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NURS 2360 Med/Surg > Exam One Perfusion > Flashcards

Exam One Perfusion Flashcards

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1
Q

Which layer of the heart is effected during an MI and Acute Coronary Syndrome?

A

Myocardium

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2
Q

Physiology of the heart

A

Vena Cava –> Right Atrium –>tricuspid valve
–> right ventricle –> pulmonary valve –> pulmonary artery –> lungs –> left atrium –> mitral valve –> left ventricle –> aorta (system)

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3
Q

What does the coronary artery do?

A

it is off the aorta. It delivers oxygenated blood to the heart.

it fills during relaxation (diastole)

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4
Q

What are collateral blood vessels?

A

new vessels that form as we age. It is stimulated by the progression of CAD & is helpful in redirecting blood flow

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5
Q

What do coronary veins do?

A

Carry unoxygenated blood. They bring used blood back to circulation. They eventually join together to form 1 large vein the coronary sinus which opens to R atrium

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6
Q

What is considered the pacemaker of the heart?

A

SA node, but if it’s sick another part of the heart can be.

Rhythms originate in the SA node

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7
Q

What ions are important for depolarization?

A

sodium, potassium, calcium

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8
Q

What happens during diastole?

A

the heart is resting. Ventricles are filling and atria are emptying. Coronary arteries are filling

tricuspid and mitral valves are open - blood flowing from atria to ventricles

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9
Q

What happens during systole?

A

Contracting. Ventricles are ejecting blood to pulmonary artery and aorta

the pulmonic and aortic vlaves are open, blood is flowing from ventricles to PA or aorta

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10
Q

What creates the S1 (lub) sound?

A

closing of the AV valves

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11
Q

What creates the S2 (dub) sound?

A

closing of the semilunar valves (pulmonic/aortic)

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12
Q

Age Related Cardiac Changes

A

myocardium decrease in efficiency and contractility.

SA node increases in thickness and decreases in number of pacemakers cells.

left ventricle hypertrophy, prolonged diastole, increase diastolic filling time.

aorta is elongated and dilated.

valves are thicker and more rigid.

PVR increases

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13
Q

What causes chest pain?

A

not getting enough O2 to the myocardium

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14
Q

What assessment to do for somebody experiencing chest pain?

A

vital signs (all)
LOC
color
presence of jugular vein distention (right)
edema (right)
peripheral pulses
extremities and skin
cap refill

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15
Q

S3 heart sound cause

A

too much fluid

heard during early diastole

“slosh—ing—in”

left ventricular heart failure, valve regurgitation or too much fluid.

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16
Q

S4 heart sound cause

A

ventricular wall effected.

Before S1

“A–stiff–wall”

MI, angina, aortic stenosis, HTN, pulmonary HTN, pulmonary stenosis.

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17
Q

Pericardial Friction Rub

A

caused by inflammation of pericardial sack.

Sounds like leather rubbing together between S1 and S2

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18
Q

When should you do lung assessment with cardiac complaint?

A

CHF
Left sided failure
fluid overload
Dyspnea

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19
Q

What labs would you draw for cardiac?

A

Cholesterol
C-Reactive Protein
Cardiac enzymes
CBC
Coags
BMP

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20
Q

What are the cardiac enzymes?

A

Troponin (most reliable)
CK
Myoglobin
CK-MB

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21
Q

What diagnostics would you do for cardiac?

A

CXR
12 lead EKG **
Stress Test
Holter monitor
EP study
Echocardiogram
Nuclear Cardiology
pericardiocentesis

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22
Q

Cardiac Catheterization

A

Gold standard chest pain intervention to revascularize

May gain access via femoral, brachial, or radial artery

assess heart function, block, or narrowing

insert stent, balloon, fibriolytics

determine need for coronary artery bypass graft or other surgery

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23
Q

Cardiac Cath. Pre-Procedure

A

patient teaching/informed consent

allergies (iodine)

assess and document peripheral pulses determinant of where entering body

NPO except meds 6-8 hours before if elective

IV access

Oral anticoagulants held for elective CC (warfarin, dobigatran, apixoban, etc.)

