Exam 2, Deck 2 Flashcards Preview

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Flashcards in Exam 2, Deck 2 Deck (74):
1

Hypoxia symptoms (4)

Light-headedness
Dizziness
Syncope
Change in LOC

2

Cardiac symptoms (3)

Chest pain
Tightness
Palpations

3

Arrhythmia symptoms (6)

Similar to...

**Similar to when cardiac output falls:

Decreased LOC
Pale and cool skin
Possible FVE with JVD distention and lung crackles
Decreased urine output
Decreased BP

4

Cardioversion / Defibrillation: Mechanism

Deliver electrical current to stop the heart; allow the SA node to take over as pacemaker.

5

How much pressure for hand-held defib paddles?

20-25 lbs vertically

6

Cardioversion synchronizes and discharges the ___ in order to avoid _______.

QRS Complex
To avoid the R on T problem

7

Which requires higher Joule levels: Defib or Cardioversion

Defib

8

What is the function of electrophysiological studies

To evaluate and treat arrhtyhmias

9

What is mapping and ablation?

Mapping: Finding the group of cells that induce anarrhythmia (irritable cells)

Ablation: Destroys the problem cells

10

Coronary artery disease (CAD) : Two pathophysiological causes

- Atherosclerosis
- Atheroma

11

Define atherosclerosis

An abnormal accumulation of lipid and fibrous tissue in the vessel wall

12

What is a danger of atherosclerosis?

A rupture signals body to send platelets --> Clot forms --> Further blockage to artery results.

13

Define atheroma

Blockage that narrows vessel wall and decreases blood flow to the myocardium. PLAQUE.

14

What are the dangers of atheroma?

- Ruptures and clot forms
- Vessel becomes completely occluded: Myocardial infarction

15

Three things that could potentially cause vasospasm of coronary arteries

- Big burst of energy
- Cold weather or cold beverages
- Trauma, acute blood loss

16

Define acute coronary syndrome

Umbrella term for any acute coronary issue from angina to MI

17

Four non-modifiable risk factors for CAD

- Family hx
- Gender
- Aging
- Race

18

Risk factors for CAD: Male versus female

Prior to menopause, men have 3x more myocardial incidents. After menopause, the numbers are even between men and women.

19

Seven modifiable risk factors for CAD

- High cholesterol
- Cigarettes
- Hypertension
- DM
- Lack of physical activity
- Obesity
- Stress

20

Define angina pain

Pain lasting for less than ten minutes; usually radiates to the neck or left arm and is alleviated by rest and/or nitroglycerine

21

Angina categories (3)

- Classic ("stable") angina
- Unstable angina
- Prinzmetals / variant angina

22

Three characteristics of classic angina

- Pain or pressure lasting less than ten minutes (usually 3-5 minutes)
- Most common type of pain
- Predictable: Relieved by rest and/or nitroglycerine

23

Characteristic of unstable angina

UNPREDICTABLE. Pain with little or no activity.

24

Two characteristics of Prinzmetals / variant angina

- Second CA Vasospasm
- Not provoked by exercise

25

What can precipitate angina pain? (5)

- Physical exertion
- Exposure to cold
- Eating a heavy meal
- Stress, emotional factors
- Stimulants

26

What are three stimulants that may precipitate angina pain?

Cocaine
Coffee
Cold and cough meds with adrenergics in them

27

What causes angina pain, physiologically?

Occurs when the heart receives insufficient blood for oxygen demands at the time, such as in atherosclerosis and arteriosclerosis

28

Nature of angina pain (3)

- Localized
- Midsternal
- Possible radiation to shoulders, arms, neck, jaw

29

Four other assessments of an angina patient

Apprehension
Tightness or choking sensation
Weakness, fatigue
Numbness in arms

30

Four lab work components done on an angina patient

CK-MB
Troponin
Myoglobin
Chem 7

31

What position should an angina patient be in

FOWLER'S. Patient will assume this position automatically.

32

What happens to an ECG when a patient is in pain?

ST depression indicates ischemia -- ST segment will be lower than isoelectric line when patient is in pain.

