Term
| What do you worry about with any abnormal rhythm? |
|
Definition
|
|
Term
| How do you evaluate for decreased CO with VS? |
|
Definition
Compare arms
Note pulse pressure |
|
|
Term
| How do you evaluate for decreased CO with EKG? |
|
Definition
Rate & Rhythm
PR, QRS & QT intervals
Depression or elevation of ST
Pacing & Conduction |
|
|
Term
| How can you observe decreased CO? |
|
Definition
Evaluate for cyanosis & edema
Chest, arm & jaw discomfort |
|
|
Term
| What is a friction rub evidence of? |
|
Definition
|
|
Term
| How can you assess tissue perfusion? |
|
Definition
Pulse assessment
Quality & regularity
Cap refill
Peripheral pulses
Auscultations |
|
|
Term
| When listening to the heart sounds of someone with decreased CO what do you look for? (3) |
|
Definition
|
|
Term
| What electrolyte levels may be indicative of heart problem? (2) |
|
Definition
|
|
Term
| What aspects of CBC do you look at more closely for <3 problems? (6) |
|
Definition
H&H
WBCs
Coagulation levels
Lipid profile
Cardiac enzymes/isoenzymes
Levels of cardiac meds eg dig |
|
|
Term
| Important nsg Dx r/t dec. CO |
|
Definition
| Activity Intolerance (energy mgmt & self care assistance) |
|
|
Term
| What actions does Decreased CO r/t altered cardiac pump function require? (2) |
|
Definition
Acute cardiac care
Hemodynamic regulation |
|
|
Term
| What actions does impaired gas exchange r/t decreased perfusion to the lungs require? (3) |
|
Definition
Airway mgmt
O2 therapy
Respiratory monitoring |
|
|
Term
| Inability of the heart to pump blood to meet the body's need |
|
Definition
|
|
Term
| This type of HF has reduced contractility |
|
Definition
|
|
Term
| This type of HF has impaired cardiac relaxation & impaired ventricular filling (stiff) |
|
Definition
|
|
Term
| What is the leading cause of death in US? |
|
Definition
|
|
Term
| 25% of pts die in __ yrs following Dx with HF. |
|
Definition
|
|
Term
| What do people with HF die from? |
|
Definition
| Cardiac pump failure & congestion |
|
|
Term
| What CHF pts have poorer prognosis? |
|
Definition
| Pt's with systolic & diastolic HF |
|
|
Term
| What causes cor pulmonale? |
|
Definition
|
|
Term
| How does the <3 remodel? (3) |
|
Definition
Chamber wall dilates
Hypertrophies
Becomes more spherical |
|
|
Term
| When EF is <__% exercise is limited and ability to do ADLs is affected. |
|
Definition
|
|
Term
| What is our goal with CHF Tx? |
|
Definition
|
|
Term
|
Definition
ACEi's
ARBs
B blockers
Diuretics |
|
|
Term
| What is L sided failure mostly due to? |
|
Definition
|
|
Term
| What does L sided HF result in? |
|
Definition
| Pulmonary vascular congestion & edema |
|
|
Term
| What is R sided failure usually due to? (3) |
|
Definition
L sided <3 failure
Pulmonary HTN
Lung disease |
|
|
Term
| What does R sided HF result in? |
|
Definition
|
|
Term
| MIs affect CO, what side do they usually happen on? |
|
Definition
|
|
Term
| What is biventricular failure due to? |
|
Definition
| Left and Right Ventricular MI |
|
|
Term
| Standard of care Rx Biventricular HF |
|
Definition
|
|
Term
|
Definition
|
|
Term
| This drug is Rxd for HF bc it vasodilates and reduces fluid return to the heart. |
|
Definition
|
|
Term
| These drugs (class/members) are Rxd for HF. They inc. contractility and decrease SVR. They are superior to dobutamine for pt's on oral B blockers. |
|
Definition
Inodilators:
milrinone
amrinone |
|
|
Term
| This inotropic drug is slows the HR and is used for HF. |
|
Definition
|
|
Term
| Either of these drugs are Rx'd for HF to support BP & enhance contractility. |
|
Definition
|
|
Term
| What is the digoxin level based on (esp in elderly)? |
|
Definition
| Creatinine levels (Indicative of kidney function). |
|
|
Term
| These drugs are potent vasodilators Rxd for HF. |
|
Definition
|
|
Term
| This med reduces preload for HF. |
|
Definition
|
|
Term
| This medication reduces preload & afterload but is only used short term. |
|
Definition
|
|
Term
| Why is nitroprusside only used short term? |
|
Definition
| Avoid thiocyanate poisoning. |
|
|
Term
| This Rx increases CO by vasodilation w/o inc. HR in HF. |
