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Adult Health 2 > CVD 2 > Flashcards

CVD 2 Flashcards

1
Q

What is cardiac catheterization used for?

A

to identify and diagnose arterial blockages

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2
Q

What will happen during cardiac catheterization?

A
  • long thin catheter is inserted into an artery in the groin or wrist and threaded to heart
  • dye is injected so that heart structures and patency can be visualized via x-ray
  • patient is awake but given medicine to relax
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3
Q

What medications are often given during heart cath?

A

Versed and Fentanyl

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4
Q

Balloon Angioplasty

A

-catheter has a small balloon on tip that is inflated at site of blockage

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5
Q

How does the balloon angioplasty restore blood flow?

A

Balloon flattens or compresses the plaque against the artery wall opening up the vessel

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6
Q

Stent Placement

A
  • stent is replaced around the balloon, once the balloon has inflate, it expands against the vessel wall
  • balloon is removed but the stent remains in place
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7
Q

Pre-procedure for Heart Cath Care

A
  • vascular status of extremity used
  • Allen’s test
  • ensure patient is NPO for at least 8 hrs
  • shave area
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8
Q

Allen’s Test

A

done prior to using the radial artery for angioplasty to assess the arterial blood supply of the hand

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9
Q

Modified Allen’s Test

A
  • locate the radial and ulnar artery of hand to be used
  • ask patient to clench fist then occlude arteries
  • have patient open hand and relax
  • release pressure on ulnar artery while still occluding radial artery
  • color should return in about 7 seconds
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10
Q

If it takes longer than 7 seconds for color to return to hand what would that mean?

A

Allen test is positive and the radial artery should not be used (poor collateral blood flow)

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11
Q

Radial Artery Benefits

A
  • reduced risk of bleeding, vascular complications, and death
  • improved patient comfort
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12
Q

Femoral Artery Use

A
  • operator experience
  • higher vascular complications
  • bedrest is necessary
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13
Q

How often should you assess Heart Cath site for bleeding after procedure?

A

q 15 minutes for the first hour then per protocol

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14
Q

If a hematoma occurs what should be done?

A

Notify provider immediately then apply direct pressure

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15
Q

How long should the patient be on continuous cardiac monitoring and have vitals taken?

A

q 15 mins for first hour then q 30 minutes the next hour

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16
Q

How long should the extremity used be kept straight?

A

4 hours

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17
Q

How long could the patient be on bedrest?

A

2-8 hours

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18
Q

Post Cath Procedure care

A
  • assess for bleeding
  • educate patient to report bleeding or chest pain immediately
  • IV fluids x 2 hrs then increase oral fluids
  • assistance will be needed first time OOB
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19
Q

How is the heart catheter inserted?

A

inserted through a plastic introducer sheath (long hollow tube)

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20
Q

Sheath Care

A
  • sometimes patient returns to unit w/ sheath in place
  • bending affected limb is contraindicated
  • HOB at least 30 degrees or less
  • removed by trained cardiac nurse and patient remain on bedrest for 6 hrs
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21
Q

Patient Education after Heart Cath

A
  • no bending at the waist, heavy lifting, or straining for 24 hrs
  • no heavy exercise for 4-6 weeks
  • no driving for 24-48 hours
  • showers only
  • monitor for numbness/tingling
22
Q

When should the patient call the doctor after Heart Cath?

A
  • bleeding
  • swelling
  • new bruising
  • pain at site
  • fever > 101.5
23
Q

If the radial artery was used you should avoid what?

A

Sleeping on hand and repetitive movement for 24-48 hours

24
Q

Risks after having Femoral Heart Cath

A
  • hematoma
  • pseudoaneurysm
  • loss of pulse distal to insertion site
  • acute kidney failure
  • allergic reaction
  • cardiac tamponade
  • chest pain
25
Q

What happens during a Coronary Artery Bypass Graft (CABG)?

A

A blood vessel is grafted to the occluded artery, improving blood flow to the heart

26
Q

When would a patient qualify for a CABG?

