MIS/Cardiogenicshock/aneurysms Flashcards
(91 cards)
1
Q
What are DRGs
A
hospitals doing their best to prevent readmissions of patients… if they are readmitted then the insurance companies will not pay for stay
2
Q
this risk factors for CAD are just
A
risk factors! they are not known to cause CAD
3
Q
ACS refers to what?
A
unstable angina
NSTEMIS
STEMIS
4
Q
what happens to people with unstable angina
A
put in observation bed for 24 hours
5
Q
define after load
A
the pressure that the ventricles must over come in order to push blood out of the aorta
6
Q
what is angina pectoris?
A
pain caused by ischemia due to poor blood flow caused by clogged up veins
7
Q
what can cause chest pain
A
aortic disection cholecystisis anxiety and depression muscle strain costochondritis esophegeal spasm PE herpes zoster GERD pericarditis pneumonia pneumothorax pulmonary hypertension pancreatisis
8
Q
questions to ask about chest pain (the 5 Ws)
A
what does it feel like where is it located what makes it worse what causes it what makes it better
9
Q
also ask about
A
quality location duration intensity accompanying symptoms aggravating and relieving factors (ask about exercise to rule out any ischemic causes of pain) ask family and self history age (CAD is more common the older you get)
10
Q
factor associated with chest pain
A
cold (men over 50 cover mouth when cold outside)
eating heavy
stress
physical exertion
11
Q
stable angina
A
predictable and persistant angina relieved by rest or nitroglycerin
12
Q
unstable angina
A
preinfarction/crescendo angina- caused by ischemia, may or may not be relieved with nitro/rest
13
Q
how much nitro can you give
A
3 5 minutes apart, if not relieving chest pain call the doctor
14
Q
variant angina
A
pain at rest that causes an ST elevation, thought to be caused by coronary vasospasm
15
Q
clinical manifestations of an MI
A
impending sense of death apprehension neck jaw shoulders innerportion of arm (normally left arm) tightness heavy choking strangling feeling like a vice diabetic neuropathy may be blunt pain women have symptoms like indigestion
16
Q
silent ischemia
A
clinical manifestations of an MI but patient reports no pain
17
Q
gender role in chest pain
A
more common in women over 50 and men over 40
chest pain is different in women
18
Q
signs and symptoms of mis that women experience
A
fatigue, tiredness, sleep disturbances before a cardiac event
19
Q
red flags in the VS of a cardiac event
A
abnormal vital signs bradycardia or tachycardia tachypnea hypertension hypotension
20
Q
red flag symptoms of an MI/ unstable angina
A
pallor sweating dyspnea nausea productive cough (caused by remodeled LV which means fluid backing into lungs, which means pt is going into HF)
21
Q
assessment and diagnostic findings of CAD
A
ECG Twave inversion Cardiac biomarkers echocardiogram halter monitor cardiac catheterization nuclear scan
22
Q
medical management of CAD
A
pharmacological therapy
reperfusion such as PTCA (percutaneous transluminal coronary angioplasty)
23
Q
Treating angina
VIP slide
A
if pt has pain or prodromal symptoms (indegestion, choking, heaviness, weakness) take immediate action
stop all activity and bed rest in semi fowlers
measure vs
12 lead ecg
ST and T wave changes
Nitro sublingual tabs, give up to 3 times or as stated by provider
assess VS after each administation of nitro
give oxygen by 2 L of o2
24
Q
identifying types of MIs
A
Nstemi stemi anterior wall inferior wall posterior wall lateral wall point in time acute evolving old
25
sign of an old MI
Q wave
26
RCA/PDA occlusion
RV/RA infarct front and back
alters lung perfusion
may act as hypovolemic since it can't return blood to the heart
27
LAD/Circumflex occlusion
LA/LV circumflex occlusion - front to back
| Alters perfusion to the rest of the body
28
Left main occlusion
```
"widow maker"
most critical- feeds the LV
many never make it to the hospital (fatal rhythm)
emergent CABG
cannot stent
```
29
acute inferior wall mi
leads II, III, and AvF represent ECG changes in ST elevation developing Q waves and T wave inversions
30
anterior wall MI
more serious and worst prognosis
| ST segment elevation and leads I, aVL and precordial leads overlying the anterior lateral surfaces of the heart
31
clinical manifestations of MI
```
some prodromal symptoms
chest pain
SOB
Indigestion
nausea
anxiety
cool, pale, moist skin
elevated HR and RR
```
32
assessment and diagnostic findings in cardiovascular system of an MI
chest pain not relieved by nitro, palpitations, heart sounds, s3, s4, and new onset murmur
palpitations
heart sounds such as S3, S4
BP may be elevated or decreased (depends on sympethetic stimulation could be elevated, could be decreased because of impending cardiogenic shock or medications) irregular pulse may indicate a fib
33
respiratory findings in MI
SOB
Dyspnea
Tachypnea
crackles if MI had caused pulmonary congestion
34
Gi findings in an MI
nausea, indigestion, vomiting
35
Skin findings during MI
cool, clammy, diaphoretic, pale
36
neurologic findings during MI
anxiety, restlessness, lightheadness
37
psychological findings during MI
fear of impending death or thinking that nothing is wrong
38
medical management of an MI
```
ecg
medications
evaluate for reperfusion therapy
(PTCA, Thrombolytic therapy)
therapy like IV LMWH, or heparin, plavix, glycoprotien inhibitor, bedrest for 12 to 24 hours
```
39
medications for MIs
```
oxygen
nitroglycerin
morphine
aspirin
beta blockers
ace inhibitors with in 24 hours
anticoagulation with heparin
```
40
when there is an mi what must happen with the ecg
it must be be read with in 10 minutes
41
what does a Qwave represent?