|
Definition
| Cardiac neurohormone (BNP/nesiritiride infusion) |
|
|
Term
| This class of meds decreases pre & afterload, increases CO and reduces the workload of the heart. (HF) |
|
Definition
|
|
Term
| This class of meds for HF reduce contractility and reduce O2 consumption of the heart. |
|
Definition
|
|
Term
|
Definition
Inc. Contractility
Dec. Preload
Dec. Afterload |
|
|
Term
| What is a side effect of L sided HF? |
|
Definition
|
|
Term
| What can occur very quickly with pulmonary edema? |
|
Definition
| Acute respiratory failure |
|
|
Term
| Your patient has pulmonary edema. What do you do? |
|
Definition
Give O2
Prepare for CPAP or ET tube/ventilation
Prepare to give:
IV Lasix or Bumex
Vasodilators
Inotropics
IV Morphine
B Blockers |
|
|
Term
| What drug class is a very potent afterload reducer? |
|
Definition
|
|
Term
| This drug is not as potent of an afterload reducer as Nitroprusside but does decrease afterload as well as preload. |
|
Definition
|
|
Term
| What diet should HF pts be on? |
|
Definition
|
|
Term
|
Definition
Biventricular pacing - cardiac resynchronization
LV assist devices (LVAD)
Ventricular reconstruction surgery |
|
|
Term
| This device is a minimally invasive percutaneous <3 pump catheter that flows up to 2.5-5 L/min. Similar to LVAD. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Important to monitor with HF |
|
Definition
|
|
Term
| Pts with HF should have ____ wts in hospital, ___ wts at home. |
|
Definition
|
|
Term
| 1 kg = __ L of fluid = ___ lbs |
|
Definition
|
|
Term
| Pts with HF should not gain more than __-__ lbs/wk ever. |
|
Definition
|
|
Term
| #1 cause of death for women |
|
Definition
|
|
Term
| Pain due to insufficient coronary artery blood flow to meet myocardial oxygen demands |
|
Definition
|
|
Term
| Predictable pattern angina |
|
Definition
|
|
Term
| Angina at rest or with normal activity |
|
Definition
|
|
Term
| What are acute or unstable coronary syndromes chest discomfort caused by? |
|
Definition
Myocardial Ischemia
Pain associated with MI |
|
|
Term
|
Definition
1. Plaque (narrowing of CA)
2. CA perfusion pressure low (sudden HoTN)
3. Dysrhythmias (tachy inc. workload) (brady coronary perfusion deficit) |
|
|
Term
| Ideal time from door to inflation of balloon in cath. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| This results of the <3 muscle as a result of absolute lack of blood supply to myocardium. |
|
Definition
|
|
Term
| Why is it important to reverse MIs ASAP? |
|
Definition
| Every second leads to more muscle death |
|
|
Term
| This is a type of MI caused by drugs or when athletes have sudden cardiac death. |
|
Definition
|
|
Term
| What is the site and size of infarction determined by? |
|
Definition
|
|
Term
| The closer to the beginning of CA the blockage is the more ___ the muscle death. |
|
Definition
|
|
Term
| What determines prognosis of AMI? |
|
Definition
| Amt of <3 muscle & location of damage |
|
|
Term
| When a pt developes a Q wave with an MI what does this mean? |
|
Definition
| Goes through all 3 layers of <3 muscle |
|
|
Term
| Why does a Q wave develop? |
|
Definition
|
|
Term
| What three Acute coronary syndromes can be treated? |
|
Definition
Unstable angina
STEMI
NSTEMI |
|
|
Term
| Do STEMI/NSTEMIs develop a Q wave? |
|
Definition
|
|
Term
| Unstable angina (_____) = ____-rich clot. |
|
Definition
|
|
Term
| Stable angina (_____)= _____-rich clot. |
|
Definition
|
|
Term
| What determines appropriate treatment of MI? |
|
Definition
| Type of clot present in CA |
|
|
Term
Pulmonary embolus
Pneumonia
Bronchitis
Pneumothorax
Aortic arch/high thoracic aneurysm
Esophagitis
Hiatal hernia
Cholecystitis
GERD |
|
Definition
| Extracardiac causes of CP |
|
|
Term
| Bruising of <3, treated same as MI |
|
Definition
|
|
Term
| Types of cardiac pain not related to ischemia |
|
Definition
Valvular disease
Cardiac trauma
Cardiac tamponade
Pericarditis
Endocarditis |
|
|
Term
| What are pt's that come in presenting with MI Dxd with? |
|
Definition
|
|
Term
| What do providers check to R/O MI? (4) |
|
Definition
Hx
Physical exam
EKG
