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Critical Care week 1 > Cardiac Disease Treatments > Flashcards

Cardiac Disease Treatments Flashcards

1
Q

What are pacemakers?

A

Initiate heartbeat when heart’s intrinsic electrical activity is inadequate

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2
Q

Why would someone need temporary pacing?

A 
Bradydysrhythmias
d/t
drug toxicities
electrolyte imbalances
ACS
Prophylactic support

Tachydyshrhythmias
d/t overdrive pacing

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3
Q

What is demand pacing

A

MOST COMMON

Acts like an AV node. Will kick out a pulse if no beat is detected at a certain rate. Ensures HR does not drop below whatever rate is set to.

Pacer pads and EKG Leads on patient (to look for electrical activity)

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4
Q

What is sensing threshold?

A

What beat to look for and how much power to deliver.

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5
Q

What are bipolar pacemakers?

A

two electrodes located within the heart

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6
Q

What are unipolar pacemakers?

A

negative electrode in direct contact with myocardium

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7
Q

Where are pads placed on transcutaneous pacers?

A

Right chest

Left lower ribcage, left of sternum

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8
Q

What is a pacing artifact?

A

Spike seen on EKG as pacer delivers stimulus

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9
Q

Transcutaneous pacing only paces the___

A

ventricle

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10
Q

If you see a P wave and then a pacer spike, the ___ are being paced

A

atria

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11
Q

If you see no P wave, but a spike and then a QRS wave, the ___ are being paced.

A

ventricles

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12
Q

If you see two pacer spikes (one at P wave, one at QRS), we are pacing ____

A

both chambers

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13
Q

What is failure to pace?

A

Slow HR with no pacer spikes

common with transvenous pacers

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14
Q

What is failure to capture?

A

Pacer delivering spike, but not strong enough to capture control of heart.

Pacer spike with no immediate response

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15
Q

What is failure to sense?

A

Pacer brain not detecting underlying rhythm. Attempting to pace even though heart working right.

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16
Q

What is undersensing?

A

Pacer not turning off when heart returns back to intrinsic rhythm

Underlying heart rhythm AND pacer spikes on top of it.

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17
Q

What is the nursing management for pacemaker patient?

A

Ensuring the patient is getting adequate pacer spikes.

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18
Q

What is the biggest thing to avoid if you have a pacemaker?

A

magnets.

They can turn pacer on./off

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19
Q

What is an implantable cardioverter defibrillator?

A

Detects V-Tach and delivers shock to fix rhythm

Also worn by severe heart failure patients

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20
Q

What does an ICD do?

A

Delivers ‘shock’ to provide electrical energy for shocks

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21
Q

What is the goal of fibrinolytic therapy?

A

Dissolve clot and restore blood flow to area.

22
Q

When can someone not receive fibrinolytic therapy?

A

< 12 hours of when chest pain started (tissue now dead)

Persistent ST elevation (muscle actively dying)

If had recent stroke, had operation, or trauma within last 6 weeks

23
Q

What to watch for if someone is getting fibrinolytic therapy?

A

bleeding!

monitor vitals and neuro for next 24 hours

24
Q

What is evidence of reperfusion?

A

CP quits

ST elevation goes back to baseline

dysrhythmias

CK-MB peaks and decreases faster

25
Q

What is percutaneous coronary interventions?

A

Cath lab procedure of balloon angioplasty.

Percutaneous because they go in through femoral artery

26
Q

It is important to watch liver labs on cath lab patients because ___ is nephrotoxic

A

dye

27
Q

What is a stent?

A

Metal net that opens up the narrow vessel

28
Q

What is arthrectomy?

A

Dissolve/break down the clot using a roto-rooter drill bit type thing

29
Q

What labs are done prior to cath lab procedures?

A

Creatinine.

If > 1.6, they are ok to go. Premedicate with steroids and fluids to protect kidneys

30
Q

If a patient has an iodine allergy, can they get a cath procedure done?

A

Yes, with lots of steroids prior to procedure

31
Q

What are complications of PCI?

A 
Coronary spasm
Coronary thrombosis
Coronary dissection
Bledding
Hematoma
Retroperitoneal bleed
32
Q

What is the nursing management for PCI?

A 
Monitor for:
Recurrent angina
Bleeding @ site
Hemostatic devices
peripheral pulses
EVERY 15 MINUTES

Protect kidney function by giving pushing IV fluids to rinse out dye

Promote ambulation after 6 hours

33
Q

How long do legs need to remain straight after cath?

A

6 hours

34
Q

What is CABG?

A

Vein is used for grafting

35
Q

What things need to be monitored after CABG?

A

surgery site

graft sites

bleeding

36
Q

What do we teach about sternal protection post CABG?

A

do nothing that applies force or stretch the sternum.

37
Q

What is pericardial tamponade?

A

blood leaks into pericardium, limiting heart movement.

38
Q

What is beck’s triad?

A

Signs of cardiac tamponade:
~narrow pulse pressure
~JVD
~muffled heart sounds

39
Q

What do you monitor for in chest tube output after CABG?

A

sudden increase (something’s leaking)
OR
quick cessation of flow (something’s clogged)

40
Q

What is treatment for cardiac tamponade?

A

bedside thoracotomy

41
Q

What is valvular surgery?

A

replace broken/bad heart valves

42
Q

What is the biggest concern after heart transplant?

A

rejection

43
Q

What are signs of heart failure rejection?

A

Pain
High fever
Failure of organ

44
Q

Biggest risk after valve surgery?

A

clotting

Will be on coumadin

Keep INR between 1.5 - 2

45
Q

What is cardiopulmonary bypass?

A

Blood shunted away from heart so we can operate on it

46
Q

What is nursing management for cardiac post surgery?

A

~Optimize cardiac output

~Monitor temp (they are chilled during surgery)

~Look for drastic increase or stoppage of drainage

47
Q

What are the indications to use intraorticic balloon pump?

A

Left ventricular failure after cardiac surgery

Unstable angina not managed by medications

Recurrent angina after MI

Complications of acute MI

Unresolved ventricular dysrhythmias

48
Q

What is cariogenic shock?

A

HTN that occurs when heart does not pump right

49
Q

What does intraaortic balloon pump do?

A

Inflates in diastole when aortic valve closes. (Increases myocardial oxygen supply)

Deflates just prior to opening of aortic valve (decreases resistance of left ventricular ejection)

50
Q

What do we measure closely with balloon pump?

A

Skin level measurement.

51
Q

What is a trans thoracic echocardiogram?

A

ultrasound of heart done through chest

52
Q

What is a trans thoracic echocardiography?

A

looks for clots in the heart before a cardioversion

Critical Care week 1 (6 decks)

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