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Ngozi's Acute and Chronic Care II > ED Care PT w/ ACS > Flashcards

ED Care PT w/ ACS Flashcards

Exam 2

1
Q

What labs do you get for chest pain?

A

CBC CMP BMP and Troponin
Maybe a PT PTT and INR

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2
Q

What should the total ischemia time for chest pain be? Should the patient be taken to a hospital with PCI [Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat the blockages in a coronary artery] capabilities?

A

under 120 min
Yes

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3
Q

What are pulsus alternans

A

change in pulse amplitude every other beat

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4
Q

What does T stand for in chest pain assessment?

A

Timing

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5
Q

ECG and ischemia, injury, and infraction

A
  1. Ischemia - causes depressed ST segment
  2. Injury - ST elevation on ECG
  3. Infarction - Q wave on ECG
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6
Q

What occurs when a pt has an mi?

A
  • Within minutes of hypoxia to an area, the cells lose their contractility.
  • If o2 isn’t restored to the area, mi occurs.
  • Infarcted cells can’t help the heart contract.
  • Scar tissue builds up and ventricular remodeling can occur, changing the shape of the heart muscle.
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7
Q

What condition is increased in heart disease that presents with these clinical manifestations?
>40(men) or >35(women) inch waists, high triglyceride levels, high ldl, low hdl

A

Metabolic syndrome
changing lifestyle can help

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8
Q

What determines blood pressure?

A

Flow through the vessels and vessel resistance

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9
Q

How does oxygen-rich blood enter the heart?

A

From the lungs and goes out to the body

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10
Q

What does ACS stand for?

A

acute coronary syndrome insufficient blood supply to heart muscle causing chest pain

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11
Q

What is the main cause of development of fatty plaques in coronary arteries?

A

Atherosclerosis

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12
Q

What is atherosclerosis?

A

Accumulation of lipids/fatty substance/fibrous in vessel wall

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13
Q

What is stable angina?

A
  • is the accumulation of plaque in coronary arteries
  • occurs with exertion and is relieved by rest
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14
Q

What are nonmodifiable risk factors for atherosclerosis and ACS?

A

Family history, increasing age, gender, race

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15
Q

What are some modifiable risk factors for atherosclerosis and ACS?

A

High blood cholesterol levels, smoking tobacco use, HTN, diabetes mellitus, lack of estrogen in women, physical inactivity, obesity, behavior patterns

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16
Q

What does LDL stand for?

A

below 130 mg/dl want it LOWWW to the ground

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17
Q

What is metabolic syndrome also known as?

A

Insulin resistance syndrome

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18
Q

Which is most severe injury, ischemia, infarct?

A

Infarct
Injury
then ischemia

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19
Q

What is infarct

A

An absence of blood flow to the myocardial tissue, leading to necrosis.

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20
Q

What is the manifestation associated with myocardial oxygen demand exceeding supply?

A

Chest pain

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21
Q

What does I see all leads stand for?

A

Inferior II , II , avf
Septal v 1 v2
Anterior v3 v4
Lateral v5 v6

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22
Q

Angina can be…

A

stable angina, unstable angina, and variant
Stable angina occurs with exertion and is relieved by rest.
Unstable angina pain is often more severe, may occur at rest, and requires more frequent nitrate therapy.
Variant angina caused by coronary artery spasms.

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23
Q

What route and med would you not giving if you have an st elevation in the leads II, III, and AVF?

A

Inferior Stemi – ST elevation in II, III, AVF
Nitro sublingual because you cannot adequately control how much and how fast you are giving nitro?

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24
Q

What shows the septal view of the heart?

A

V1 and V2

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25
Q

What shows the lateral view of the heart?

A

V5 and V6

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26
Q

What is angina?

A

Chest pain caused by myocardial ischemia

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27
Q

What are concerning signs for angina?

A

Radiation to left hand, elbow, arm, shoulder, neck, head, jaw, tooth
When it lasts longer than 20 mins and us unrelieved by rest or nitro

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28
Q

What is stable angina?