Serum enzyme levels |
|
|
Term
| What two things does smoking do to inc. risk for ACS? |
|
Definition
Plaque development
Vasoconstriction |
|
|
Term
| Occurs with exertion of emotional stress, onset abrupt or general. |
|
Definition
|
|
Term
| Increases in severity over months, lasts 1-4 min or up to 30 min. Relieved with NTG in 45-90 s. |
|
Definition
|
|
Term
| What sets stable angina apart? |
|
Definition
|
|
Term
| Can occur at rest. Feel substernal pressure, chest tightness, heaviness or squeezing in chest. |
|
Definition
|
|
Term
| How often does NTG need to be replaced? |
|
Definition
|
|
Term
| What will patient feel when taking NTG? |
|
Definition
|
|
Term
| What type of angina is usually caused by coronary artery spasm at rest or during sleep? |
|
Definition
|
|
Term
| What can precipitate Prinzmetals? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Some people may have an MI and may not feel it, why could this be? |
|
Definition
| Development of collateral circulation |
|
|
Term
| Who is painless MI common in? |
|
Definition
| Diabetics, elderly, women |
|
|
Term
| What may silent MI victims feel? |
|
Definition
| Extreme, sudden onset fatigue |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Fatigue, pain between shoulders, Indigestion |
|
|
Term
| This can be abrupt or gradual, does not subside with rest. Crushing substernal CP radiating downL arm or up to jaw. N/V, SOB, anxiety/apprehension, diaphoresis |
|
Definition
|
|
Term
| AMI lasts longer than __ minutes, not relieved by ___. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| ST segment depression in 2 contiguous leads. |
|
Definition
|
|
Term
| ST segment elevation in 2 contiguous leads. |
|
Definition
|
|
Term
|
Definition
ST: elevated in 2 leads
T: Initial hrs tall, peaked over infarcted area, later T wave inverts
Q: may or may not form Q waves |
|
|
Term
| What is a pt with AMI especially at risk for in first hr. |
|
Definition
|
|
Term
|
Definition
Possible fever
BP up/down (related to CO)
HR up/down (r/t SNS) |
|
|
Term
| What are S3 & S4 indicative of? |
|
Definition
|
|
Term
| What are S3 & S4 indicative of? |
|
Definition
|
|
Term
| What is a friction rub indicative of? |
|
Definition
|
|
Term
| CBC changes in MI, when does this value peak? |
|
Definition
Leukocytosis (lg. MI r/t stress & tissue necrosis.
2-4 days |
|
|
Term
| Cardiac enzymes/isoenzymes are drawn in ____ pattern (eg q8 x 3). |
|
Definition
|
|
Term
|
Definition
Not specific to <3 muscle
Rises in 1-3 hrs; peaks 6-7 |
|
|
Term
|
Definition
<3 specific
Rises 3-12 hrs, peaks in 24 hrs |
|
|
Term
| This value is diagnostic of MI; Rises in 3-12 hrs, peaks in 24 hrs. |
|
Definition
|
|
Term
| This value can also be elevated in skel muscle injury. Rises in 3-12 hrs, peaks 12 hrs to 2 days |
|
Definition
|
|
Term
| This value indicates stretch of ventricular muscle. What condition is it elevated with? |
|
Definition
|
|
Term
| This value indicated inflammation of coronary artery plaques. Higher risk for acute coronary event. |
|
Definition
|
|
Term
| You cannot get an MI from a ____, instead you get a ___. |
|
Definition
|
|
Term
|
Definition
| Prevention of initial or new coronary thrombus |
|
|
Term
|
Definition
Heparin (LMW or unfractionated)
Antiplatelet Drugs (aspirin, clopidogrel, GP IIB/IIIA inhibitors) |
|
|
Term
|
Definition
Cardiac cath
Percutaneous Coronary Intervention (PCI) |
|
|
Term
| This is used to confirm physical findings & provide baseline for med/surg Tx. |
|
Definition
|
|
Term
| Why may a pt feel CP during cath? |
|
Definition
| Dye for angiogram does not carry O2 |
|
|
Term
| Pt premedication pre cath |
|
Definition
| Antihistamine or corticosteroid for potential dye allergy |
|
|
Term
|
Definition
| D/C coumadin 1-3 d pre & start on Hep drip |
|
|
Term
| What do you tell patient to do when dye is injected? |
|
Definition
|
|
Term
| What do you need to check for when dye is in CA? |
|
Definition
|
|
Term
| What Rx given during cath? |
|
Definition
Hep IV
NTG if CP
Fluid bolus if HoTN |
|
|
Term
Post-femoral cath:
Pressure to site for __-__ min or until bleeding stops.
