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Complex Exam One > Week Two > Flashcards

Week Two Flashcards

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1
Q

Acute Coronary Syndrome (ACS) includes….

A

unstable angina
NSTEMI
STEMI

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2
Q

NON Modifiable Risk Factors for CAD

A

age
gender
ethnicity
family history
genetic predisposition

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3
Q

Modifiable RF for CAD

A

HTN
smoking
exercise (lack thereof)
obesity
diabetes
metabolic syndrome
psychologic state (stress)
homocysteine level
substance abuse

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4
Q

Stable (chronic, exertional) Angina

A

blockage of coronary artery
predictable
relieved by rest
ST depression or T wave inversion
TREATMENT: rest and NTG

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5
Q

Prinzmetal’s Angina (Variant)

A

different things cause the chest pain
vasospasm of a coronary artery
smoking, alcohol, caffeine
transient ST elevation during pain episodes
cardiac cath
TREATMENT: CCB (relax coronary artery)

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6
Q

Silent Ischemia

A

ischemia without the patient reporting pain
diabetes- neuropathy
elderly
woman (present different)

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7
Q

Women Presentation with angina

A

unusual fatigue
sleep disturbances
SOB
weakness
cold sweat
lightheadness
Nausea
dizziness
indigestion

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8
Q

Unstable (crescendo) Angina

A

atherosclerotic plaque instability and possible thrombus formation
ST depression or T wave inversion
unpredictable
TREATMENT: rest, NTG, drugs affecting platelets, re-vascularization (stents and bypass)

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9
Q

Acute Myocardial Infarction (AMI)

A

ischemia with myocardial cell death (necrosis) r/t disruption or deficiency of blood supply to coronary arteries
imbalance of O2 supply and demand

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10
Q

CM of ACS

A

chest pain
diaphoretic
skin (pale/ashen, cool and clammy)
syncope
N/V
dysrhythmias
fever in the 1st 24 hours
Initially increase in HR and BP but then BP drops because of decreased CO
crackles
JVD
S3 or S4 heard
new murmur

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11
Q

how to classify an MI

A

ECG changes
depth of heart damage
location of the area of the heart affected

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12
Q

progression of an AMI

A

ischemia (lack of O2)
- ST depression, T wave inversion, tall peaked T wave

injury (occlusion with ischemia)
- ST elevation

infarction (death)
- pathological Q wave - ain’t getting fixes

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13
Q

Transmural

A

full-thickness damage of the heart
endocardium, myocardium, epicardium
pathological Q wave from scarring

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14
Q

Non Transmural

A

limited damage of the myocardium (middle layer of heart)

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15
Q

most frequent site of MI

A

left ventricle

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16
Q

most frequent coronary artery of a MI

A

left vein coronary artery (widow maker)

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17
Q

Anterior MI

A

left anterior descending
V3-V4

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18
Q

septal

A

left anterior descending
V1-V2

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19
Q

lateral

A

left circumflex
1, aVL, V5-V6

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20
Q

inferior MI

A

right coronary artery
2, 3, aVF

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21
Q

posterior MI

A

left circumflex
V1- V3

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22
Q

MI healing

A

within 24 hours, leukocytes infiltrate the area of cell death
neutrophils and macrophages remove necrotic tissue by 4th day (there is a thin wall)
10-14 days scar tissue is still weak
very vulnerable to stress
by 6 weeks, scar tissue replaced
normally, the heart will hypertrophy and dilate in an attempt to compensate for dead tissue

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23
Q

management of AMI

A

O2 supply
decrease myocardial demand (MONA)
M: morphine
O: o2
N: NTG
A: aspirin
IN THIS ORDER: ONAM

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24
Q

medical management of AMI

A

Call 911
O2
coags
decrease HR (increase ventricular filling time)
decrease preload
decrease afterload
decrease myocardial oxygen
lipid-lowering agents
thrombolytics
intensive glucose therapy