antiplatelets do NOT need to be held (aspirin, ticagrelor, clopidogrel)

heparin IV bolus and/or infusion standard

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24
Q

Cardiac Cath. Post Procedure

A

bedrest - FLAT if femoral artery assessed

minimize movement of effected extremity

hold pressure over site

frequent site assessment for bleeding/hematoma

assess peripheral neurovascular circulation

monitor renal function

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25
Arterial Pressure
pressure bag must be maintained so blood doesnt backup - keeps line open insert radial, brachial, axillary, or femoral can draw ABG with it assess efficacy of vasoactive medications
26
Risks of arterial line - nursing actions
biggest risk is bleeding & hemmorhage infection air embolism may impede circulation to digits nurse monitors waveform and pressure readings maintain saline filled pressure tubing dressing changes as ordered NEVER infuse meds through arterial line may draw ABG avoid BP cuff in same extremity. titrate medications as needed based on hemodynamic readings.
27
Pulmonary Artery Catheterization
Assess pulmonary HTN, organ perfusion, & shock states assess CVP in right atrium PA systolic, diastolic, & mean additional ports can be used for meds
28
Pulmonary Artery Cath Risks - nursing action
hemorrhage air embolism PA rupture and death Nurse must monitor waveform and pressure readings. maintain saline filled pressure bag. dressing changes as ordered titrate medications based on hemodynamic readings.
29
What is myocardial ischemia?
when oxygen supply is inadequate to meet metabolic needs
30
Preload
the amount of cardiac muscle fiber stretch/tension that is present at the end of diastole - amount of fluid returning to the heart
31
Afterload
the force that ventricles have to overcome to eject the blood volume
32
Acute Coronary Syndrome
Coronary blood flow is significantly reduced - leads to MI Most people have significant atherosclerotic occlusion of one or more coronary arteries.
33
Mycocardial Infarction
Blood flow to portion of cardiac muscle is COMPLETELY blocked. Good collateral circulation can limit size of MI
34
What distinguishes an MI from Stable Angina?
MI not relived by rest/nitroglycerin radiates to shoulders, neck, jaw, arms
35
MI diagnostic testing
CK CK-MB troponin myoglobin ABGS CBC echocardiography hemodynamic monitoring
36
Treatment of MI
goal: retore blood flow relieve chest pain reduce extent of damage improve oxygen maintain cardiovascular stability decrease cardiac workload (preload and afterload) long term: slow process of CAD manage risk factors
37
Acute management of MI (happening now)
O2 if <94% 12 lead EKG Assess ST segment and T wave IV access draw cardiac enzymes give nitroglycerin Give aspirin 160-325 mg (chew!) consider morphine (decreases preload and afterload) cardiac cath within 90 minutes!
38
Thrombolytics/Fibrinolytics
first-line drug for acute MI ASE ending break down clots must be given within 6 hours of the ONSET of symptoms Exclusion if have any bleeding issues Fibrinolytics is CONTRAINDICATED for NSETEMI
39
Fibrinolytics nursing actions
Prior to administration: draw blood for baseline 3 large bore IVS 18 or 20 all other invasive procedures prior to tPA (Ex. foley) Once administered: V/S frequently Heart rhythm pulse ox heart and lung sounds neuro status (at risk for neuro changes) ST segment and T wave changes (Should see improvements) Chest pain Cardiac enzymes
40
Heparin and fibrinolytics
heparin given after fribinolytics to prevent new clots monitor for signs of bleeding! decreased BP, decreased H&H, bruising, bloody urine
41
Heparin
used for NSTEMI treatment fibrinolytic treatment is contraindicated for NSTEMI treatment standard during cardiac cath to prevent thrombotic events titrate based off of PTT or aPTT results
42
aPTT normal range
30-35 seconds
43
PTT normal range
60-70 seconds
44
Statins
Cholesterol reducing medications
45
antiplatelets
aspirin ticagrelor clopidogrel
46
ACE inhibitors
decrease afterload lisinopril
47
Angiotensin receptor blockers
decreased afterload valsartan
48
Beta blockers
decrease afterload "lol" endings
49
calcium channel blockers
decrease afterload (eject more blood) amlodipine
50
nitrates
decrease preload and afterload. Dilate blood vessels monitor for side effects! headache, decrease in BP (check BP between doses)
51
Pharmacological Management of MI
cholesterol reducing medications (Statins) antiplatelets ACE Inhibitors (pril) Angiotensin Receptor Blockers (Artan) Beta Blockers (lol) Calcium Channel Blockers (pine) Nitrates Antidysrhythmics IV inotrope infusions IV vasoactive infusions Stool Softener
52
IV inotrope Infusions
maintain cardiac output dobutamine
53
IV vasoactive infusions
maintain BP norepinephrine
54
Revascularization Procedures