Lie flat for __-__ hrs. |
|
Definition
|
|
Term
| What dictates time of lying flat after fem cath? |
|
Definition
|
|
Term
| What do you need to check for post cath? |
|
Definition
| Check site for bleeding, pulses distal to site & arrhythmias (Low K+ r/t diuresis) |
|
|
Term
| If pt cannot pee lying flat what must be done? |
|
Definition
|
|
Term
| Post femoral assess pt for new onset _____. |
|
Definition
|
|
Term
| What is an important nutritional point of care post fem cath? |
|
Definition
| Force fluids to remove dye |
|
|
Term
| What should you have available post fem cath for vasovagal rxn? |
|
Definition
|
|
Term
| Acronym/Order for Relief of acute ischemic pain. |
|
Definition
(M)orphine - 4
(O)xygen - 1
(N)itrates - 3
(A)spirin - 2 |
|
|
Term
| This drug decreases pain & anxiety & reduces workload of <3 |
|
Definition
|
|
Term
| O2 standard ischemic pain |
|
Definition
|
|
Term
| Aspirin instructions/dosage acute CP |
|
Definition
| 81 mg chewed immediately if not given before hospital; within 1 hr of Sx |
|
|
Term
| If the ischemia is lessening what should the T wave do? |
|
Definition
|
|
Term
| What are forms of NTG other than IV for? |
|
Definition
| Short-term or longer-lasting prophylactics |
|
|
Term
| What do you give a person with unstable angina or evolving MI? |
|
Definition
|
|
Term
| What must you monitor with IV NTG |
|
Definition
BP sys 80 or >
Titrate for pain relief |
|
|
Term
| Rx classes (3) to prevent coronary artery clot formation |
|
Definition
Antithrombin therapy
Antiplatelet therapy (pt c marked ST depression)
Direct thrombin inhibitors |
|
|
Term
| Abciximab, eptigibatide, tirofiban "liquid aspirin" |
|
Definition
| GP IIB/IIIA inhibitors (Anti-platelet) |
|
|
Term
| This class of drugs inhibits thrombin bound to fibrin or fibrin degradation products. Bivalirudin. |
|
Definition
| Direct thrombin inhibitors |
|
|
Term
| When are direct thrombin inhibitors used typically? why? |
|
Definition
| During PCI b/c duration of action is short (returns to normal after 1 hr)) |
|
|
Term
| ACS bedrest with bedside commode for __ hrs after onset of Sx. |
|
Definition
|
|
Term
| What do you want your post ACS pt to avoid? How do you do this? |
|
Definition
| Valsalva manuever; stool softener |
|
|
Term
| This Rx decreases HR, BP, myocardial contractility and is Highly recommended for AMI |
|
Definition
|
|
Term
| These drugs decrease BP & reduce resistance to ventricular EF (for long-term BP control after MI) |
|
Definition
|
|
Term
| This drug class is not recommended for ACS unless CA spasms suspected. |
|
Definition
|
|
Term
| Two main care priorities for ACS |
|
Definition
Prevention, recognition and Tx Dysrhythmias
Prevent contrast-induced nephropathy |
|
|
Term
| How do you prevent contrast induced nephropathy? |
|
Definition
Force fluids PO & IV
Mucomyst |
|
|
Term
| What can you use to monitor unstable AMI pt c ST elevation? |
|
Definition
|
|
Term
| Surgery in which balloon tipped cath is inserted into coronary arterial lesion and inflated to compress plaque against the wall. |
|
Definition
| PTCA (Percutaneous transluminal coronary angioplasty |
|
|
Term
| Why is radipaque injected during PTCA? |
|
Definition
| To see if stenosis is reduced to less than 50% of diameter of vessel after PTCA. |
|
|
Term
| Name some PTCA complications |
|
Definition
Acute coronary occlusion
Coronary artery dissection
Reocclusion in AMI
CA spasm
Renal hypersensitivity to contrast
Vasovagal Rxn
Dysrhythmia
HoTN |
|
|
Term
| This procedure removes plaque from the CA. A cutting device shaves the plaque. |
|
Definition
|
|
Term
| When is a coronary arthrectomy used? |
|
Definition
|
|
Term
| A metal-mesh tube used during cardiac caths |
|
Definition
|
|
Term
| Most common form of stent |
|
Definition
|
|
Term
| Procedure used to debulk distal tortuous CAs to allow for reperfusion. Ablates only tissue it touches. |
|
Definition
| Laser coronary angioplasty |
|
|
Term
| What may pt feel when dye is injected during PTCA? |
|
Definition
|
|
Term
| PT post PTCA will have to lie flat for 6-12 hrs unless what is used? |
|
Definition
|
|
Term
| Why should post PTCA pt take anti-platelet meds? |
|
Definition
|
|
Term
| What should PTCA pts avoid for a few weeks? |
|
Definition
|
|
Term
| How long post PTCA should pt visit cardiologist? |
|
Definition
|
|
Term
|
Definition
GI upset (could be angina)
Repeat angina
Syncope |
|
|
Term
| What does thrombolytic therapy do in Acute STEMI? |
|
Definition
|
|
Term
| What does heparin do to clots? |
|
Definition
| Prevents them from forming but does not break them down |
|
|
Term
| Exclusion criteria for thrombolytic therapy |
|
Definition
Intra-cerebral bleed
Head trauma
trauma or surgery in previous weeks |
|
|
Term
| 1st gen Thrombolytic streptococcal antigent Rx. Steroids or antihistamine given before to prevent hypersensitive rxn. |
|
Definition
|
|
Term
| 1st gen Thrombolytic drug with fewer systemic lytic effects than streptokinase |
|
Definition
|
|
Term
| 2nd gen thrombolytic clot specific. Given in a single 5s bolus & dosed by weight. |
|
Definition
|
|
Term
| 2nd gen thrombolytic c shorter half-life <5 min |
|
Definition
|
|
Term
| 2nd gen thrombolytic not clot-specific, drop in fibrinogen levels; return to normal in 48 hrs; half life 13-16 min. Give in 2 boluses 39 min apart, each over 2 min |
|
Definition
|
|
Term
| How often do you assess IV site for bleeding and bruising c thrombolytic therapy |
