Quiz 3 Flashcards by Emily Herrera

Describe how acute coronary syndrome starts

start with:
atherosclerosis
stable angina
unstable angina
heart attack (NSTEMI and STEMI)

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What is stable angina?

chest pain with exercise or stress, but chest pain goes away with rest

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What is unstable angina? What is the treatment?

chest pain with exercise or at rest, but increases with occurrence, severity, and duration

tx: nitroglycerin every 5 minutes for 3 doses

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What is NSTEMI?

non-ST-segment elevation MI

least dangerous
no changes in EKG
decreased cardiac tissue, won’t see damage
decreased cardiac output (HR shows)

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What is STEMI?

ST-segment elevation MI

emergency
EKG changes - ST elevation

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What are the causes of acute coronary syndrome?

SODDA

S - stress, smoking, stims
O - obesity (BMI >25)
D - diabetes / HTN
D - diet (high cholest)
A - african male/ age (over50)

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What are the clinical manifestations of acute coronary syndrome?

Pain - jaw, back, shoulder, heartburn, substernal “crushing”
SOB
N/V
Diaphoresis
Pale cool skin
Anxiety

starts w/ brady then goes to tachy
HTN

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Who experiences silent MIs?

older white females

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What are the diagnostic studies for acute coronary syndrome?

Troponin
CK-MB, myoglobin

Stress test
Echocardiogram
Coronary angiogram

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Troponin

I or T : any + value indicates damage to cardiac tissue

High sensitivity cardiac troponin (HSCT) : important to measure during heart attack

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What are the two types of stress test?

exercise - treadmill
pharmacologic - Lexiscan

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Describe the pharmacologic stress test

radionuclide myocardial perfusion imaging

pt given Lexiscan if they are unable to run

shows which portion of the heart is having trouble perfusing

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What is Lexiscan?

regadenoson

vasodilates the coronary arteries and induces cardiac hyperemia

increases cardiac output

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What is an echocardiogram?

EKG
ultrasound of the heart
shows damage of heart attack and ejection fraction %

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What is a coronary angiogram (cardiac catheterization)?

invasive procedure where a catheter is threaded into artery balloon inflates and stent is left = opening artery

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What are people with stent given to take?

anticoagulants
- eliquis (apixaban)
- xarelto (rivaroxaban)

aspirin

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What are therapeutic procedures for acute coronary syndrome?

angioplasty
stent
coronary artery bypass graft

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What are the nursing interventions for a heart attack?

morphine, oxygen, nitro, aspirin (MONA)
semi or full-fowler
monitor VS and EKG
IV access

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What should you ask a patient before giving nitroglycerin? Why?

if they are taking sexual enhancing drugs (sildenafil)

it can lead to shock

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What medications are used after heart attacks?

morphine (pain and slow down breathing)
ACE inhibitors (-pril)
anticoagulants
antidysrhythmics
antilipemic
beta blockers (-lol)
Ca channel blockers (-dipine, -zem, - amil)
stool softener

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What ACE inhibitor is given after heart attacks? Why?

What is an adverse effect when taking this? What is expected?

lisinopril (chill pril)
- first choice
- treats heart failure after attack

precaution: angioedema (STOP)
expected: cough

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What antilipemic is given after heart attacks?

What is seen if the patient is taking the medication short term vs long term?

atorvastatin

decrease calcium absorption

short: joint pain, muscle pain
long: osteoporosis, decrease bone density

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What beta blockers are given after heart attacks? Why?

What are precautions when taking this?

sedalol - antiarrhythmic
metoprolol - cardioselective

Lol = sLOws down HR and BP

Precautions: BBB
Bad for CHF
Bradycardia (<60)
Breathing - asthma

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What calcium channel blockers are given after heart attacks? Why?

What is an adverse effect when taking this?

Study These Flashcards

nifeDIPINE - declined BP and HR
diltiaZEM - zen yoga for heart
verapAMIL - chill heart

calms BP and HR from dysrhythmias after heart attack

adverse: BLE edema

What stool softener is giving after heart attacks? Why?

docusate sodium prevents from straining because the pt can bear down which results in decreased HR (valsalva maneuver)

What are post heart attack complications?

DARTH VADER Death Arrhythmias (dysrhythmias) Ruptures Tamponade Heart failure (Right vs Left Acute vs Chronic) Valvular disease Aneurysm Dressler's Syndrome Embolism Recurrence

What are examples of dysrhythmias? What do they mean?

atrial fibrillation - ventricular tachycardia - ventricular fibrillation - asystole (death) hearts last effort to save itself

What is the treatment for ventricular fibrillation?

defibrillation

What should a nurse ask a pt who has afib?

smoking hx

What is a person at risk for who has afib?

cerebrovascular accident (CVA) left atria can't pump blood - clot can form - clot can cause embolic stroke

What is the treatment of heart failure?

