cardiovascular + lines Flashcards
(94 cards)
1
Q
definition
acute coronary syndrome
A
impaired blood flow to the heart causing myocardial injury, ischemia, & infarction
2
Q
what are the types of heart conditions characterized by acute coronary syndrome?
A
- non-STEMI
- STEMI
- unstable angina
3
Q
definition
myocardial ischemia
A
reversible incident of impaired oxygen supply
4
Q
definition
myocardial injury
A
acute period of both ischemia & infarction
5
Q
definition
myocardial infarction
A
irreversible myocardial necrosis
6
Q
definition
unstable angina
A
a clinical syndrome typically resulting from atherosclerosis
7
Q
when does chest pain usually occur for unstable angina?
A
at rest
8
Q
unstable angina usually involves ischemia–what does this entail?
A
the condition is reversible
9
Q
what is the difference between all the cardiac conditions?
A
severity of ischemia (duration) & the levels of cardiac markers
10
Q
what are the 2 cardiac markers that can signify myocyte injury?
A
- troponin
- CK-MB isoenzyme
11
Q
how long does complete necrosis of myocytes take?
A
4-6 hours
12
Q
which of the cardiac markers is more sensitive than the other?
A
Troponin
13
Q
how long after a cardiac injury do Troponin levels rise?
A
4-8 hours
14
Q
for how long do Troponin levels remain elevated?
A
2 weeks
15
Q
dependent cardiac risk factors
(7)
A
- smoking
- HTN
- hypercholesterolemia
- obesity
- sedentary
- stress
- DM
16
Q
characteristics of CP in MI
A
- crushing
- sustained
- unrelieved (or partial by rest/ Nitro)
- radiating
17
Q
what are the treatments for MI?
MONA
A
- Morphine
- Oxygen
- Nitroglycerin
- Aspirin
18
Q
what are the goals for a nurse who is treating an MI?
(4)
A
- preserve LV function
- decrease amount of myocardial necrosis
- start fibrinolytic therapy quickly
- percutanenous coronary intervention
19
Q
what are contraindications to MI treatments?
(2)
A
- ischemic stroke in the last 3 months
- recent bleeds from GI, cerebral, & surgical
20
Q
what does the nurse expect the provider to say in explaining cardiac catheterization to a patient?
A
analgesics are administered in order for a catheter to be inserted through the groin or arm to reach the coronary vessels & inject a dye that will allow blockages to show on an x-ray or use the catheter to clear blockages
21
Q
what does a nurse assess for in a patient post-cardiac catheterization?
(5)
A
- dysrhythmias
- hematoma
- temperature & color of site
- agent-induced renal failure
- (must advise for 2-6 hours bed rest)
22
Q
what are some of the procedures that improve cardiac function?
A
- CABG
- IABP (intra-aortic balloon pump)
- VAD
- transplant
23
Q
definition
endocarditis
A
infection of the inner layer of the heart
24
Q
s/s of endocarditis
A
- fever
- heart mumur
- chills
- weakness
- fatigue
- malaise
- anorexia
25
how does *endocarditis* manifest in the vessels?
| (5)
* splinter hemorrhages in nailbeds
* Roth's spots
* Janeway lesions
* Osler's node on extremities
* systolic murmur
26
what are the risk factors for *endocarditis*?
| (4)
* prosthetic valves
* hemodialysis
* IV drug abuse
* invasive dental procedures
27
why does a nurse need to administer *prophylactic ABX treatment* to a patient who just had an invasive procedure?
to prevent endocarditis
28
***thrombotic vegetation*** results from which cardiac condition?
endocarditis
29
what are the diagnostic procedures for *endocarditis*?
| (6)
* blood cultures
* CBC ESR
* C-reactive protein
* CXR
* ECG
* echocardiography
30
what procedure does a patient with *endocarditis* need to undergo?
valve replacement or repair
31
why does a patient with *endocarditis* need repeat blood cultures?
determine the presence of bacteria, virus, or fungus that caused it
32
# definition
pericarditis
inflammation of the outer lining of the heart
33
*pericarditis* is usually accompanied by which cardiac condition?
pericardial effusion
34
s/s of *pericarditis*
| (5)
* sudden & severe pain
* dyspnea
* ***pericardial friction rub***
* fever
* anxiety
35
what are the complications for *pericarditis*?
| (4)
* pericardial effusion
* cardiac tamponade
* hiccups
* pulsus paradoxus
36
what are the pharmacological interventions for *pericarditis*?
* ABX
* NSAIDS
37
what are the invasive interventions for *pericarditis*?
| (2)
* pericardiocentesis
* pericardial window
38
what are the appropriate labs that allow for management of *pericarditis*?
* CBC
* CRP *(C-reactive protein)*
* ESR
* Troponin levels
* blood culture
* culture of pericardial fluid
* pericardial biopsy
39
what does the nurse anticipate to be ordered for a patient with presumed *pericarditis*?
| (5)
* 12 lead EKG
* echocardiogram
* CT
* MRI
* CXR
40
what are the types of *cardiomyopathies*?
| (4)
* hypertrophic cardiomyopathy
* dilated cardiomyopathy
* arrhythmogenic RV dysplasia
* restrictive cardiomyopathy
41
# definition
dilated cardiomypathy
the muscle in the LL chamber stretches & thins, causing the chamber to enlarge
42
# definition
arrhythmogenic RV dysplasia
replacement of muscle tissue in the LR chamber w/ scar tissue
43
# definition
restrictive cardiomyopathy
ventricles become stiff due to formation of fibrous tissue
44
what are the medications administered for *cardiomyopathies*?