a hx of an mi
42
how does the ecg evolve over time?
t wave inversion (repolarization is altered)
st segment elevation (injured cardiac cells repolarize faster)
q wave after the epsiode
development of tachycardia, bradycardia, or other dysrhythmias
43
how far does the st segment raise during an mi
about 1mm
44
what is troponin
released during an mi
| can be raised for 3 weeks after an episode
45
CK-MB (cardiac muscle)
NOT CK-BB and CK-MM
| elevated indicates an acute mi elevated in a couple hours and peaks 24 hours after event
46
myoglobin
not very specific but negative results can rule out an MI
| starts to increase 1-2 hrs after event and peaks 12hrs after onset of symptoms
47
cardiogenic shock
decreased CO make decreased perfusion, body responds the same way it does during hypovolumic shock
48
cycle of events in cardiogenic shock
heart failure dt ischemia, producing forward and backward failure, circle of events just keeps getting worse
49
when does cardiogenic shock occur?
```
following an MI when a large area of the myocardium becomes ischemic and hypokinetic
end stage HF
cardiac tamponade
PE
cardiomyopathy
dysrhythmias
```
50
what type of MI puts people at the greatest risk for cardiogenic shock
anterior wall mi
51
What can cause cardiogenic shock other than cardiac issues
SLE
COPD
RF
Multiple trauma
52
clinical manifestations of cardiogenic shock
HF
Low BP, CO+CL, SVR high, PVR high
tachycardia w dysrhythmias
Tachypnea, shallow, poor saturation, ARD
Changes in LOC (CVA)
decreased peristalsis leads to bowel infarc/ischemia
skin pale, cool, cyanotic, clammy
abnormal lab values with all organ systems
53
pharmacological management of cardiogenic shock
based on
| preload, afterload, contractility, goal is to restore cardiac funciton
54
first line of trx in shock
```
o2
pain control
ECG and hemodynamic monitoring (a-line, Pulmonary artery catheter)
lab monitoring (CK-MB, BNP, cTn-1)
fluid therapy (watch for overload)
```
55
first line medications for cardiogenic shock
diuretics, positive inotropic drugs, vasopressors, anticoagulants
56
mechanical assist devices for cardiogenic shock
Intra-aortic balloon pumps
57
aim of vasoactive therapy
improve cardaic contractiity
decrease preload and afterload
stabilize heart rhythm
58
two drugs often used together in cardiogenic shock
inotropic medications and vasodilators
59
nursing management of cardiogenic shock
```
prevent cardiogenic shock
monitor hemodynamic status
administering medications (IV fluids)
maintaining intra-aortic balloon counter pulsation
ensuring comfort and saftey
```
60
what is an intra-aortic balloon pump?
