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401 > Unit 3 B > Flashcards

Unit 3 B Flashcards

1
Q

Stable Angina

A

Predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin

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2
Q

Unstable Angina

A

Symptoms increase in frequency and severity; may not be relieved with rest and/or nitroglycerin

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3
Q

Variant Angina

A

Pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm

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4
Q

Silent Ischemia

A

Objective evidence of ischemia (ECG changes during stress test), but pt reports no pain

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5
Q

Angina Pectoris: Meds

A
  • Nitroglycerin: Decreases preload, dilates coronary arteries, decreases afterload
  • CCBs: Dilate coronary arteries, decrease HR, decrease contractility
  • Beta-Blockers: Decrease HR, decrease afterload, decrease contractility
  • Anti-platelet: prevent platelet aggregation, prevents formation of thrombi/plaques
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6
Q

Nitroglycerin: Pt Teaching

A
  • Moisten mouth before taking
  • Carry at all times
  • Keep in original bottle
  • Renew supply every 6 months
  • Record time to pain relief
  • Sit down when taking
  • S/E: HA, hypoTN, tachycardia, flushing
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7
Q

MONA

A
  • Used in the early management of MI
  • Morphine
  • O2
  • Nitrates
  • Aspirin
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8
Q

Management of MI

A
  • Goals are to: minimize myocardial damage, preserver myocardial fxn, and prevent complications
  • Thrombolytics (streptokinase, tPA)
  • Dobutamine to decrease SVR
  • Diuretics/vasodilators (Nitro) decrease preload and afterload in order to decrease O2 demand
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9
Q

MI: Door to Balloon Time

A

90 minutes

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10
Q

PCI: Post-procedure Care

A
  • Assess for back pain
  • Check pulses (15 min for 2 hrs, then Q1-2 hrs)
  • HOB less than 30 degrees while sheath in place
  • Leg straight for several hours
  • Direct pressure for 15-30 minutes after removal of sheath
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11
Q

Coronary Bypass: Number One Complication

A

Pneumonia

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12
Q

Coronary Bypass: Post-procedure Assessment

A

-Asses for: Decreased CO, fluid volume and electrolyte imbalances, impaired gas exchange, impaired cerebral circulation

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13
Q

Cardiogenic Shock

A
  • “Pump failure”
  • Decreased CO causes inadequate tissue perfusion
  • High mortality rate of 50-75%
  • Treat cause
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14
Q

Cardiogenic Shock S/S

A

Cerebral hypoxia (restlessness, confusion, agitation), Decreased BP, rapid/weak pulse, cold/clammy skin, tachypnea, crackles

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15
Q

Sudden Cardiac Arrest: Management

A
  • Maintain open airway
  • Provide artificial ventilation
  • Promote artificial circulation
  • Defibrillate
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16
Q

Mitral Regurgitation

A
  • *Common in elderly

- “Systolic murmur”, high-pitched, blowing

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17
Q

Aortic Regurgitation

A
  • “Leaky valve”
  • P-P interval is widened
  • Diastolic murmur
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18
Q

Aortic Stenosis

A
  • P-P interval narrowed

- Low-pitched systolic murmur

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19
Q

Infective Endocarditis

A
  • S/S: Petichiae, Osler nodes , Janeway lesions, Splinter hemorrhage
  • Tx: Abx or valve replacement
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20
Q

Myocarditis

A
  • Assess for: JVD, dysrhythmias

- S/S: Flu-like symptoms, ST depression, gallop rhythm

21
Q

Pericarditis

A
  • *Post-op
  • Assess for: Cardiac Tamponade
  • S/S Positional pain, friction rub
22
Q

Left Heart Failure: S/S

A
  • *Blood backs up in lungs
  • Tachypnea
  • Tacycardia
  • Cough
  • Crackles
  • Hemoptysis
  • Pulmonary edema
  • Fatigue
  • Orthopnea
23
Q

Right Heart Failure: S/S

A
  • *Blood backs up in bodily vasculature
  • Peripheral edema
  • Hepatomegaly
  • Splenomegaly
  • Hepatojugular reflex
  • Ascities
  • JVD
  • Pulmonary HTN
  • Weakness
  • Anorexia
  • Indigestion
  • Mental changes
24
Q