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25
CORE MEASURES OF AMI
start ecg ASA on arrival (and prescribed at discharge) ACEI or ARB for LVSD (EF> 40) smoking cessation Beta-blockers at discharge TBA (fibrinolytic therapy within 30 min of getting to hospital) 90 min from door to balloon statin at dischage
26
nursing management of AMI
pain control cont monitoring (ECG, ST segments, Heart and breathe sounds, VS, Pulse ox, I&O) rest and comfort anxiety reduction emotional support pt teaching cardiac rehab for chest pain: - semi fowler's -O2 -assess VS - 12 lead ECG - NTG followed by opioid analgesic - auscultate heart and breath sounds
27
reperfusion strategies
Fibrinolytic (Thrombolytic) therapy -6-hour window to start from the onset of symptoms -less than 30 with admission -TBA -Adjuncts: heparin and glycoprotein inhibitors -start 2-3 IVS Cath (90 min) PTCA Intracoronary artery stenting bypass grafts
28
Cath/coronary angiography
visualize and open blockages - percutaneous coronary interventions (PCI) - balloon angioplasty -stent
29
PTCA
balloon cath is inflated temporarily to open vessel
30
intracoronary stent
tubes placed in conjunction with angioplasty to keep vessel patent anti coag therapy
31
Pre Cath Care
NPO 6-12 hours Insulin/hypoglycemics adjusted day of procedure Benadryl if allergic to dye ASA, Clopidogrel or platelet inhibitor may be given PT awake during procedure
32
Post Cath Care
bedrest (HOB 30) monitor for bleeding/ hematoma immobilize arm monitor cardiac rhythm encourage fluid intake (get dye to filter through kidneys) I&O observe for reaction to dye (angiography) assess for chest pain, back pain, SOB antiplatelet drugs after go home 6-8 hours after
33
Nursing Management after Cath
monitor ECG and serial 12 leads VS q15min until stable monitor O2 stat cont monitor serial troponin and/or cardiac biomarkers monitor PT/APTT and observe for signs of bleeding in receiving thrombolytic therapy manage hemodynamic compromise as ordered (Dopamine, Dobutamine) assess for signs of HF (S3, S4, rales, edema, weight gain, decreased CO, decreased UOP)
34
patient education ACS
ambulatory and home care cardiac rehab pt and caregiver teaching physical activity - level of activity - METs or Borg scale - monitor HR - low-level stress test before discharge - isometric vs. isotonic activities resumption of sexual activities after 7-10 days or when you can climb two flights of stairs do not take nitrates with ED meds take a prophylactic nitrate before sex CAD- symptoms (when do they need to seek help) Diet is an AHA diet (reduces fat, total cholesterol <200, HDL > 40, LDL <100) reduces salt smoking cessation control HTN, diabetes achieve ideal body weight avoid Valsalva maneuver med teaching
35
Hemodynamic Monitoring
measurement of pressure, flow, and oxygenation within the cardiovascular system assess heart function, fluid balance, and effects of drugs on CO
36
Cardiac Output (CO)
volume of blood pump through heart in a min
37
Cardiac Index (CI)
cardiac output based on patients weight
38
Stroke Volume (SV)
amount ejected w each beat this is effected by preload, afterload, and how healthy the heart is
39
Stroke Volume Index (SVI)
is the volume of blood pumped by the heart with each beat divided by the body surface area
40
Ejection Fraction (EF)
% of heart contracting (>60%)
41
Systemic Vascular Resistance (SVR)
How the heart has to overcome each body system how much you are starting with and how much is left
42
pulmonary vascular resistance
what the heart has to overcome to pump through the lungs
43
preload
volume of blood within ventricle at end of diastole PAWP: reflects left vent CVP: reflects right vent (what is left for the next heart beat)
44
afterload
forces opposing ventricular ejection SVR and arterial pressure of left vent afterload PVR and pulmonary pressure of right vent afterload
45
SVR and PVR (resistance) reflects ......
afterload
46
MAP
avg perfusion pressure SBP + 2(DBP) divided by 3 >60 mmHg
47
Intra-arterial Pressure monitoring
cont BP readings
48
components of pressure monitoring system
