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Nursing 283 > Week 5 and 6 Acute Coronary Syndromes > Flashcards

Week 5 and 6 Acute Coronary Syndromes Flashcards

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1
Q

What is infarction?

A

necrosis or cell death, causes irreversible damage

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2
Q

What causes infarction?

A

Prolonged severe ischemia and decreased perfusion

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3
Q

How to differentiate unstable angina from an MI (lab)

A

Will have ST changes on ECK but no elevation in CK or triponin

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4
Q

3 categories of MI

A

ST elevation MY(STEMI)
Non-ST elevation (NSTEMI)- most common in women
Unstable angina

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5
Q

Primary factor in development of MI

A

atherosclerosis

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6
Q

Major risk factor for heart disease

A

Metabolic syndrome

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7
Q

Metabolic syndrome

A

3 of the following risk factors: HTN, triglycerides, fasting blood glucose >110, waist > 40 M > 35 F, increased C reactive protein, increased blood clotting factors

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8
Q

Use of thallium scan

A

identify “cold spots” that indicate ischemia or infarction

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9
Q

Priority main medication in MI

A

morphine

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10
Q

Medications post MI

A

Beta blocker within 2 hours
ACE or ARB within 48 hours
Possible Ca+ blocker

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11
Q

Function of ACE or ARB order

A

prevent ventricular remodeling and development of heart failure

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12
Q

Class I HF

A

pts often respond well to reduction in preload with IV nitrates and diuretics, no crackles or S3

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13
Q

Class II HF

A

may need diuretics, IV nitroglycerin, need beta blockers, ACE and ARBs, crackles in the lower half of the lungs and possible S3

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14
Q

Class III HF

A

may need diuretics, IV nitroglycerin, need beta blockers, ACE and ARBs, crackles more than halfway up the lungs and frequent pulmonary edema

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15
Q

Class IV HF

A

Necrosis of more than 40% of the L ventricle occurs, stuttering pattern of chest pain, monitor for cardiogenic shock

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16
Q

Sx of cardiogenic shock

A

Tachycardia, hypotension, BP less than 90 or 30 from baseline, urine output less than 30!!, cold clammy skin and poor peripheral pulses, agitation restlessness confusion, pulmonary congestion, tachypnea, continuing chest discomfort

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17
Q

Myocardial O2 requirements during an MI

A

Increased O2 demand and tissue is already O2 deprived. This can cause ventricular dysrhythmias

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18
Q

When is tx of MI needed

A

within 4-6 hours, physical changes to the heart occur after 6 hours

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19
Q

ventricular remodeling

A

when scar tissue permanently changes the heart, can cause dysrhythmias

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20
Q

CK-MB lab

A

most specific test for MI but doesn’t peak until 24 hours after

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21
Q

Priority problems for Pts with CAD

A

Acute pain (r/t < myocardial O2), inadequate tissue perfusion, activity intolerance, ineffective coping

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22
Q

Additional potential problems for a Pt having an MI

A

Potential for dysrhythmias
Potential for HF
Potential for recurrent symptoms and extension of injury

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23
Q

New onset a-fib

A

May signal MI in patients with DM and CAD, they may not experience chest pain or pressure because of neuropathy.