33

Seven nursing interventions for an angina patient

1) Rest
2) O2
3) Nitroglycerine
4) Other meds
5) Patient education
6) Psychological support
7) Stress Reduction

34

ARB Mechanism

Block angiotensin II receptors

35

Patient education: Angina: Lifestyle changes (5)

- Stop smoking
- Lose weight
- Exercise
-Take meds as directed
- Avoid cold weather

36

Patient education: Angina: Dietary changes (6)

- If diabetic, control blood sugar
- Alcohol in moderation
- More fruits, veggies
- More lean meats
- Less sodium
- Less trans fats

37

Etiology of Myocardial Infarction (3)

1) Reduced blood flow
or
2) Complete arterial occlusoin
or
3) Reduces cardiac blood flow

38

Two things that could reduce blood flow ending in MI

Ateroma
Vasospasm

39

Two things that could cause complete arterial occlusion ending in MI

Thrombi
Emboli

40

Two things that could reduce CADIAC blood flow ending in MI

Hemorrhage
Shock

41

Takotsubo

Broken heart syndrome -- death of grief with clear cardiac arteries.

42

Nature of MI pain (5)

- Substernal pressure
- Crushing
- Radiating
- Often not related to exercise / stress
- Not relieved by rest or nitro

43

How often are MIs "silent"?

30% of the time

44

From the onset of chest pain, how long do you have to reverse the damage?

Six hours. TIME IS TISSUE.

45

What other symptoms might a patient experience with MI (besides pain) -2

- Anxiety, feeling of impending doom
- NV

46

Leading cause of death from MI

Dysrhythmia / arrhythmia 2/2 alteration in function

47

Objective changes provider will observe with MI (6)

- Pulse changes
- Diaphroetic
- Pale skin
- Increased temp and WBCs 2/2 inflammation
- Change in LOC
- Signs of cardiogenic shock

48

Two lab indications of an MI

Increased CK-MB
Increased Troponin

49

If you're not sure whether the patient is having an MI, when should you keep them in the hospital anyway?

- Pain unrelieved by nitro
- Vomiting
- Diaphoresis

50

What differences would you see on an ECG between angina, a STEMI and a non-STEMI

- Angina only alters ECG when patient is in pain
- NSTEMI has no changes in ST
- STEMI has ST segment elevation, T wave changes

51

What do the ECG changes on a STEMI indicate?

Severe tissue necrosis and the need for emergency revascularization

52

What interventions constitute emergency re-vascularization?

- PTCA with or without a stent
- CABG

53

Labs for angina vs NSTEMI vs STEMI

Angina - normal CK-MB and Troponins
NSTEMI and STEMI - elevated CK-MB and Troponins

54

What four systems are altered by an MI?

- Cerebral
- Cardiac
- Peripheral
- Kidneys

55

Effect of MI: Cerebral

LOC

56

Effect of MI: Cardiac (2)

Chest pain
Arrhythmias

57

Effect of MI: Peripheral (3)

Edema
Decreased pulses

58

Effect of MI: Kidneys

Increased creatine
Decresaed urine output

59

Four goals of MI care

- Minimize myocardial damage
- Prevent complications
- Restore circulation
- Reduce myocardial oxygen demand

60

Why should an MI patient avoid Valsalva?

Bearing down increases thoracic pressure, decreases BP slightly

61

When can an MI patient have sex again?

Once a patient can walk up 2 flights of steps and be asymptomatic --> Ready for sex

62

Medical interventions for an MI (3)

1) PTCA
2) Coronary Stent
3) CABG

63

What does PTCA stand for?

Percutaneous Transluminal Coronary Angioplasty

64

What patients are candidates for PTCA?

- Must be a CABG candidate
- Patients who are contraindicated for thrombolitics
- Patients at hospitals who have this capacity
- Patients whose vessels are 70-80% occluded

65

How is a PTCA performed? (3)

- Catheter through femoral artery
- Dye injected to find narrowing
- Inflate catheter balloon fora few seconds at a time to push plaques to the side

66

What must you have a patient sign before a PTCA is performed?

Consent for a CABG

67

Six complications of a PTCA

- Dissection, perforation or vasospasm of the coronary artery
- MI
- Dysrhythmias
- Cardiac arrest
- Hemorrhage
- Thrombus

68

Why would PTCA cause an MI?

If balloon is inflated for too long

69

Post PTCA (4)

- Observe for 24 hours
- Assess for chest pain
- Nitroglycerine
- Anticoagulants

70

What is the biggest risk with a coronary stent?

Clot formation post-placement

71

How is heart stopped for CABG?

Cold slurry with a lot of potassium put into chest cavity

72

How is blood oxygenated during CABG?

- Catheter in the vena cava that brings blood to pump to oxygenate

73

How much is patient cooled for bypass?

4-6 degrees celsius

74

What vessel is harvested for CABG?

Either greater or lesser saphenous vein from leg