Term
|
Definition
| released into the bloodstream in response to an ischemic event - Tropin is most specific! |
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Term
| Expected ranges for cardiac enzymes |
|
Definition
CK-MB: specific to heart, should be 0, elevated for 2-3 days
Troponin: *most accurate and specific to the heart*
(Troponin-T: should be less than 0.1; elevated for 10-14 days)
(Troponin-I) should be less than 0.03; elevated for 7-10 days
-Myoglobin: elevated d/t heart damage for skeletal muscle damage; should be less than 90 mcg/L, elevated for 24 hours |
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Term
| Cholesterol Levels and expected ranges |
|
Definition
- total cholesterol <200 mg/dL
-HDL >55 mg/dL (women), >45 mg/dL (men0
-LDL <130 mg/dL
-Triglycerides 35-135 mg/dL (women), 40-160 mg/dL (men) |
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Term
|
Definition
| Central Venous Pressure (CVP)- should be between 2-6 mmHg; greater than 6 indicates HF |
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Term
|
Definition
able to obtain pressure inside veins, arteries, and heart
-CVP, PAWP, CO |
|
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Term
| PAWP- Pulmonary Artery Wedge Pressure |
|
Definition
| 6-15 mmHg; greater than 15 indicates heart failure |
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Term
|
Definition
| 3-6 L/min; lower than 3 means heart failure |
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Term
| Nursing care nursing Arterial line insertion |
|
Definition
Level transducer with phlebostatic axis (4th intercoastal space, midaxillary line)
-zero system
-confirm placement with X-Ray |
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Term
| Coronary Angiogram (i.e. cardiac cath) |
|
Definition
| an invasive procedure used to determine if the patient has coronary artery blockage or narrowing. catheter inserted into the femoral artery and threaded up to heart. |
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Term
| Pre-procedure Coronary Angiogram |
|
Definition
| NPO 8 hours prior to procedure. Assess for allergy to iodine or shellfish. Assess kidney function (BUN, creatine) to determine if kidneys can excrete the dye. |
|
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Term
| Post-Procedure Coronary Angiogram |
|
Definition
| Check insertion site for bleeding, check extremity distal to puncture site (pulses, capillary refill, temperature, color). Take VS every 15 min x 4, every 30 min x2, every hour x 4. The patient lies flat in bed for 4-6 hours after the procedure. |
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Term
|
Definition
| Accumulation of fluid in the pericardial sac |
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Term
|
Definition
| hypotension, muffled heart sounds, distended jugular veins, PARADOXICAL PULSE (variance of 10 mmHg or more SBP between inspiration and expiration) |
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Term
| diagnosis of cardiac tamponade |
|
Definition
| Chest x-ray, echocardiogram |
|
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Term
| treatment of cardiac tamponade |
|
Definition
| pericardiocentesis (removal of fluid from pericardial sac) |
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Term
| PICC- peripherally inserted central catheter |
|
Definition
| used for long-term administration of IV antibiotics, TPN, chemotherapy. Tup positioned in lower 1/3 of superior vena cava. Can stay in place for 12 months. |
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Term
|
Definition
1. flush with 5-10 mL (use 10mL or larger syringe) of normal saline before and after medication administration to prevent medication interaction from occurring and to ensure the client receives the full dose
2. change gauze dressings on site every 48 hours and transparent dressing every 7 days
-when removing the transparent dressing, the nurse should remove it by gently pulling it from the sides to avoid dislodging the catheter
3. nurse should administer an intermittent IV BOLUS dose of heparinized saline to flush a PICC line when it is not in use
4. plan to administer a thrombolytic agent (alteplase) in the event a PICC line becomes clotted and blood return cannot be obtained |
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Term
|
Definition
| long term (>=1 yr) vascular access; common with chemotherapy. Access with non-coring (Huber needle). |
|
|
Term
|
Definition
1. Phlebitis
2. Infiltration
3. Air embolism |
|
|
Term
| Phlebitis - IV Complication |
|
Definition
inflammation of the vein
S/S: erythema, pain, warmth, edema, induration or cord-like veins, red streak
*discontinue the infusion, remove catheter, apply warm compress* |
|
|
Term
| Infiltration- IV Complication |
|
Definition
fluid going into a tissue rather than the vein
S/S: edema, coolness, taught skin, pale skin
*discontinue infusion, use cool or warm compresses, elevation* |
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|
Term
| Air embolism - IV complication |
|
Definition
accidentally injected air in the vein
s/s: SOB
*place pt. on LEFT side in Trendelenburg position, provide oxygen, notify provider |
|
|
Term
|
Definition
HR <60 bpm
If symptomatic, administer atropine.