|
Definition
| Q 15, 30, hr (each x4 if stable) |
|
|
Term
| What do you start with thrombolytic infusion |
|
Definition
|
|
Term
| HOB & extremity position for thrombolytic therapy |
|
Definition
| 15; straight for several hrs |
|
|
Term
| What can an arrhythmia indicate during thrombolytic therapy? |
|
Definition
| Reperfusion of <3 muscle. Transient arrhythmia |
|
|
Term
| You should monitor for Vtach, AV blocks and ST depression 2-3 hrs post infusion of what? |
|
Definition
|
|
Term
| Your pt just got alteplase post MI and needs to go to the bathroom, what do you tell him to do? |
|
Definition
| Don't flush so can monitor any bleeding in body fluids |
|
|
Term
| No injections for __ hrs post thrombolytics. |
|
Definition
|
|
Term
| What may you need to administer post thrombolytic therapy? |
|
Definition
|
|
Term
| Not a primary intervention, can be done median sternotomy or minimally invasive technique, robots can be used to assist, cardiac bypass machine utilized |
|
Definition
| Surgical Revascularization (CABG) |
|
|
Term
| This type of valve has a long life, need life long anticoagulation therapy. |
|
Definition
|
|
Term
| This kind of valve replacement has a shorter life & does not require anticoagulation. |
|
Definition
|
|
Term
| Type of biological valves used |
|
Definition
|
|
Term
| Surgery that creates new paths around narrowed or blocked arteries. |
|
Definition
|
|
Term
| What can happen after valvular replacement (complication)? |
|
Definition
| Prosthetic valve endocarditis |
|
|
Term
| How long after valvular replacement does prosthetic valve endocarditis usually occur? |
|
Definition
| Within 2 months of surgical repair |
|
|
Term
| How can you prevent prosthetic valve endocarditis? |
|
Definition
| Avoid upper resp infections |
|
|
Term
| How long are pacing wires attached? Why? |
|
Definition
| 24-48 hrs. Emergency pacing if stimulate AV node. |
|
|
Term
| What are pleural chest tubes for? |
|
Definition
|
|
Term
| Your pt has a mediastinal chest tube, but no fluid is draining? What are you worried about and how do you assess for it? |
|
Definition
| Cardiac tamponade - muffled <3 sounds |
|
|
Term
| What specific aspects of a patients history do you need prior to <3 surgery? |
|
Definition
Cardiac/Resp
Depression
ETOH/smoking |
|
|
Term
| What lab things must be done prior to <3 surgery? |
|
Definition
Type & Cross
Culture throat, sputum & urine
Routine labs & Cardiac Enzymes |
|
|
Term
| 3 steps of surgical prep for pt. |
|
Definition
Hair Removal
Antibacterial shower
Sedation |
|
|
Term
| What emotional issue are <3 surgery pts at risk for? |
|
Definition
|
|
Term
| What respiratory care should you prepare <3 surgery pts for? |
|
Definition
Ventilator
IS
Resp. infections |
|
|
Term
| What 4 functions does heart lung machine perform on blood during <3 surgery? |
|
Definition
Circulates
Cools/Warms
Filters
Oxygenates |
|
|
Term
| What kind of invasive monitoring with post-op <3 surgery pts have? |
|
Definition
|
|
Term
| If <3 doesn't restart on its own after surgery what must be done? |
|
Definition
|
|
Term
| Bleeding, infections, embolism, cardiac arrest, arrhythmias and tamponade are complications of what? |
|
Definition
|
|
Term
| What meds should <3 surgery pt have post op. |
|
Definition
| Pressure meds, fluids & antiarrhythmics prn |
|
|
Term
| IABP inflates during ______ and deflates during _______. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What does the balloon being inflated during diastole help? |
|
Definition
| Better filling of CAs. Inc. O2 to <3 Dec. Afterload. |
|
|
Term
| 2 IABP ultimate functions. |
|
Definition
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Term
|
Definition
Circulation
Balloon rupture
Improper synchronization |
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Term
| What do you need to check the insertion site of IABP for? |
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Definition
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|
Term
| How is the weaning procedure of IABP done? |
|
Definition
# inflates : # <3 beats
1:1
1:2
1:4
1:8 |
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Term
| Why do we assess A&O after <3 surgeries? |
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Definition
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|
Term
| How do you assess pain post <3 surgeries? |
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Definition
| Surgical pain vs. new cardiac chest pain? |
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|
Term
| Where are post CABG pts likely to have incisions? |
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Definition
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|
Term
| What trauma can happen during surgery to cause CP? |
|
Definition
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|
Term
| How long do dressings stay on post-<3 surg. |
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Definition
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|
Term
| What do you clean incisions with post <3 surg? |
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Definition
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Term
| Drinkers can have this problem post <3 surg. |
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Definition
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Term
| Why may your post-CABG pt be confused? |