Percutaneous Transluminal Coronary Angioplasty (PTCA) aterectomy (instrument shaves away plaque - large so hard in small BV or women) Laser Angioplasty (laser used to break up plaque) CABG (vessels harvested to reroute blood around stenosis, done for acute angina)
55
Post cath/CABG care
ICU for 24-48 hours ambulation limitations site assessment O2 if SpO2 <94% mid-sternal wound and chest tube care low-fat, low-cholesterol, low-sodium diet avoid large caffeine
56
Other management of decreased coronary output
Intra-aortic balloon pump (temp. take over function of heart, offered in ICU while waiting on surger) VAD (long term support. high risk of infection. mechanical failure life threatening)
57
What is the measurement of a big box on an EKG strip
1 big box = 5 little box 0.20 seconds
58
Little Box EKG strip
0.04 seconds
59
Boxes on EKG
left to right measures time up and down measures voltage
60
Calculating HR of EKG
rhtym must be regular count # of QRS complexes between 2 hash marks on EKG paper Each hash mark represents 3 seconds multiply by 10
61
P wave
represents atrial depolarization (contraction) smooth, rounded, upright should occur befoer each QRS impulse comes from the SA node
62
PR interval
the time required for the SA impulse to travel to the AV node measure from start of P wave to start of Q normal: 0.12-0.20 (3-5 little boxes) prolonged means bradycardia
63
QRS
represents ventricular depolarization (contraction) usually the tallest part Q: first downard deflection R: upward deflection above baseline S: any negative deflecton after the R wave measure from start of Q to end of S normal: 0.04-0.12 seconds prolonged means depolarization is taking longer than it should
64
T wave
represents ventricular repolarization (relaxation) smooth, round shape follows QRS and usually points in the same direction
65
ST segment
represents the start of ventricular repolarization end of QRS to start of T wave looking for ACUTE ischemia if up or down 2 vertical boxes = acute iscemia
66
QT interval
represents total time of ventricular depolarization and repolarization start of QRS and end of T wave normal: 0.32-0.44 prolonged QT indicates a prolonged relative refractory period - period of time between repolarization and depolarization can lead to torsades de pointes prolonged: electrolyte imbalance
67
U Wave
not normally seen would be rounded upright following T wave if seen means hypokalemia
68
Rhythms originating in the SA node
normal sinus rhythm (60-100) sinus bradycardia (<60) sinus tachycardia (101-150) supraventricular tachycardia (150-200)
69
Rhythms NOT originating in SA node
atrial fibrillation atrial flutter
70
A FIB
irregular rhythm with NO discernable P waves. Fluttering noted at baseline T wave may or may not be visible suseptible to atrial fibrillation with rapid ventricular response (elevated HR) R/O clots D/T stagnant blood, pulmonary embolism, stroke Meds: anticoagulants
71
Atrial Flutter
atrial rhythm is regular, ventricular rhythm is normally regular "saw tooth rhythm" P:QRS ration may be 2:1, 4:1, 6:1, etc
72
Rhytms orginating in ventricle
Ventricular Tachycardia Ventricular Fibrillation Asystole
73
V Tach
may or may not have a pulse no pulse: start CPR, defibrillator, give epi pulse: consider cardioversion or antidysrhymic looks like a bnch of humps torsades de pointes: crazy points. Magnesum imbalance
74
V FIB
lethal rhythm! start CPR, must defibrillate, give epi
75
Asystole
not shockable, start CPR, give epi
76
Pulseless Electrical Activity
organized rhythm on monitor but pt has no pulse start CPR, cannot defib., give epi review reversible causes (H & T)
77
Synchronized Cardioversion
done for atrial dysrhythmias or VT with a pulse - patient is ALIVE superventricular tachycardia, a fib with rapid ventricular response VT with a pulse Timed with cardiac cycle - machine knows must press SYNC
78
Defibrillation
done for pulseless V TACH or V-Fib patient is dead higher voltage synchronous mode must be OFF no QRS within 2 minutes of arrest
79
Automatic Implantable Cardioverter-defibrillator
for those who go into V TACH pacemaker may be incorporated
80
Pacemaker
if SA node is not generating an impulse or fails to conduct impulse to ventricles can stimulate the myocardium and induce ventricular contraction for bradycardia, heart blocks, and other dysthymias causing LOW HR External pacemaker: delivered through chest wall for emergency situation - hurts!
81
What is cardiomyopathy
the heart can't pump properly, perfusion issue
82
Dilated cardiomyopathy
most common! 20-60 year olds Cause unknown associated with toxins, metabolic conditions, infection as the heart muscle becomes thinner and dilates LV enlarges then RV and RA enlarge, heart muscle becomes weak
83
Hypertrophic Cardiomyopathy
usually inherited possibly chronic HTN sudden death in otherwise healthy people thickening of ventricular muscle decreased ability to pump blood Decreased ventricular filling - decreased CO due to low LV volume and poor ejection.
84
Restrictive Cardiomyopathy
