cardiac Flashcards

Question

acute coronary syndrome symptoms

Answer 1

pain (crushing) pressure radiating to the L arm and L jaw N/V pain between shoulder blades ``` women: GI s/s epigastric discomfort pain between shoulders aching jaw or choking sensation unusual fatigue inability to catch a breath ``` ``` ****SOB is the number one sign for elderly cold, clammy BP drops CO down ECG changes vomiting ```

Answer 2

troponin T <0.10 | troponin I <0.03

Answer 3

*****worry about stemi client stemi: ST segment elevation myocardial infarction having a heart attack get them to cath lab for PCI (percutaneous coronary intervention) in less than 90min nstemi: non-st segment elevation myocardial infarction less worrisome

Answer 4

CPK-MB cardiac specific isoenzyme high w/ damage to cardiac cells elevates within 3-6hours and peaks in 12-24 hours troponin: cardiac biomarker w/ high specificity to myocardial damage elevates within 3-4 hours and remains elevated for up to 3 weeks myoglobin: increases with 1 hour and peaks in 12 hours negative results are a good thing troponin is the most sensitive for an MI or delays seeking care

Answer 5

pulseless vtach vfib asystole

Answer 6

treatment: defibrillate epinephrine or vasopressor amiodarone or lidocaine

Answer 7

neuro changes

Answer 8

anti-arrhythmic of choice | SE: hypotension

Answer 9

O2 if less than 90 aspirin (chewable) nitro morphine Head up to decrease workload and increase CO

Answer 10

used to dissolve a clot that is blocking blood flow to the heart muscle and decrease the size of the infarction alteplase tenecteplase reteplase streptokinase should be given within 6-8 hours after onset of pain ****bleeding is a major complication obtain bleeding hx bleeding precautions during and after administration draw blood when starting IVs to decrease pokes do not do ABGs r/t high risk for bleeding

Answer 11

``` abciximab acetaminophen acetylsalicyclic acid apixaban clopidogrel dabigatran enoxaparin sodium eptifibatide heparin rivaroxaban warfarin ```

Answer 12

percutaneous transluminal coronary angioplasty stents angioplasty complication: MI if any problems-- surgery chest pain after procedure-- call provider r/t reoccluding

Answer 13

``` acetylsalicylic acid clopidogrel prasugrel abciximab eptifibatide ```

Answer 14

aka open heart surgery used for multiple vessel disease or coronary artery occlusion L main coronary artery supplies the entire L ventricle ****L main coronary artery occlusion-- think sudden death or widow maker

Answer 15

``` smoking cessation stepped care plan (increase activity gradually) low fat low salt low cholesterol no isometric exercise no valsalva no straining no suppository sex resumed 7-10days safest time for sex is 8-9am walk teach s/s of HF (weight gain, ankle edema, SOB, confusion) ```

Answer 16

``` complication from cardiomyopathy valvular heart disease endocarditis acute MI *****hypertension ```

Answer 17

blood not moving forward into aorta and go back into lungs ``` pulmonary congestion dyspnea cough blood tinged frothy sputum restlessness s-3 orthopnea nocturnal dyspnea ```

Answer 18

not moving into lungs back into venous system causes: normally a disease in lungs (PE, COPD) ``` distended neck veins edema enlarged organs weight gain ascites ```

Answer 19

heart can't contract and eject

Answer 20

ventricles can't relax and fill

Answer 21

BNP: sensitive indicator if on Nesiritide turn off for 2hr prior to drawing secreted by ventricular tissues in the heart when ventricular volumes and pressures are increased CXR: enlarged heart pulmonary infiltrates (fluid/edema) echocardiogram: looks at pumping action or ejection fraction of heart ``` New York Heart association functional classification of persons with HF: class 4 is the worse "can they complete activities of daily living test" ```