A

Chest pain with exercise, it is predictable and relived by rest or nitro

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29
Q

What is unstable angina?

A

More severe form of chest pain
Can be an indication of impending MI

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30
Q

What is the possible cause of Variant or Prinzmetal’s Angina?

A

Vasospasms with minimal plaque causing chest pain at rest

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31
Q

What is a myocardial infarction?

A

Abrupt deprivation of oxygen to the heart

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32
Q

What are the three stages of an acute myocardial infarction?

A

Ischemia, Injury, Infarction

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33
Q

What leads are considered inferior?

A

II, III, AVF

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34
Q

What are the leads that show ST-segment elevations suggestive of septal myocardial infarction?

A

Septal V1, V2

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35
Q

n/v shob, dizziness, diaphoresis – associated symptoms
Increase in mi oxygen demand when they get up
left pain arm mean mi
Coughing – respiratory
Is movement the problem increase mi oxygen

A

Chest pain assessment s/s

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36
Q

What does the ‘R’ in chest pain assessment stand for?

A

Radiation – move to chest

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37
Q

Color of skin and mucous membranes.
Pallor of lower extremities with legs raised may be indicative of arterial insufficiency.
Pale upper plate can tell a lot by what occurs in month
Cyanosis may be indicative of low PaO2 or Right to Left shunting.
Edema: may be indicative of Right Vent Failure.
Varicosities: Predisposition to thrombophlebitis.
Clubbing: Indicative of chronic O2 deficiency.
Position of comfort: Orthopnea may be indicative of Left Vent. Failure.

A

What do you look for in cardia assessment in terms of perfusion?

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38
Q

Skin temperature: does temperature reflect good circulation? Why? Why not? – it can help indicate – signs pt is not getting good refill
LOC: How alert is my patient?
Breathing: Is my patient SHOB?
Heart tones
Skin color
Extremities
Pulses
What do each of these things tell me about my patient?

A

Cardiac Assessment: Palpation & Percussion

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39
Q

What should be assessed in the cardiovascular examination?

A

Rate, rhythm, presence of murmurs

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40
Q

What is the anatomical location of the carotid pulse?

A

Neck

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41
Q

What are the points on the chest to auscultate for the heart?

A

Aortic pulmonic tricuspid and mitral
APE TO MAN

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42
Q

What is the normal range for pulse pressure?

A

30-40 mm Hg

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43
Q

What should you assess in the neck veins during a cardiac inspection?

A

RIJ distention and pulsation
HOB 30 to 45 degrees to check

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44
Q

What should be evaluated during cardiac assessment of neck veins?

A

RIJ distention, pulsation, Jugular Venous pressure, Hepato-jugular reflux

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45
Q

What is the recommended O2 level for patients with indicated spo2 <94%?

A

2-4L

46
Q

What should be done when a patient presents with chest pain?

A

O2 - 2-4L if indicated spo2 <94%
IV line(s)
12 - Lead EKG
Continuous cardiac monitoring
Lab Tests
Patient Position

47
Q
  • EKG confirms ST elevation in any group of leads
  • There will be ST elevation + (eventually if not already present) the release of troponin I, which is a protein that is specific to the heart muscle when damage occurs.
  • Reperfusion therapy should be administered to all eligible patients with a STEMI (Tenecteplase)
  • PCI is the recommended method (Percutaneous Coronary Intervention)
  • Fibrinolytics after STEMI: Check PT/PTT/INR
A

STEMI

48
Q

What should you always check before giving Nitro?

A

Blood pressure

49
Q

Angina v MI

A

ANGINA
Occurs with exertion (physical or emotional)
Is relieved by rest
Is relieved by nitroglycerin
Last for minutes

50
Q

What are s/s you’ll see in an MI

A

Pian radiating to back necj jaw shoulder arm
Dyspnea
Syncope
N/V
Weakness
Diaphoresis
Tachy

Are you having any nausea/vomiting/shob/dizziness/diaphoresis/radiation to left side?