Electrical intervention: pacemaker |
|
|
Term
| Afib,SVT, Ventricular tachycardia with pulse |
|
Definition
administer anti-arrhythmic medication
(ex: amiodarone, adenosine, verpamil)
Electrical intervention: cardioversion
Nursing care:
1. patient must be on anticoagulation for 4-6 weeks before cardioversion
2. staff needs to stand clear of patient when shock is delivered
3. After the procedure: assess airway, monitor VS, obtain EKG. Monitor S&S of dislodged clot (PE, stroke, MI). |
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|
Term
| Ventricular tachycardia without pulse, VFib |
|
Definition
administer anti-arrhythmic medication
ex: amiodarone, lidocaine, epinephrine
Electrical intervention: defibrillation |
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Term
|
Definition
| provides electrical stimulation of heart when natural pacemaker in heart doesn't maintain proper rhythm. Programmed to pace atrial (A), ventricular (v), or both chambers (AV) |
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Term
|
Definition
1. Asynchronous: fires at a constant rate regardless of heart's electrical activity
2. synchronous: fires only when heart's intrinsic rate falls below a certain rate |
|
|
Term
| indications for pacemakers |
|
Definition
| symptomatic bradycardia, heart block, sick sinus syndrome |
|
|
Term
| Nursing care and patient teaching: pacemakers |
|
Definition
1. provide sling and instruct patient to minimize shoulder movement
2. *Assess for hiccups* which may indicate pacemaker is pacing the diaphragm
3. instruct patient to: carry pacemaker ID card, take pulse daily, avoid contact sports, heavy lifting for 2 months
4. pacemaker will set off airport security detectors
5. MRIS are contraindicated
6. OK to use garage doors and microwave |
|
|
Term
| percutaneous coronary intervention (PCI) |
|
Definition
| procedure to open coronary arteries. performed *within 3 hours* of the onset of MI symptoms. |
|
|
Term
| percutaneous coronary intervention (PCI) 3 types |
|
Definition
1. atherectomy- removal of plaque in the vessel
2. placement of stents
3. PTCS (inflating a balloon to widen the arterial lumen) |
|
|
Term
| percutaneous coronary intervention (PCI) complications |
|
Definition
1. Artery dissection- monitor hypotension and tachycardia
2. cardiac tamponade
3. bleeding/hematoma at an insertion
4. embolism
5. retroperitoneal bleeding (monitor for flank pain and hypotension)
6. restenosis of vessel (monitor for chest pain, assess EKG) |
|
|
Term
| coronary artery bypass graft |
|
Definition
| surgery to bypass one or more coronary arteries, due to blockages and/or persistent ischemia. Saphenous vein often used. patient's core temperature lowered to decrease metabolic (and oxygen) demand during procedure |
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|
Term
| coronary artery bypass graft key nursing care |
|
Definition
1. monitore BP. hypertension can cause bleeding from ggrafts. hypotension can cause collapse of graft
2. monitor chest tube. *over 150 ml/h can indicate hemorrage- notify profider. |
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|
Term
| coronary artery bypass graft - patient teaching |
|
Definition
treat angina with sublingual nitroglycerin (let dissolve under tongue,rest and wait 5 minutes take 2nd dose, call 911 if still experience, take no more than 3),
quit smoking, consume heart healthy diet, participate in cardiac rehab program |
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Term
|
Definition
| surgery to restore blood flow to extremity due to peripheral artery disease |
|
|
Term
| peripheral bypass graft nursing care |
|
Definition
pre: obtain consent, NPO 8 hours before prcedure, monitor pedal up;ses/capillary/ skin color and temo
post: bed rest for 18-24 hours with legs straight; avoid sitting for long periods of time or crossing leg; wear antiembolic stockings monitor for compartment syndrome - worseing pain, swelling, taught skin |
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Term
|
Definition
| widening or ballooning in the wall of a blood vessel |
|
|
Term
|
Definition