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Definition
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|
Term
| What activity restrictions are on <3 surg pts? |
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Definition
Driving limitations
No lifting > 20 lbs
No walking outside if v. hot or cold |
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Term
| Gives support to cardiac muscle? |
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Definition
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|
Term
| Go between ribs on L side, usually 1 vessel disease, use internal mammary artery. D/C after 48 hrs. |
|
Definition
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|
Term
| Infection of innermost layer of <3; usually involves natural or prosthetic valve. |
|
Definition
| Acute Infective endocarditis (IE) |
|
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Term
|
Definition
Bac
Viruses
Fungi
Rickettsiae |
|
|
Term
| __% of people with IE have underlying <3 disease. |
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Definition
|
|
Term
| Why do murmurs form c prosthetic valves. |
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Definition
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|
Term
| IE mortality rate is __%-__%. |
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Definition
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|
Term
|
Definition
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|
Term
| IE more likely to happen in ____ > 50 yo. |
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Definition
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|
Term
| Can IE stem from a congenital or acquired defect? |
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Definition
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Term
| Formation of a sterile _______ can give rise to vegetation and cause IE. |
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Definition
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|
Term
| _________ from colonization in thrombus can occur and cause IE. |
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Definition
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|
Term
| High level of __________ __________ promotes growth of vegetation (IE). |
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Definition
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|
Term
| Portals of entry of infecting organism in IE. (5) |
|
Definition
Mouth/GI
Upper Airway
Skin
External GU
IV (drug use) |
|
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Term
| Most common valves affected by IE |
|
Definition
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|
Term
| IV drug use increases ________ valve IE. |
|
Definition
|
|
Term
|
Definition
Valvular Dysfunction:
Insufficiency
Regurgitation
Embolization
Dec. CO |
|
|
Term
| Acute IE presentation has onset within __ weeks of infection. |
|
Definition
|
|
Term
| Subacute presentation of IE shows up in up to ___ weeks. |
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Definition
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|
Term
| Staph _____ in IE more severe than Strep _______. |
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Definition
|
|
Term
| Staph _____ in IE more severe than Strep _______. |
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Definition
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|
Term
| What do symptoms and treatment of IE depend on? |
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Definition
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Term
| Fever, Tachycardia, dysrhythmias and HoTN can occur with what? |
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Definition
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|
Term
| Why must you use hemodynamic monitoring carefully with IE pts? |
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Definition
| Normal ranges assume normal valves |
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Term
| What altered values do you expect to see with hemodynamic monitoring of IE pts? |
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Definition
| Elevated PAP & CVP c reduced CO |
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|
Term
| What can Hemodynamic monitoring cause in IE pts? (3) |
|
Definition
Valvular dysfunction
Embolization
Infection |
|
|
Term
| Diaphoresis, fatigue, anorexia, joint pain, wt loss & abd pain can occur during the acute infective stage of what? |
|
Definition
|
|
Term
| Bleeds under fingernails. (IE) |
|
Definition
|
|
Term
| Painless small hemorrhages on palms, soles, nose or ears. (IE) |
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Definition
|
|
Term
| Painful red nodules on pads of toes & fingers (IE) |
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Definition
|
|
Term
|
Definition
|
|
Term
| ____________ in 10 days r/t activation of reticuloendothelial system (IE). |
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Definition
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|
Term
| IE pts can have possible _____ sided failure. |
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Definition
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|
Term
| What must you draw specifically with IE, how do you do it? |
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Definition
Blood cultures.