51
Q

What is the recommended frequency for monitoring vital signs while titrating NTG?

A

Q 5 min

52
Q

What high risk monitoring should you do?

A

Assess LOC - sensitive indicator – decrease bloodflow causes confusion
Cardiogenic Shock – not able to perfuse enough blood – low bp – inferior stemi – 60/90 is cardiogenic shock

53
Q

What is the effect of hyperkalemia on the T wave?

A

T wave elevated

54
Q

What is a high sensitivity troponin flowsheet?

A

Documentation tool for monitoring high sensitivity troponin levels
Less than or equal to 15

55
Q

What are signs of cardiogenic shock?

A

Decreased LOC
Tachycardia
SBP < 80
Narrowed pulse pressure – top number and bottom are getting closer together
Pale, cool, clammy skin – might give levophed

56
Q

What is afterload?

A

Resistance against which the ventricle has to pump to eject blood
(resistance) – all the blood outside of the venous system

57
Q

What does HDL stand for?

A

High Density Liproprotein want above 45 mg/dl for a client to feel HIGGHHH and HEALTHY

58
Q

What happens to insulin levels in metabolic syndrome?

A

Elevated insulin levels because the pancreases overreacts to make more insulin

59
Q

How does nitroglycerin help relieve pain?

A

vasodilates the vessels

60
Q

How does Variant or Prinzmetal’s Angina present?

A

With normal findings and the area where it the vasospasm occurred will cause the most pain

61
Q

What are the phases of tissue injury in a myocardial infarction?

A
  1. Ischemia - no damage as long as MI doesn’t extend as circulation is compensated/(causes depressed ST segment)
  2. Injury - Tissue may be saved if O2 is increase in area/(ST elevation on ECG)
  3. Infarction - O2 deprived/irreversible damage/(Q wave on ECG)
62
Q

What is represented by tissue death and Q waves?

A

Infarction

63
Q

What is an inferior MI?

A

Damage to the inferior wall of the heart

64
Q

What can jugular venous distention indicate?

A

Right sided failure

65
Q

MI v Angina

A

MI
Can occur at rest
Is not relieved by rest
Is relieved by morphine rather
than NTG
Lasts for at least 20 minutes

66
Q

What medications are indicate for MI?

A

ASA - asprin
Oxygen
NTG - sublingual
Morphine – decrease oxygen demand and cardio work load
NTG - IV drip
Thrombolytic (Tnkase/T-pA)\
Heparin

67
Q

How often should vital signs be assessed once stable?

A

Q 15 min

68
Q

What is released when there is damage to the heart?

A

Tropin

69
Q

What is the effect of hypokalemia on the T wave?

A

T wave depressed

70
Q

If dysrhythmias occur due to MI…

A

Antiarhythmic
Amiodorone
Lidocaine
Atropine – increase HR
Pacemaker
Cardioversion

71
Q

How does oxygen-poor blood enter the heart?

A

From the body and goes out to the lungs

72
Q

Left side v right side

A

Left is lungs – shob, hypoxia, confusion, anxiety – not pumping as much blood as we are supposed to
Right for rest of body edmea, jvd, anything that is not resp is probably right

73
Q

What does clubbing of the nails indicate?

A

Chronic low oxygen saturation

74
Q

Where is the point of maximal impulse usually visible? Anterior chest appearance

A

4th to 6th I.C. space medial to left midclavicular line

75
Q

What should be done immediately for a patient with chest pain?

A
  1. Arrive to ED
  2. Nurses immediately notified
  3. Call for ECG immediately/placement of monitors (cardiac and vitals)
  4. IV access/with simultaneous lab draw-CBC, CMP, TROP, CXR, maybe BNP
  5. Aspirin 162-324mg depending on facility (chewed)
  6. Nitro if not contraindicated (inferior STEMI)
76
Q

What is a desirable quality of IV Nitro that SL Nitro does not have?