| (6)
* Nitrates
* B-blockers
* antiarrhythmics
* diuretics
* inotropes *(Digoxin)*
* anticoagulants
45
which invasive interventions can the nurse expect to suggest to a patient with *cardiomyopathy*?
| (5)
* VAD
* cardiac resynchronization therapy
* ICD
* transplant
46
s/s of *dilated cardiomyopathy*
LHF/ biventricular
47
s/s of *hypertrophic cardiomyopathy*
| (3)
* CP
* syncope
* dyspnea
48
s/s of *restrictive cardiomyopathy*
| (3)
* dyspnea
* fatigue
* RHF *(progression to LHF)*
49
# definition
aortic dissection
inner layer of aorta tears, causing other layers to dissect
50
s/s of *aortic aneurysm/ dissection*
sudden CP
*(accompanied with other symptoms common to cardiac dysfunction)*
51
what is the normal range for *systemic vascular resistance*?
700-1500
52
*systemic vascular resistance (SVR)* indirectly affects ***stroke volume***
true
53
how is *systemic vascular resistance* calculated?
(MAP-CVP)/ CO
| CVP - central venous pressure
54
what reasons could the nurse infer why a patient needs a *central line*?
| (6)
* inadequate peripheral venous access
* TPN
* medications
* hemodialysis
* frequent blood draws
* central venous & arterial monitoring
55
for what purpose is a CVC preferable than a PVC?
measuring hemodynamics
56
what are the risks that come with *central lines*?
| (6)
* CLABSI
* hematoma
* arterial puncture
* hemothorax
* thrombosis
57
what are the indications for an *arterial line*?
| (3)
* need a live monitoring of BP
* frequent ABG analysis
* inability to use non-invasive monitoring on the pt
58
for what events is a live monitoring of BP indicated?
| (4)
* critical illness
* administration of vasoactive meds
* hemorrhage
* high-risk procedures that will cause drastic BP changes
59
what does it mean to *"zero"* a *pressure regulated transducer* for ***arterial lines***?
for every position change the reference point of pressure needs to be reset to ZERO for accurate measurement of BP
60
at what level does *transducer* needs to be placed?
phlebostatic axis *(in level with atria)*
| HOB 30 + arm level
61
what kind of data about blood pressure does an *arterial line* provide?
real-time systolic, diastolic, & MAP
62
what does the *central venous pressure* represent?
right atrial pressure *(venous return to the heart)*
63
what is another term for *venous return to the heart*?
preload
64
what causes ***increased*** CVP?
| (3)
* fluid overload
* cardiac tamponade
* RHF
65
what causes ***decreased*** CVP?
| (3)
* dehydration
* hypovolemia
* venous dilation
66
where are the possible placements of an *arterial line*?
* radial
* brachial
* femoral
67
what does a ***decreased*** MAP indicate?
poor tissue perfusion
68
what is *MAP* used for?
assess perfusion pressure
69
what is the normal range for *MAP*?
70-100 mmHg
70
how is *pulse pressure* calculated?
SBP-DBP
71
what is the normal range for a *pulse pressure*?
30-100
72
what does an elevated *pulse pressure* indicate?
aortic incompetence
73
what does a narrow (lowered) *pulse pressure* indicate?
hypovolemia
74
how is a *pulmonary artery catheter* placed?
| (4)
1. SVC
2. RA
3. RV
4. PA
75
what are the indications for a *pulmonary artery catheter*?
| (3)
* acute pulmonary HTN
* cardiac tamponade
* measurement of various cardiac pressures
76
what does a *pulmonary artery catheter* measure?
| (6)
* CO
* SV *(stroke volume)*
* SVR *(systemic vascular resistance)*
* RAP
* PAP
* pulmonary wedge pressure
77
where does the catheter of a *central line* end up?
inferior or superior vena cava
78
which vein is easiest to access for a *CVAD*?
internal jugular vein
| moderate risk of infection
79
what are the indications for using the *subclavian vein* for access?
lowest risk of infection
| HOWEVER, more difficult to access
80
why is the *femoral vein* least desirable for a *CVAD* access?
high risk for infection
| HOWEVER, easier to access for emergency
81
what are the indications for a *CVAD*?
| (8)
* vesicant medications
* multiple infusions
* large rapid infusions *(for emergency)*
* TPN
* lipids
* PIV cannot be achieved
* central monitoring of BP
* temporary dialysis access
82
what are the nursing actions to ensure patient safety with a *CVAD*?
| (3)
* do not bolus with *vasopressors*
* do not draw blood *(PV most appropriate for blood cultures)*
* push + pause w/ 10cc syringes
83
what is the standard dressing change rule?
every 7 days or PRN
84
how often does the gauze for a *CVAD* need to be replaced?
q24h
85
what does the nurse need to look out for when performing *CVAD* removal?
* SOB
* hypotension
86
what does the nurse do when the patient becomes SOB & hypotensive while removing *CVAD*?
lay on left side in order to trap the air in RA
87
how is the patient positioned for a *CVAD* removal?
* flat
* deep breaths w/ forced exhale
88
how does the nurse remove a *CVAD*?
* quick
* stop for resistance
* hold pressure w/ gauze for 5mins.
* place occlusive dressing
89
STEMI ECG
90
what kind of heart sound is heard in *pericardial tamponade*?
friction rub
91
what are the typical complications of *hemodynamic lines*?
* hemothorax
* pneumothorax
92
what is *pulsus paradoxus*?
a decrease in SBP upon inspiration concurrent with *cardiac tamponade*
93
for how long can a *PICC line* stay in place?
1 week for vascular access
94
for how long can a *midline catheter* stay in place?
4 weeks