Draw several sets (aerobic & anaerobic) from different puncture sets |
|
|
Term
| This is used as a comparison over course of hospitalization for IE pts. Shows a global ___ segment elevation. |
|
Definition
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|
Term
| What do IE pts take before and after selected invasive procedures? |
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Definition
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Term
|
Definition
|
|
Term
| What should IE pts diet be high in? |
|
Definition
|
|
Term
| Observe for signs of _________ during first 3 months (IE) |
|
Definition
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|
Term
| When do they do surgical valve replacement on IE pts? (2) |
|
Definition
HF worsens
Infection fails to respond to ABX |
|
|
Term
| Your pt comes in with prosthetic valve endocarditis 30 days after valve replacement. What do you suspect as the cause? |
|
Definition
| Perioperative contamination |
|
|
Term
| Your pt comes in with prosthetic valve endocarditis 90 d after surgery. What do you expect as the cause? |
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Definition
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|
Term
| What must you be very careful about with IE pts? |
|
Definition
| Strict aseptic technique, handwashing & good hygiene |
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|
Term
| Concurrent problem with IE |
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Definition
|
|
Term
| Two important teaching points for IE pts |
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Definition
Necessity of prophylactic ABX
Report Sx of recurring infections |
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|
Term
| Inflammation of pericardium & epicardial surface of <3 |
|
Definition
|
|
Term
|
Definition
AMI
Acute infection
Chronic renal failure |
|
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Term
|
Definition
|
|
Term
| Late Acute pericarditis (after 6 wks) |
|
Definition
| Evolves into pericardial effusions; pericardial tamponade |
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|
Term
| Acute Pericarditis is usually a _______ finding following CABS, valve replacement or chronic renal failure. |
|
Definition
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|
Term
| Large effusions from acute pericarditis can lead to what? |
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Definition
|
|
Term
| Fluid compresses <3 and impairs filling of chambers and EF. Chambers of <3 can collapse |
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Definition
|
|
Term
| How do you assess acute pericarditis? |
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Definition
| R/O EKG changes & Cp as acute coronary syndrome |
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|
Term
| What is acute pericarditis characterized by? (3) |
|
Definition
CP
Pericardial friction rub
Serial EKG changes |
|
|
Term
AMI
Recent bacterial/viral infection
Chronic renal failure
Autoimmune diseases
radiation therapy
Cardiac surgery
Chest trauma
are risk factors for what? |
|
Definition
|
|
Term
| 3 common causes of acute pericarditis |
|
Definition
|
|
Term
| Aggravating factors AP. (3) |
|
Definition
Supine position
Coughing & deep breathing
Swallowing |
|
|
Term
|
Definition
Fatigue
Pallor
Fever
Anorexia |
|
|
Term
|
Definition
| Inc. dyspnea, crackles, JVD |
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|
Term
| Stabbing CP radiating to neck or shoulder is likely what? |
|
Definition
|
|
Term
| BP elevated in ____ arm c ensuing cardiac tamponade |
|
Definition
|
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Term
|
Definition
HoTN
Elevated CVP c JVD
Muffled <3 sounds with cardiac tamponade |
|
|
Term
|
Definition
Narrowing pulse pressure
Pulsus paradoxus |
|
|
Term
| Systolic pressure 10 mm HG greater during expiration than inspiration |
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Definition
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|
Term
| As effusions increase ________ decreases. |
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Definition
|
|
Term
| Pressures in all <3 chambers equalize & patient cardiac arrests |
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Definition
|
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Term
|
Definition
| Pericardial friction rub (may or may not be present) |
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Term
| In AP cardiac enzymes will be positive if __________ is inflamed. |
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Definition
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Term
| 2 first steps for Tx of AP |
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Definition
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|
Term
| Class of medications given for inflammation in AP |
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Definition
| NSAIDs (indomethacin, ibuprofen) |
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|
Term
| Rx AP also given to gout. |
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Definition
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|
Term
| What pts is colchicine not safe in? |
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Definition
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|
Term
| If AP pt has no response to NSAIDs what will be given? |
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Definition
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|
Term
| Why can't patients with AMI receive prednisone? |
|
Definition
| Causes cardiac muscle to thin |
|
|
Term
| Mgmt cardiac tamponade (procedure) |
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Definition
|
|
Term
| What is used to guide catheter tip in pericardiocentesis? |
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Definition
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|
Term
| Avg mLs drained with pericardiocentesis |
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Definition
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|
Term
| Surgical window made in pericardial sac |
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Definition
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Term
| Syndrome characterized by hypoperfusion of body tissues & results in a lack of O2 to the cells that eventually leads to an anaerobic metabolism & metabolic acidosis. |
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
| Container too large for amt of fluid shock |
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Definition
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|
Term
| Shock seen with SCIs --> vasodilation b/c can't constrict. |
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Definition
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Term
|
Definition
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|
Term
|
Definition
|
|
Term
Very young & very old
Immunosuppressed
Steroid therapy
Altered immune system
Urologic & GI surgeries
Poor nutritional states
Invasive procedures
These patients are at higher risk for what? |
|
Definition
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|
Term
| What does shock lead to if not treated? |
|
Definition
|
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Term
|
Definition
| Stroke volume variability |
|
|
Term
| Systolic pressure stays same or inc. slightly and diastolic pressure elevates slightly. |
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Definition
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Term
| Systolic pressure drops, diastolic pressure inc. r/t vasoconstriction (compensation) & then drops severely c widening pulse pressure |
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Definition
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Term
| Goals of care for Shock (3) |
|
Definition
Tx underlying cause
Inc. arterial oxygenation
Improve tissue perfusion |
|
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Term
|
Definition
| Stabilize shock pt within first hr of any injury |
|
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Term
|
Definition
|
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Term
|
Definition
Decrease - blood loss
Increase - plasma loss |
|
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Term
| What do you check ABGs for with shock? |
|
Definition
O2 levels
metabolic acidosis |
|
|
Term
| Decrease in _____ levels in early stage of shock. |
|
Definition
|
|
Term
Electrolyte changes in shock:
Sodium _________.