A

IV Nitro can be titrated with a drip

77
Q

What is the use of NTG IV drip?

A

Used for continuous relief of angina

78
Q

What is the recommended dosage of aspirin for a patient experiencing chest pain?

A

Chew and take 81-325 mg of asprin

79
Q

What should be checked in the legs, ankles, and feet?

A

Edema, pulses, sensation, pressure areas

80
Q

What are the most common side effects? What should you educate your patient on?

A

Dizziness and headache.
1. Warn them it may and probably will happen.
2. Recline their head of bed and discourage standing up.
3. Consider making your patient a “fall risk”

81
Q

What is preload?

A

Stretch on the ventricular myocardium at the end of diastole

(filling pressures) – the blood that has not completely returned to the heart

82
Q

What does a clot indicate?

A

Congestion and no traffic meaning the body cannot perfuse to that part of the cardiovascular system

83
Q

What are the three levels of acute coronary syndrome?

A

ischemia, injury, and infract

84
Q

What are the two types of ACS?

A

STEMI and non-STEMI

85
Q

What happens when the vasculature supplying oxygen to the coronary muscle narrows?

A

Limited blood flow

86
Q

What are atherosclerosis symptoms and complication based on?

A

the location and degree of narrowing of arterial lumen

87
Q

When does stable angina become unstable and dangerous?

A

when the plaque ruptures or becomes unstable in the vasculature

88
Q

What is the fasting glucose level in metabolic syndrome?

A

Fasting glucose >110

89
Q

Which tissues become unresponsive to insulin in metabolic syndrome?

A

Skeletal muscle, fat, and liver

90
Q

What is ischemia?

A

Temporary interruption of myocardial blood supply

91
Q

What is injury in the context of myocardial blood flow?

A

Prolonged interruption of blood flow

92
Q

What does angina pectoris mean?

A

Strangling of the chest

93
Q

What is the effect of nitro on blood pressure?

A

lowers blood pressure and vasodilates

94
Q

Which leads show the anterior view of the heart?

A

V3 and V4

95
Q

When should an ECG be obtained for toothaches?

A

One-sided toothaches in absence of poor dentition

96
Q

How do you tx variant angina?

A

Cardizem
Treated with calcium channel blockers.

97
Q

What is St depression?

A

Ischemia indicator

98
Q

What is represented by ST segment depression, T wave inversion, or both?

A

Ischemia

99
Q

What is represented by ST segment elevation?

A

Injury

100
Q

P wave represents?

A

atrial contractions

101
Q

QRS represents?

A

Atrial contraction of the ventricles

102
Q

T wave represents?

A

Relaxation of the ventricles

103
Q

What does the ‘P’ in chest pain assessment stand for?

A

Provoke

104
Q

What does the ‘Q’ in chest pain assessment stand for?

A

Quality – sharp stabbing aching

105
Q

What does the ‘S’ in chest pain assessment stand for?

A

Severity

106
Q

What is the anatomical location of the dorsalis pedis pulse?

A

top of foot

107
Q

What is the anatomical location of the femoral pulse?

A

Groin

108
Q

What is the anatomical location of the posterior tibial pulse?

A

Ankle

109
Q

Why is it important to know what you are listening to when you listen to the heart?

A

To provide accurate clinical information

110
Q

What abnormalities should be noted during heart tone assessment?

A

S1 & S2 abnormalities, S3, S4, and/or murmurs

111
Q

Pulsus alternans – change in pulse amplitude every other beat
Paradoxic pulse – decreased systolic blood pressure during inspiration
Blood pressure difference > 10 mm Hg between left and right arm (may indicate aneurysm, aortic dissection, obstruction, or arterial compression.
Orthostatic hypotension - significant if > than 20 mm Hg.
Bruits: caused by arterial narrowing (plaque), aortic murmur, patency of fistula.

A

Abnormal findings?

112
Q

What is paradoxic pulse?

A

Decreased systolic blood pressure during inspiration

Ngozi's Acute and Chronic Care II (4 decks)

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