secondary to something else scarring of heart muscle reduced ability to stretch and fill with blood muscle rigid impact filling of ventrciles
85
Arrhytmogenic Right Ventricular
inherited can lead to sudden death in athletes young adults 10-40 prescreening for sports can detect ventricular tachyarrythmias
86
Clinical Manifestations of cardiomyopathy
fatigue, dyspnea, decreased output, atrial or ventricular arrythmias
87
Diagnosing CMP
H&P EKG BNP CXR Echocardiogram Nuclear Imaging Cardiac Cath Endomyocardial biposy
88
Treatment for CMP
ace inhibitors, calcium channel blockers, beta blockers, digoxin, diuretics, anticoagulants, antidysrhthmics VAD cardiac remodeling surgery ICD pacemaker heart transplantation
89
goals of treatment of cmp
manage symptoms maintain cardiac output prevent dysrrthmias establish fluid balance activity tolerance
90
endocarditis
innermost layer of heart valves are the primary problem damaged valves cause portal of entry for organism to enter blood stream - dental work, IV drug abuse, surgery
91
Symptoms of endocarditis
aching joints chest pain fatigue flu like night sweats SOB new or changed heart murmur oslers notes on fingers
92
Complications of endocarditis
embolization (MI, stroke, PE) valve failure
93
treatment endocarditis
antibiotics education
94
Pericarditis
outer layer of heart becomes inflamed due to virus, post MI acute 48-72 hours post dressler syndrome: 4-6 weeks post rapid accumulation of fluid
95
S&S pericarditis
chest pain friction rub fever
96
Pericarditis diagnostic and treatment
echocardiogram ECG antibotics if bacterial NSAIDS (naproxen, ibuprofen, prednisone) pain relief anxiety management
97
cardiac tamponade
most serious complication of pericarditis very rapid accumulation of fluid EMERGENCY decreased left atrial filling leading to decreased CO - compression of heart!
98
cardiac temponade S&S
muffled heart sounds narrowed pulse pressure pulsus pardoxus tachypnea tachycardia decreased CO JVD restless, anxious, confusion
99
What is pulse pressure
difference between diastolic and systolic pressure
100
what is pulsus pardoxes
decrease in BP with inspiration
101
treatment of cardiac temponade
pericardiocentesis
102
myocarditis
viral infection, bacterial, fungi, drug reaction, radiation, generalized inflammatory process
103
S&S myocarditis
chest pain arrytmia sob edema fatigue other sign of vial infection
104
treatment of mycocarditis
treat symptoms ace, arb, b blockers, diuretics no antibiotics (viral) steroids
105
epinephrine
drug of choice for cardiac arrest excites heart muscle, increase BP patients may feel palpitations
106
H & Ts of cardiac arrest
H: hypovolemia hypoxia hydrogen ion (acidosis) hyper/hypokalemia hypothermia T: toxins tamponade tension pneumothorax thrbomosis (pulmonary) thrombosis (massive MI)
107
Ionotropes
change contractility
108
positive ionotropes
increase contractility epinephrine
109
negative ionotropes
decrease contractility beta blockers diltiazem
110
negative chronotropes
decrease HR verapamil
111
positive chronotropes
increase HR atropine epinephrine
112
epinephrine
+ ionotrope + chronotope vasoconstriction - shunts blood to brain and heart increase BP give fast increase strength of contraction
113
atropine
+ chronotrope increase HR treats bradycardia
114
lidocaine
heart to contract w/o electrical stimulation use for PVC, VT, VF can be IVP, or IV infusion antiarythmic
115
diltiazem
-chronotorpe -ionotrope inhibits AV node conduction decrease HR give slowly A FIB/flutter with rapid ventricular response (HR 140+) SVT angina HTN decrease HR and BP
116
amiodarone
- chronotrope v tach with pulse antiarythmic pulseless VT or VF rapid Afib
117
adenosine
depresses SA and AV node activity - chronotrope SVT can cause complete cessation of cardiac activity for 2-6 seconds
118
magnesium sulfate
important in heart function low values may contrute to VT hypomagnesmia torsades de pointes, polymorphic V TACH repeated or rapid dosage may lead to bradycarids, hypotension
119
sodium bicarbonate
buffer metabolic acidosis contraversal to cardiac arrest indicated if arrest is due to hypokalemia or cetrain overdoses flush IV well before and after incompatable with many drugs iv push or continuous infusion
120
Digoxin
cardiac glycoside - chronotrope + inotrope increases vagal tone which slows firing of SA node slows conduction through AV node increases contractility A FIB/flutter CHF can cause bradycardia, toxcicity (visual distubances, N/V, ABD, discomfort, decreased HR, confusion)
121
norephinephrine
vasopressor continuous infusion treats hypotension, shock, post cardiac arrest may cause tachycardia can decrease blood flow to extremities severe vesicant
122
targeted temperature managemetn
decreases metabolic demand and O2 requirements eligible if neurologic activity is impaired after ROSC cool 33-36 for 24-48 hours

NURS 2360 Med/Surg (6 decks)

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