1. abdominal aortic (AAA)- flank pain, pulsating abdominal mass
2. aortic dissection: stabbing/ripping feeling in abdomen and back, hypovolemic shock (hypotension, tachycardia, dec. pulses, N/V, diaphoresis)
3. Thoracic aortic: severe back pain, SOB, difficulty swallowing, pain |
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|
Term
| Nursing care for Aneurysms |
|
Definition
| reduce SBP to 100-120 mmHg, administer antihypertensives. Monitor VS, cardiac rhythm, ABGs, urine output *(report output less than 30 mL/h)* |
|
|
Term
| Hypertension primary vs secondary hypertension |
|
Definition
primary: no known cause
secondary: caused by disease or medications |
|
|
Term
| risk factors of hypertension |
|
Definition
primary: family hx, excess sodium intake, inactivity, obesity, smoking, stress, hyperlipidemia, race (African American)
secondary: kidney disease, crushing syndrome, pheochromocytoma |
|
|
Term
|
Definition
| headache, dizziness, visual issues, or patients may not have any symptoms |
|
|
Term
|
Definition
diuretics
calcium channel blockers
ACE inhibitors
angiotensin 2 receptor antagonists
aldoesterone receptor antagonists
beta blockers |
|
|
Term
| patient teaching hypertension |
|
Definition
| take BP regularly, limit alcohol intake, DASH diet (high in fruits, veggies), reduce weight, reduce stress, stop smoking |
|
|
Term
| 4 types of hemodynamic shock |
|
Definition
1. cardiogenic-cardiac pump failure d/t HF, MI and/or dysrhythmias
2. hypovolemic-blood loss d/t trauma, surgery or burns, fluid losses d/t GI loss (vomiting, diarrhea, diuresis)
3. obstructive-blockage of great vessels (PE, tension pneumothorax, cardiac tamponande)
4. distributive-extreme vasolidation
a. septic-endotoxins in blood stream from infection, gram-negative bacteria most common
b. neurogenic-lack of sympathetic tone in the body d/t trauma or spinal shock
c. anaphylactic-antigen-antibody reaction d/t exposure to allergen; medical emergency |
|
|
Term
|
Definition
*hypotension*, tachypnea, tachycardia, weak pulses, dec. UOP (less than 30 mL/h)
-anaphylactic S/S: wheezing, angioedema, rash |
|
|
Term
| labs for hemodynamic shock |
|
Definition
increase serum lactic acid
abnormal ABGs
increased cardiac enzymes w/ cardiogenic shock
decreased hct/hgb w/hypovolemic shock, positive blood cultures with septic shock |
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|
Term
| nursing care for hemodynamic shock |
|
Definition
| administer o2, prepare for intubation, place patient flat with legs elevated for hypotension |
|
|
Term
| meds for hemodynamic shock |
|
Definition
dobutamine
vasopressin
epinephrine
colloids for hypovolemic shock (replace volume first)
antibiotics for septic shock |
|
|
Term
| complications for hemodynamic shock |
|
Definition
1. The Multiple Organ Dysfunction Syndrome (MODS)
2. Disseminated intravascular coagulation |
|
|
Term
|
Definition
prehypertension: 120-139/80-89
stage 1 htn: 140-159/90-99
stage 2 htn: >160/ >100
hypertensive crisis: >240/ >120 |
|
|
Term
|
Definition
1. stable: occurs with exercise- relived by rest (or nitroglycerin)
2. unstable: occurs with exercise or at rest. increases in duration, occurrence, or severity over time
3. variant: related to coronary artery spasm, occurs during rest |
|
|
Term
| angina vs. myocardial infarction |
|
Definition
| pain unrelieved by rest or nitroglycerin and lasts more than 30 minutes is indicative of an MI (vs angina). MIs (unlike angina) often have other symptoms, such as nausea, epigastric discomfort, diaphoresis, dyspnea |
|
|
Term
| myocardial infarction medications |
|
Definition
nitroglycerins
analgesics
beta-blockers
thrombolytic meds
antiplatelet meds
anticoagulants |
|
|
Term
| myocardial infarction labs |
|
Definition
elevated cardiac enzymes
CK-MB, Troponin 1, Troponin T, myoglobin |
|
|
Term
| myocardial infarction risk factors |
|
Definition
| male gender, post-menopausal women, hypertension, smoking, hyperlipidemia, diabetes, stress, inactivity |
|
|
Term
|
Definition
| anxiety, chest pain, nausea, diaphoresis, cold/clammy skin, pallor, tachycardia |
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