what medication can be given?
anticoagulant heparin due to lower half-life
113
Thrombolytic therapy does what
low platelets
114
HIT stands for
Heparin-Induced Thrombocytopenia
115
HIT is defined as
immune response to heparin by the body making antibodies
116
HIT on platelets
platelets are activated
increase platelet plugs
increase R/O thrombosis
low circulating platelets
117
HIT can typically occur how many days into tx
5-10 days
- possibly in 24 hours
118
If you suspect HIT, what nursing intervention needs to happen?
DC immediately
bed rest (fall risk, bleed out and die)
Argatroban and Ivalirudin
119
What are the s/s of HIT?
Plt. <150 or drop of 50% + from baseline
Arterial or venous thrombosis
Acute systemic reactions after administration
120
What are continuous treatment of MI?
Percutaneous Coronary Intervention (PCI)
Cardiac Bypass
CABG
121
What is the main goal of continued treatment of MIs?
reperfusion of cardiac muscle
122
With continued treatment (PCI, Stents, and CABG), what does the nurse need to ask the patient before they continue?
allergy to shellfish or iodine
123
What are s/s of post-op hemorrhage?
low BP
high HR
cold
no pulses in feet
124
What should you do if the patient is bleeding from the femoral incision site?
notify HCP
put tons of pressure on the site
125
If the incision for PCI is located on the right femoral artery site, what pulse should you check?
right sided popliteal and pedal pulses and check with the left side
126
How long should the patient be on bedrest after going to the cath lab?
6 hours to clot and for the blood thinners to get out of the system
126
Cardiogenic Shock occurs
inadequate tissue perfusion due to cardiac dysfunction
- low O2 to cardiac muscles = low cardiac function = low perfusion to the body
127
Most common cause of cardiogenic shock
MI from ischemia and necrosis
128
Cardiogenic is what type of problem
pump
- MI have all the volume needed
129
Hypovolemic is what type of problem?
volume problem
- shark bite = volume, nutrient, and O2 all deplete
130
With cardiogenic shock patient, do not give them what?
fluid bolus
131
Treatment for cardiogenic shock
*fix the pump do not bolus*
- reperfusion of cardiac muscle
- find the cause and treat it
- **ASA to PCI to clopidogrel**
- symptom mgmt
132
Cardiogenic shock mortality rate
50-70%
- life-threatening
133
What are symptoms of cardiogenic shock?
dysrhythmias
Hypotension
Fluid overload
134
S/S of Cardiogenic Shock Intervention
- dysrhythmias
antidysrhythmics
- Amiodarone
135
S/S of Cardiogenic Shock Intervention
- Hypotension
positive inotropic and vasopressor agents
- Norepinephrine
- Dopamine
NO BETA BLOCKERS
Cautious fluid admin
- 250 mL fluid challenge
136
S/S of Cardiogenic Shock Intervention
- Fluid Overload
Diuretics
Vasodilators
137
What medication should the cardiogenic shock patient avoid?
Beta Blockers
138
What do the vital signs of cardiogenic shock?
Hypotension = heart not being able to beat due to the fluid surrounding it
Tachycardia = trying to compensate
139
How long does it take for a person to recover from a MI?
several weeks
- scar tissue replaces damaged heart muscles
140
What life style changes are necessary for recovery of an MI?
New medications
Diet modifications
Activity modifications
Tobacco Cessation
141
What is a good resource for MI recovery?
Cardiac rehab
- restoration of a person to an optimal state of function
142
What are the expected physiological recovery for an MI?
weight reduction
smoking cessation
physical exercise
healthy eating
rest and comfort
143
What are the expected psychological recovery for an MI?
dealing with fear, anger, and depression
144
What are the expected mental recovery for an MI?
mgmt of stress
relaxation techniques
145
What are the expected spiritual recovery for an MI?
support to deal with guilt
feeling of hopelessness
146
What are the expected economic recovery for an MI?
dealing with loss of income
restrictions on work
147
What are the expected vocational recovery for an MI?
assistance with new skills
148
What are some non-modifiable risk factors?
age
race
ethnicity
gender????
149
What can happen if the blockage can not be fixed with PCI?
Cardiac Bypass (CABG)
150
T/F: The CABG patient should not cough as it can disturb the heart
False, the CABG patient should cough so they can take a deep breath and prevent pneumonia
151
Why would a CABG patient need insulin?
due to stress from epinephrine
only for the acute phase of recovery
impair wound healing if high glucose
152
Chest Tubes are always present after a bypass to
drain excess blood
153
When does the most amount of drainage come from a chest tube?
immediately post-op upon insertion
154
Chest tube drainage post-op > 1 hour
serosanguinous
- if still fresh than hemorrhage
155
Chest Tibe drainage should not be more than ______ mL/hr
100
156
What should never be done to a chest tube?
milk or clamp the line
below the chest always
157
If the chest tube is disconnected from the setup or the setup breaks, what should the nurse do?
place the tip in sterile water
158
What should the nurse do if the chest tube is pulled out?
notify
3-sided bandage
pull and replace
159
What does AAA mean?
Aortic Abdominal Aneurysms
160
Aneurysm
artery wall weakens causing it to widen abnormally or "balloon out"
161
S/S of an unruptured AAA
Abdominal, back or flank pain
Pulsating abdomen
high HR
low BP
Pain or discoloration in the feet
162
S/S of a ruptured AAA
Severe pain
Hypotension
Pulsatile abdominal mass
MEDICAL EMERGENCY!!
163
What is the priority for AAA pt?
164
AAA can be described in simple terms as a
water hose on full blast bleeding out into the abdominal cavity
165
If the AAA patient is stable, what would nurses do?
imaging CT
consent for surgery
T&C
166
If the patient has a unstable unruptured AAA, then what should the nurse do?
do not touch if the abdomen is pulsating
- get to the OR as quickly as possible
167
If the AAA patient has ruptured, then
straight to the OR
168
When the AAA has been repaired, then you can give the patient
blood and fluids with large bore IVs
VS Baseline
Peripheral Pulses
169
Tx of AAA
open repair
endovascular aneurysm repair (EVAR)
Fluids and Blood
170
EVAR does what
replaces diseased part of the aorta
171
AAA Post-Op Complications
MI
**Bleeding**
Renal Failure
Bowel/Ureteral injury
GI complications
Leg ischemia
Graft infection (mortality of 90% with this)
172
Cardiac Tamponade is a
pericardial effusion (build-up of fluid, blood, air) extends the sac beyond its limits
- heart unable to function properly (compressing)
173
S/S of Cardiac Tamponade
Beck's Triad
- Hypotension
- Distension of Jugular Veins
- Muffled Heart Sounds (SQUISHY S1 AND S2)
Bruising of the Sternum sometimes
Tachycardia
SOB
not everyone will show all 3 signs
174
Tx of Cardiac Tamponade
- if has hemodynamic changes
Pericardiocentesis
- percutaneous fine needle (pierce and suck out the fluid)
- surgical is more unstable
175
Tx of Cardiac Tamponade
- if has NO hemodynamic changes
conservative mgmt with continuous hemodynamic assessment