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24
Q

Drugs given in acute MI

A

ASA, Nitro, morphine, O2

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25
Reperfusion therapy
uses thrombolytics to restore blood flow, best used within 6 hours of onset
26
percutaneous transluminal coronary angioplasty (PTCA)
Stent placement to re-open the clotted artery, should be done within 2-3 hours
27
Signs the clot was lysed and the artery reperfused
Abrupt cessation of pain, Sudden onset of ventricular dysrhythmias, Resolution of ST-segment depression/elevation or T-wave inversion, A peak at 12 hours of markers of myocardial damage
28
Complication after clot lysis
vessel reocclusion due to high thrombin release into the blood
29
S/Sx of left ventricular failure and pulmonary edema
crackles, wheezing, tachypnea, and frothy sputum | Listen for S3 sound
30
S/Sx of inadequate organ perfusion
change in mental status, Urine output less than 30mL/hr, Cool clammy extremities with decreased or absent pulses, Unusual fatigue or recurrent chest pain
31
Medications to reduce preload
diuretics and nitroglycerin
32
S/Sx of Rt ventricular failure
Decreased cardiac output with a paradoxical pulse, clear lungs, and JVD
33
ST segment elevation indicates what?
Infarction
34
ST segment depression indicates what?
Ischemia
35
When does the S3 heart sound occur?
during the rapid ventricular filling of diastole; low pitched; use bell
36
When does the S4 heart sound occur?
linked to resistance in ventricular filling or a vibration caused by atrial contraction; low- pitched; use bell
37
Contraindications of reperfusion therapy
any hx of bleeding disorders, anticoagulation therapy or HTN > 180/110
38
How to calculate CO and average CO
SV X HR | averages 4-8 L
39
Preload
amount of stretch on myocardial muscle fibers at end diastole determined by amount of blood in the ventricles
40
Afterload
Sum of all forces against which the ventricle muscle must contract to eject blood into the pulmonary and systemic circulation
41
SVR`
measures afterload
42
Factors that affect afterload
heart size, qty of resistance overcome by heart muscle to eject blood, qty of disease
43
When is preload increased?
hypervolemia, valvular regurgitation
44
When is afterload increased?
HTN, vasoconstriction
45
HR at which CO declines
160 BPM
46
Normal ejection fraction
55-70%
47
Acute coronary syndrome
refers to unstable angina, Non STEMI or STEMI MI
48
CO changes in sepsis
in earlier stages your CO will rise because of vasodilation and more fluids moving in, in the later stages, your CO drops
49
Do beta blockers reduce preload or afterload?
Afterload because they dilate the arterial beds
50
Are ACE and ARB preload or afterload reducers
Afterload
51
Does aldoactone reduce preload or afterload
proload because it will help move fluid out of the body
52
Ways to measure SVR (systemic vascular resistance)
Crudest is BP | Pulmonary artery catheter
53
How does the size of the heart affect afterload
The larger your heart gets, the more it increases the arterial resistance
54
What happens to myocardial O2 demand with increased afterload?
O2 demand goes up
55
What drugs depress cardiac contractility?
Beta Blockers (mild negative inotrope)
56
Test to measure ejection fraction
Echo | Cardiac cath
57
S/Sx seen in low EF %
Dyspnea, cool skin, edema, JVD, low BP, crackles
58
What reading can be obtained from the cardiac cath?
pulmonary artery pressure, Rt atrial pressure, central venous pressure, HR, BP Wedge pressure only when balloon is inflated
59
Average arterial BP
Systolic 90-140 | Diastolic 60-90
60
Mean arterial BP range
70-11 mmHg
61
Rt arterial pressure range
2-6 mmHg | Measures preload
62
Pulmonary artery pressure range
25/10 a quarter over a dime Systolic range 15-25 Diastolic range 8-15
63
Neurohormonal factors for preload
1st- SNS | 2nd- RAAS
64
Factors effecting preload levels
blood volume, decreased fluid excretion by kidneys, SV, contractility, HR
65
Steps of management in HF
1st- Preload 2nd- Afterload 3rd- Contractility
66
Correlation to high BP to afterload
afterload will be high | very high BP = increased SVR
67
Interventions in the home to decrease proload
lower legs, restrict fluid, give diuretic
68
Interventions to reduce afterload
vasodilator/antihypertensive (ACE, Nitro, etc.)
69
Interventions in acidosis and decreased CO
must fix acidosis 1st or drugs won't work Acidosis is detrimental to contractility Can give insulin
70
Functions of echocardiogram
gives EF Diagnose valve disorders Diagnose cardiac tamponade
71
Normal pulmonary capillary wedge pressure
4-12 mmHg
72
What is the significance of PCWP (pulmonary artery wedge pressure)
shows L side heart function | If pressure is up, then pressure is up in the L side of the heart
73
First intervention when high PA pressure is seen
put them on O2 | then look at pre-load and address that
74
SVR
represents arterial bed constriction
75
What 3 symptoms seen together should be reported together for ACS?
Increased HR No HTN Pulmonary congestion
76
Heart sound heard with exces fluid
S3 | Common w/ previous MI or HTN
77
What condition is indicated with S3 and S4 heart sounds
severe HF
78
Priority interventions with suspected cardiac issues
``` 1. VS and cardiac monitoring/12 lead 2 Labs 3 IV (saline lock) 4 Physical exam and chest x-ray Give MONA when 12 lead is positive ```
79
What is the biggest risk for CV issues
DM (type I or II)
80
Classic clinical manifestations of cardiac disease
Chest, jaw, left arm pain (esp. men), N/V, diaphoretic, cool, clammy, temp (mild)
81
Common sx of MI in women
SOB (biggie for women), extreme fatigue, pain/discomfort centered low in chest or upper abdomen, shoulder blade/back pain, pain/discomfort in left arm, shoulder, jaw (like men), weakness, nausea, hot, flushed, dizziness, syncope
82
3 inflammatory markers to test for
Homocystiene, lipoprotein and C-reactive protein (#1, high is 3)
83
Causes of increased imflammation (which increases CV risk)
poor nutrition, sugar, sedentary lifestyle, psoriasis, migraines, sleep apnea, gum disease
84
Labs to get when MI is possible
cardiac markers, comprehensive metabolic panel, CBC, coags, C-RP, Mg+, cholesterol
85
When to give morphine for an MI
after 3 doses of nitro have not relieved pain
86
What does ST depression indicate?
Ischemia, possibly some myocardial death but ischemia may be reversed
87
What does ST elevation indicate
Infarction (MI) | must be significant in 2 leads
88
What does an inverted/flattened T wave indicate?
ischemia
89
When to gove TpA
within 12 hours of onset if not going to cath lab/delayed if no bleeding risk (injury/trauma, CPR, recent surgery or stroke)
90
Time frame and what is needed in the H&P for cardiac injury
10 minutes | onset?, syncope?, CV Hx? DM? renal disease? smoking and diet?
91
Where is the PMI and how do you palpate?
Left MCL 5th intercostal | palpate with palm
92
S1 sound
Tricuspid and mitral valve close | heard best at 5th intercostal MCL
93
S2 sound
aortic and pulmonic closure | heard best at 2nd ICS rt of sternum
94
S3
Occurs during rapid ventricular filling, use bell | = fluid overload/ HF
95
S4
resistance to ventricular filling or vibration from atrial contraction, use bell = HF and aortic stenosis
96
Where to best hear murmurs
3rd ICS on L side (erbs point)
97
Best Pt position to hear heart sounds
Pt sit up and lean forward (to the left a little too maybe) | If have to lie down, lay on left side (left lying probably best, but often having trouble breathing, etc so sit up)

Nursing 283 (10 decks)

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