A

When they have at least 70% occlusion

27
Q

What veins are often used for a CABG?

A

Greater and Lesser Saphenous veins

28
Q

Why are the Greater and Lesser Saphenous veins often used and how are the grafted?

A
  • Easier to retrieve by one surgeon while another works on the chest
  • grafted to ascending aorta and distal to occluded portion of coronary artery
29
Q

Nursing Care Post-Op CABG

A
  • monitor patient
  • incision care
  • assess for infection
  • cardiac rehab
30
Q

What is Cardiac Rehab?

A
  • medically supervised program designed to improve your cardiovascular health
  • exercise training, heart healthy living, stress reduction
31
Q

What is a Myocardial Infarction?

A

“Heart Attack”

myocardial death secondary to rupture of atherosclerotic plaque leading to complete obstruction of one or more arteries

32
Q

Time line of a MI

A

infarction (arterial obstruction)-tissue ischemia-muscle injury-cell death which occurs over minutes to hours

33
Q

S/S of MI

A
  • acute onset of pressure, tightness, pain, or a squeezing/aching sensation in chest, arms, neck, back. or jaw
  • n/v, indigestion, heartburn, abdominal pain
  • SOB
  • cold sweat/extreme diaphoresis
  • extreme fatigue/lightheaded, dizzy
  • feeling of impending doom
34
Q

Elderly patients may experience what when having a MI?

A

“silent ischemia” or no symptoms

35
Q

EKG

A
  • determines amount of ischemia and degree of injury
  • identifies location
  • follows progression and resolution of MI
  • should be done soon after admit or after chest pain begins
  • monitor for V-fib
36
Q

Ventricular Fibrillation (V-fib)

A

lethal arrhythmia that often results after a STEMI that can result in death

37
Q

An elevation in what may be significant for skeletal or cardiac muscle injury?

A

Total Creatinine Kinase

38
Q

CK-MB

A

specific to cardiac cells; increases only when there has been damage to the myocardium

39
Q

When does CK-MB increase and peak?

A

increases w/in 4-8 hours of cardiac injury and peaks w/in 24 hours

40
Q

If CK-MB is negative for more than 48 hours you should what?

A

look for source other than cardiac

41
Q

Myoglobin

A
  • found in cardiac and skeletal muscle

- elevated level is not specific to an MI, but normal level will rule out MI

42
Q

Troponin (I&T)

A
  • specific to myocardium
  • remains elevated for up to 3 weeks
  • detects acute injury or recent injury
43
Q

When does troponin increase and peak

A

Increases w/in 3-4 hours of injury and peaks w/in 24 hours

44
Q

What is a critical level of troponin?

A

1.5

45
Q

Goal for MI

A
  • minimize damage to heart
  • preserve heart function
  • reduce O2 demand while increasing meds
  • increase blood flow to heart
46
Q

At discharge it must be documented that the patient was discharged on what?

A
  • statin
  • ACE or ARB
  • Aspirin
  • Beta blocker
47
Q

Chronic Meds for patients Post-MI

A
  • statin
  • aspirin
  • ACE/ARB
  • Beta blocker
48
Q

Phase 1 Cardiac Rehab (Acute)

A
  • at diagnosis of atherosclerosis
  • light exercise and education
  • lifestyle changes, s/s probs, when to call 911, control hypertension/diabetes, weight loss etc..
49
Q

Phase 2 Cardiac Rehab (Recovery)

A
  • after discharge/lasts up to 6 months
  • supervised exercise w/ cardiac monitor
  • individualized based on stress test results
50
Q

Phase 3 Cardiac Rehab

A
  • supervised program/cardiac monitoring no longer needed

- maintain healthy heart long-term

51
Q

Nursing Management Post MI

A
  • administer ASA & MSO4
  • assess for bleeding w/ thrombolytic therapy
  • administer O2 to assist w/ oxygen supply
  • VS q 15 mins/bedrest
  • semi-fowlers to decrease dyspnea
  • monitor for hypervolemia
  • reduce anxiety
  • neuro checks q 4

Adult Health 2 (5 decks)

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