invasive cath pressure tubing transducer - level with phelbostatic axix 3 way stopcocks pressure bag flush solution monitor and pressure cable
49
principles of invasive pressure monitoring
zeroing: calibrated to atmospheric pressure leveling: transducer so zero reference point at level of atria of heart (phlebostatic axis)
50
what test do you do before entering a material pressure monitor?
allen's test
51
how many mL do you flush an hour with APM?
3-6 mL maintains line patency limits thrombus formation
52
Pulmonary Artery Pressure Monitoring
guides pt with complicated cardiopulmonary problems Pa diastolic (PAD) pressure and PAWP = cardiac function and fluid volume status allows for precise manipulation of preload
53
Swan- Ganz
PA flow-directed cath Balloon inflated to measure PAWP
54
Pulmonary Artery Pressure Monitoring - Insertion
trendelenberg or supine w/ towel b/w shoulder blades sedation inserted deflated balloon, selected inflation to float cath into PA waveform changes as cath progression check for proper wedging for PWP or PAOP sheath chest x ray
55
When are pulmonary artery pressure measurements obtained?
PA: at the end of expiration PAWP: slowly inflate balloon with air until PA waveform changes to PAWP waveform do not inflate for more than 4 RR cycles or 8-15 sec
56
Pulmonary Artery Pressure monitoring - nursing management
level transducer and zero arterial systems utilize proximal lumen to measure RAP, infuse IV fluids, blood samples, and infusion of IV distal lumen used to measure PA pressures. lumen not used for IV fluids, only irrigation fluids balloon lumen left deflated and locked monitor RR and Cardiac status monitor for complications (pneumothorax, infection, sepsis, air embolus, PA infarction, or PA rupture, ventricular dysrhythmias)
57
Measurement parameters of PAC
PA systolic: 20-30 PA diastolic: 4-12 PA mean: 10-15 PWP/PAOP: 6-12
58
intermittent bolus thermodilution (TDCO)
continuous cardiac output (CCO) inject saline or D5W into proximal lumen of PA cath thermistor sensor detects differences in blood tempt and calculates CO uses average of three measurements
59
Increase SVR
vasoconstriction (more pressure to push through)
60
decreases SVR
vasodilation (less pressure lower BP)
61
Venous Oxygen Saturation
SvO2/ScvO2 reflect balance b/w oxygenation of arterial blood, tissue perfusion, and tissue oxygen consumption assess hemodynamic status and response to treatment/activity normal-70%
62
decrease SvO2/ ScvO2
decreased arterial oxygenation low CO low hemoglobin level increased oxygen consumption or extraction
63
increased SvO2/ ScvO2
may indicate improvement or sepsis
64
CO values
4-8 L/min
65
SV values
60-150 mL
66
Cardiac Index
2.2-4.0 L/min/m^2
67
Systemic Vascular resistance (SVR)
left side afterload indicator 800-1200 dynes/sec/cm^5/m5
68
Pulmonary Vascular Resistance (PVR)
right side afterload indicator 160-380 dynes/sec/cm^5/ m2
69
pulmonary artery wedge pressure (PAWP)
left side 6-12 mmHg
70
central venous pressure (CVP)
right side 2-8 mmHg
71
PA systolic (PAS)
20-30 mmHg
72
PA diastolic (PAD)
4-12 mmHG
73
Mean Arterial Pressure
overall measure of tissue perfusion 70-105 mmHg (at least 60 mmHg to prevent metabolism in the peripheral tissue) Formula: 2(DBP) + systolic BP (SBP) / 3
74
Cardiac Index is
cardiac output adjusted for body size
75
Stroke volume is
amount blood ejected by the ventricle with each heartbeat
76
SvO2 monitoring is
oxygen saturation of the hemoglobin in the venous return
77
purpose of SvO2 monitoring
early warning of an imbalance b/w oxygen supply and demand to the tissues and tissue use of oxygen (NORMAL: supply and demand match)
78
method of SvO2
a cath is placed in the pulmonary artery (mixed venous blood pumped out from the right ventricle) measures the amount of light reflected off the hemoglobin to determine how saturated they are with oxygen
79
normal SvO2 values
70%
80
low SvO2 means
seen in conditions that decrease O2 supple (low CO, low Hgb, and low SaO2) or increase in oxygen consumption (Vo2, sepsis, MODS, burns, shivering)
81
high SvO2
seen in conditions with low oxygen consumption such as anesthesia

Complex Exam One (3 decks)

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