inflates at the begging of diastole
results in increased perfusion of coronary arteries and peripheral arteries
deflates just before systole which results in decrease in afterload therefore a decrease in resistance which makes a increase in coranary artery perfusion
61
what position do you put someone in in cardiogenic shock
reduce venous return to prevent pulmonary edema
| high fowlers with legs down
62
saccular aneurysm
projects from only one side of the vessel, most common kind of aneurysm
63
fusiform aneurysm
entire arterial segment becomes dialated
64
mycotic aneurysm
very small aneurysm due to localized infection
65
true aneurysm
involves all three layers of the vessel wall
66
psuedoaneurysm (false)
involves a dissruption in vessel walls and can lead to disection or tear (always involves a damaged media layer)
67
risk factors for an anyuerism is
genetic predisposition
HTN
Tobacco use
68
signs and symptoms of AAA
asymptomatic till they expand or rupture
expanding causes sudden severe and constant low back, flank, abdominal or groin pain
palpable pulsating mass is the number one sign- only found in 1/2 of the cases
69
presentation of a ruptured AAA
frank shock- cyanosis, molting, AMS, tachycardia, hypotension, sudden pain, may be very dramatic, VS can be normal bc of the retroperitonal containment of hematoma
70
number 1 sign of ruptured AAA
back pain w HTN
abd pain
diarrhea
71
Clinical manifestations of AAA
pain in back, may only occur when pt is supine
dyspnea due to the pressure of the pressure on the trachea, main bronchi, or the lungs its self
cough
bloody diarrhea
hoarsness
stridor
weakness/complete loss of voice resulting from pressure against the laryngeal nerve
72
assessment diagnostic findings
80% of masses can be palpated
may hear a systolic bruit duplex or CTA(ct with dye injected into the aorta to see the size of the mass) is used to determine size. length. and location,
73
when aneurysm is small whats the plan of trx
ultrasounds every 6mos
| can remain stable for years
74
treatment for AAA is based on
```
symptoms
rate it is expanding at
what tis is caused by
if it contains a discetion or not
involved branch vessels
```
75
what do you want to do with patients with AAA
keep BP low, systolic under 120 -90
76
abd aa
```
most common anuyerism
common cause is artheriosclorosis
affects men 2 to 6 times more often then women
more common in caucasians
age has a factor
most occur below renal arteries
```
77
thoracic aa
```
discovered unexpectedly normally
less common
caused 85% by artherosclerosis
often grow to the point they rupture
men 50-70
thoracic area is the most common for dissecting aneurysm
1/3 die from ruputure
```
78
medications used for anyeruisms
based on clinical studies and images
significant when diameter of aorta reaches larger than 3 cm
preoperatively the systolic pressure is maintained at 90 to 120
use beta blockers such as esmolol or metoproplol
anti-hypertensives such as hydralazine
soduim nitroprusside may be used as a continuous drip to emergantly decrease pressure
79
surgical interventions for aneurysms
3 to 4 percent chance of developing paraplegia
goal is to restore vascular continuity with a vascular graft
intensive monitoring is required after surgery
80
gerentological considerations of AAA
most occur between ages 60-90
| consider r/f death vs r/f surgical complications (may not be a candidate for surgery)
81
rupture is likely when?
coexisting HTN and an aneurysm greater than 6cm
82
moderate risk for rupture and how large does it need to be to be repaired
5 cm
83
great risk for rupture at
6cm
84
signs and symptoms of complications of AA
```
changes in pulses
cool extremities
white or blue extremities or flanks
sever pain
abdominal distention
VS deteration
```
85
endovascular graphs
places around AA and decrease complications
maybe be placed during gore tex or PTFE material reinforced w titanuim stents
inserted vis the brachial or femoral sites
86
nursing management of endovascular repair
supine for 6 hrs
HOB elevated 45 degrees after 2 hrs
VS and doppler assessments of periphiral pulses every 15 minutes then progressively longer intervals (if they remain stable)
assess for bleeding, pulsation, swelling, pain, hematoma formation, skin changes in lower extremities
temp every 4 hours
any signs of post implantation syndrome should be reported
87
signs of impeding rupture
back or abd pain (severe)
pain localizes in the middle or lower abd left of the midline
rupture into the peritioneal cavity is rapidly fatal
retroperitoneal cavity results in hematomas in the scrotum, perinuem, flanks, or penis
symtoms of HF and a large bruit
bloody diarrhea (bc bowel ischemia)
88
dissecting aorta
tear in the media or intima degenerate
occur in aortic arch (highest mortality rate)
arterial dissections are assoicaited with uncontrolled htn
blunt chest trauma
cocaine use
89
clinical manifestations of dissecting aorta
sudden
severe persistant pain described as ripping
pain is anterior chest or back and extends to the shoulders, epigastric area, or abdomen
aortic dissection is mistaken for an acute MI
pale, diaphoretic, tachycardic
elevated BP
BP may be different in one arm vs the other
90
assessment and diagnostics of dissecting aorta
arteriography
| duplex ultra sound
91
intraaortic balloon pumps inflate during
Diastole and increase cardiac output