Left Heart Failure: Management

A
  • O2 therapy
  • Morphine
  • Diuretics
  • IV Meds (decrease preload and afterload, increase stroke volume): Dobutamine, Nesiritide, Milrinone
25
Q

Right Heart Failure Management

A
  • Meds: ACE inhibitors, B-Blockers, Diuretics, Digitalis
  • Nutritional therapy
  • Additional therapy: O2, ICD
26
Q

Triponin Markers

A

-Rise in 3-12 hours, peak in 24-48 hours

27
Q

Pulse Scale

A
  • 0 Absent
  • 1 weak/thready
  • 2 Diminished
  • 3 Easy to palpate/full
  • 4 Strong/bounding
28
Q

Role of Nurse in OR

A

Safety!

29
Q

Pre-op Fasting Guidelines

A
  • Clear liquids: 2 hrs
  • Light meal: 6 hrs
  • Reg/heavy meal: 8 hrs
  • Infants: breast milk 4 hrs, non-human milk 6 hrs
30
Q

Why don’t you mark surgical site on neonate?

A

Can leave a permanent mark on skin

31
Q

Hypothermia (OR): Risk Factors

A

Skinny and elderly

32
Q

Malignant Hyperthermia

A
  • Higher risk: bulky muscle, hx of muscle cramps/weakness
  • Genetic link
  • S/S: *Lock-jaw, initial tachycardia, generalized muscle rigidity
  • Tx: *Dantrolene (reversal), hyperventilation (100% O2), Iced NS, monitor body temp and liver fxn
33
Q

Sedation Depth Guidelines

A
  • *Document pt rxn to anesthesia
  • Ativan and Valium: Minimal sedation
  • Propofol: Moderate sedation, depressed consciousness
  • Do NOT leave pt unattended
34
Q

Stages of Anesthesia

A
  • Stage 1: Beginning (shaking/shivering)
  • Stage2: Excitement (aggressive behavior)
  • Stage 3: Surgical anesthesia (unconsciousness)
  • Stage 4: Medullary depression (watch respirations)
35
Q

Laryngeal Mask Airway (LMA): Contraindications

A

Pregnancy, full stomach, intestinal obstruction

36
Q

Reversal Agents: Opiates and Benzo’s

A
  • Opiates: Narcan

- Benzo’s: Romazicon

37
Q

Laryngospasm: Tx

A
  • Raise HOB, hyperextend neck, O2

- Prevention: suction before extubation

38
Q

DKA: S/S

A
  • Type I

- Hyperglycemia (300-800), profound dehydration, acidosis

39
Q

HHS: S/S

A
  • Type II
  • HypoTN, profound dehydration, tachycardia, neuro status changes, Hyperglycemia (600-1200), normal pH
  • Often caused by infection
40
Q

HHS Tx

A
  • Fluid replacement
  • Correct electrolyte imbalances
  • K is added to fluids once UO is adequate
41
Q

DKA Tx

A
  • Replace fluids at 5 units/hr or 0.1 units/kg/hr
  • Hourly glucose checks (reduce by 10% per hour)
  • Only regular insulin can be given IV
  • Monitor EKG, UO, precipitating factors
42
Q

Calculating Cardiac Output

A
  • Stroke volume X HR

- (4 to 8 L/min is expected)

43
Q

Phlebostatic Axis

A
  • Intersection of midaxillary line and 4th intercostal space
  • If below axis, gives high readings
  • If above, gives low readings
44
Q

Water Seal Chamber (2nd chamber)

A
  • Bubbling indicates air leak
  • Should see tidaling: Fluid level rises during inspiration, and falls during expiration (Mech vent pt will be backwards)
45
Q

Suction Chamber

A

-Bubbling is normal here

46
Q

Chest Tube

A
  • Sudden increase in bloody drainage (more than 200 ml) could be hemorrhage
  • Sudden decrease could be clogged tube, or occluded by pt laying on it (turn pt first)
47
Q

Removing Chest Tube

A

Ask pt to take a deep breath in and bear down

48
Q

Suctioning a Trach

A
  • *Set suction no higher than 120

- Sterile procedure if open system

401 (4 decks)

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