Answer 22

``` ace inhibitors: drug of choice suppress RAS prevent conversion of angiotensin 1 to 2 results in arterial dilation and high SV SE: dry, naggy cough ``` ARBs: block angiotensin 2 receptors cause low arterial resistance and low BP ``` beta blockers: first line therapy relax vessels decrease BP decrease afterload decrease workload of heart ``` ACE and ARBs both block aldosterone so we lose Na and H2O and retain K most likely sent home on ace inhibitor and/or beta blocker because they decrease workload on the heart and prevent vasoconstriction to increase CO and keep blood going forward digoxin monitor for toxicity sinus rhythm or afib and has accompanying chronic HF makes contractions stronger slows HR (gibes ventricles more time to fill with blood) high CO high kidney perfusion good to diurese r/t HF pts cannot handle extra fluid ****HF pts should not get whole blood-- only give what they need (RBCs, platelets) ``` diuretics: furosemide hydrochlorothiazide bumetanide spironolaction decreases preload give in AM ``` severe HF: IV inotropes (milrinone, dobutamine) vasodilators (nitroprusside, nesiritide, nitroglycerin)

Answer 23

``` good to diuresis working when CO goes up s/s of toxicity: early-- anorexia, N/V late-- arrhythmias and vision changes (yellow halos) ``` check apical pulse (5th ICS mid clavicular line) before giving monitor electrolytes (hypokalemia + dig = toxicity)

Answer 24

0.5-2 toxicity if over 2

Answer 25

low Na diet: decreases fluid retention and helps decrease preload watch salt substitutes (contain excess K) elevate HOB daily weight (report 2-3lbs) s/s of recurring failure pacemaker

Answer 26

"natural" = SA node or sinus node sends impulses to make heart contract used to increase HR with symptomatic bradycardia ****always worry if HR drops below set rate demand pacemaker sets in only when they need it fixed rate fire at a fixed rate constantly rate should never decrease--okay to increase post procedure monitor incision common complication: electrode displacement immobilize arm assisted passive ROM to prevent frozen shoulder don't raise arm higher than shoulder ``` s/s of malfunction capture: no contraction follows stimulus sense: fires at inappropriate times may not be programmed right electrodes can dislodge battery may be dead watch for s/s of low CO or low HR ``` ``` teaching: check pulse daily ID card/bracelet avoid electromagnetic fields avoid MRIs ```

Answer 27

risk factors: IV fluid fast young/old hx of heart or kidney disease fluid backing into the lungs heart cannot move the volume forward usually occurs at night during bed

Answer 28

``` sudden onset breathless restless/anxious hypoxia productive cough ```

Answer 29

O2-- keep above 90 upright position legs down improves CO promotes pooling in lower extremities prevention: lung sounds avoid FVE

Answer 30

diuretics: furosemide diuresis & vasodilate and traps more blood out in the arms and legs and reduces preload nitroglycerin: vasodilation decrease afterload = increase CO because heart is pumping again less pressure and more blood moved forward morphine decrease preload and afterload nesiritide IV infusion short term-- no more than 48hours vasodilates veins and arteries and has a diuretic effect turn off infusion 2 hours before drawing BNP

Answer 31

blood, fluid or exudates leak into pericardial sac results in compression of the heart

Answer 32

``` low CO (ventricle is being squeezed) *****high CVP *****low BP muffled or distant heart sounds distended neck veins pressure in all 4 chambers shock narrowed pulse pressure (difference between systolic and diastolic reading) ```

Answer 33

narrow: cardiac tamponade wide: increased ICP

Answer 34

pericardioentesis to remove blood from the heart | surgery

Answer 35

if you have atherosclerosis in one place you have it everywhere ``` medical emergency if occluded numbness and pain cold extremity no palpable pulse more symptomatic in lower extremities ****intermittent claudication (arteries only) arterial blood isn't getting to the tissue--> coldness, numbness, ***Decreased peripheral pulses, atrophy, bruit, skin/nail changes, and ulcerations pain at rest means severe obstruction ``` ***artery issues = something is not getting O2

Answer 36

pain will increase if you elevate legs angioplasty endarterectomy

Answer 37

****arteries carry oxygenated blood ****veins carry deoxygenated blood inflammation and chronic ulcers can occur could develop a DVT V: elevate veins A: dangle arteries

Answer 38

intermittent claudication pain (pain progresses at rest) decrease or absent pulses pale when elevated red with lowering of leg cool mild or absent edema thin, shiny, loss of hair over foot/toes, nail thickening ulceration if present will involve toes or areas of trauma on feet (painful) gangrene may develop don't use compressions

Answer 39

``` none to aching pain normal pulses (may be hard to palpate r/t edema) normal color (may see petechiae or brown pigmentation with chronic) normal temp edema brown pigmentation around ankles possible thickening of skin scarring ulceration if present on sides of ankles no gangrene compression ```

cardiac Flashcards

(63 cards)