ACE inhibitors

What is the difference between left and right sided heart failure?

HF = heart failure (heavy fluid) Right - ROCKS body with fluid - peripheral edema Left - LUNG fluid - pulmonary edema

What is pericarditis? What causes it?

inflammation outside the heart - heart gets compressed and can't pump less cardiac OUTput = less oxygen OUT causes: HAIR - Heart attack - Autoimmune disorders - Infection - Renal failure

What are the clinical manifestations of pericarditis?

- pericardial friction rub - pulsus paradoxus (> 10mmHg BP systolic drop while pt holds breath) - pleuritic chest pain (rib cage) - dyspnea - fever (>100.4)

What diagnostic studies can be done for pericarditis? What will the labs show?

ECG (ejection fraction) Blood culture (infection in blood) Throat culture (strep) CXR, CT scan Pericardiocentesis (drains fluid or blood in heart sac) Labs: - increased WBC (>10,000) - increased troponin - increased ESR and c-reactive protein (markers for inflammation)

What indicates that a pericardiocentesis worked? What should be monitored after?

increase in BP = increase in cardiac output signs of pneumothorax

What medications are used for pericarditis?

NSAIDS Corticosteroid Colchicine Antibiotic

What NSAID is given for pericarditis? Why?

indomethacin decrease inflammation

What corticosteroids are given for pericarditis? Why?

methylprednisolone solumedrol prednisone treats inflammation

What is colchicine? How is it used for pericarditis? What should be monitored?

plant poison used for gout treats inflammation monitor N/V and diarrhea

What is endocarditis?

inflammation inside the heart, heart valves can't fully close infective = bacteria, mold on heart valves noninfective = no bacteria, only inflammation less cardiac output = less oxygen out

What are causes of endocarditis?

- dirty needles (IV drug abuse) - heart sx (prosthetic valves or CABG) bacteria easily comes - untreated strep throat

How is endocarditis treated?

Antibiotics (blood culture first then broad spectrum antibiotics) Valve repair or replacement

What are the clinical manifestations for endocarditis?

fever murmur (aortic/mitral valves) tachycardia Roth spots (eyes) petechiae (capillary rupture) splinter hemorrhages (nailbed) Osler nodes (raised bumps fingers/toes) Janeway lesions (bruises palms/soles)

What are the diagnostic studies for endocarditis? What will the lab show?

Blood culture CXR ECG Cardiac catheterization Lab: Increased WBC, ESR, C-reactive protein

What are the nursing interventions for endocarditis?

MOLD Monitor for infection and s/s of stroke (neuro check) Oral care Let all providers know Hx of endocarditis Dental tx: antibiotics prior to tx

What is cardiomyopathy? What are the 3 types?

physical change in heart muscle that leads to decreased cardiac output = uncontrolled BP dilated restrictive hypertrophic

Describe dilated cardiomyopathy

distended (thinned) heart muscle heart chamber can fill, but can't push blood out

What are the clinical manifestations of dilated cardiomyopathy?

Low oxygen - restlessness - dizzy - SOB Left sided HF (lung fluid)

What medications are used to treat dilated cardiomyopathy?

ACE inhibitors (prils) digoxin

Describe hypertrophic cardiomyopathy

Huge trophy like heart muscle (enlarged) obstruction to aortic outflow heart can push, but no blood to push

What are the clinical manifestations of hypertrophic cardiomyopathy?

Low oxygen - restlessness - syncope - dyspnea - fatigue (common) Left sided HF (lung fluid)

What medications are used to treat hypertrophic cardiomyopathy?

Beta blockers (lol) - lower BP and slows heart down Calcium channel blockers

What are the nursing interventions for hypertrophic cardiomyopathy?

Syncope avoid strenuous activity and dehydration (important!) rest and elevate legs to improve venous return avoid vasodilators

Describe restrictive cardiomyopathy

rock hard heart muscles, stiffen heart can fill but can't contract

What are the clinical manifestations of restrictive cardiomyopathy?

Low oxygen - restlessness - dyspnea - syncope - fatigue Exercise intolerance Left sided HF (lung fluid)

What is the treatment for restrictive cardiomyopathy?

transplant list

What should a client be educated on if they have cardiomyopathy?

DRESS Diet (low sodium/fat) Rest Exercise (avoid strenuous) Stop smoking/alc Stress reduction

Quiz 3 Flashcards

(58 cards)