Potassium __________ with metabolic acidosis. |
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Definition
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|
Term
| Why would you draw blood cultures on your pt in shock? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Inc. neutrophils c shock indicate what? |
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Definition
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|
Term
| Inc. eosinophils c shock indicate what? |
|
Definition
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|
Term
| Why do you draw serum cardiac enzymes c shock? |
|
Definition
| With cardiogenic shock to R/O MI |
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Term
| All pts in shock should receive what? |
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Definition
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|
Term
| Maintain shock pts at >__ PaO2 |
|
Definition
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|
Term
| How can you correct respiratory acidosis in pts in shock? |
|
Definition
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|
Term
| Fluid replacement is used to Tx all forms of shock except for what? |
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Definition
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|
Term
| This type of fluid inc. volume & O2 carrying capacity |
|
Definition
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|
Term
| This fluid used to Tx shock inc. intravascular volume by 25% and interstitial by 75%. What does this put the pt at risk for? |
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Definition
| Crystalloids; peripheral edema |
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Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| This fluid is isotonic in bottle but hypotonic in pt. |
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Definition
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|
Term
| What kind of fluid is D5LR |
|
Definition
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|
Term
Contain substances that cannot diffuse through capillary membranes.
What does this do? |
|
Definition
Colloids
Inc. osmotic pressure within vessels |
|
|
Term
| What can pull fluid from interstitial spaces into vascular compartment? |
|
Definition
|
|
Term
| 5% albumin, Dextran & Hetastarch are examples of what? |
|
Definition
|
|
Term
| What do you give with blood to shock pt? |
|
Definition
|
|
Term
| What do you need to monitor in pt receiving colloids? |
|
Definition
|
|
Term
| Colloids can decrease what resulting in decreased coagulation? |
|
Definition
|
|
Term
| What complications do you need to watch our for with shock pt on colloids? |
|
Definition
CHF
Bleeding
Dehydration
Hypersensitivity |
|
|
Term
| H/H goal for bleeding pt receiving blood products |
|
Definition
|
|
Term
| what does stored blood contain? What is it deficient in? |
|
Definition
| Anticoagulants; clotting factors |
|
|
Term
| What do you give with stored blood? (2) |
|
Definition
| Vit K &/or FFP (fresh, frozen plasma) |
|
|
Term
| What type of med should be given to shock pts when fluid is replaced? |
|
Definition
Vasoconstrictors eg.
Aramine
Levophed
Epi
Dopa
Phenylephrine |
|
|
Term
| Where should you give vasoconstrictors for shock pt? |
|
Definition
| Central vein (can cause necrosis of tissue) |
|
|
Term
| Inotropic drugs for shock |
|
Definition
Dopamine
Dobutamine
isuprel |
|
|
Term
| Vasodilators usually used to Tx cardiogenic shock (used with inotropes) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Controversial Tx of metabolic acidosis if ph<7.2 |
|
Definition
|
|
Term
|
Definition
| Supine c legs elevated (not trendelenberg) |
|
|
Term
| Good indicator of fluid status (hemodynamic monitoring) |
|
Definition
|
|
Term
| What problem may your shock patient have that you might be unaware of? |
|
Definition
| Anxiety r/t loss of others, trauma etc |
|
|
Term
| Shock pt: Promote rest, ________ for pain, support family & pt. |
|
Definition
|
|
Term
| Is shock pt at risk for pressure ulcers? |
|
Definition
|
|
Term
| Mortality rate of cardiogenic shock is >___% |
|
Definition
|
|
Term
| Most dangerous manifestation of cardiogenic shock |
|
Definition
|
|
Term
| Decrease in arterial O2 pressure & saturation. Secondary to inc. PCWP. |
|
Definition
|
|
Term
| What must be monitored very carefully in cardiogenic shock pts? |
|
Definition
|
|
Term
| 4 meds Rxd for cardiogenic shock |
|
Definition
Inotropes
Diuretics (dec. preload)
Vasoconstrictors (improve BP, then..)
Vasodilators (reduce pre & afterload) |
|
|
Term
| Why do you monitor lactate levels in cardiogenic shock pt? |
|
Definition
| Lactic acid Inc ->> metabolic acidosis |
|
|
Term
| Possible inteventions for cardiogenic shock. |
|
Definition
IABP
R &/or L VAD
MI related: Thrombolytic therapy &/or angioplasty |
|
|
Term
| Resp support cardiogenic shock |
|
Definition
|
|
Term
| What extra condition may you need to treat r/t pH in cardiogenic shock? |
|
Definition
| Lactic acidosis - resolves c good perfusion - pH <7.2 bicarb |
|
|
Term
| Why is a CBC drawn with R/O MI? |
|
Definition
| O2 carrying capacity (H/H) |
|
|
Term
| What do you check before giving nitro? |
|
Definition
|
|
Term
| Why do you need 2 IVs in pt with AMI? |
|
Definition
| Critical - Thrombolytics need own IV |
|
|
Term
| What abnormal EKG change can be seen with Tx of MI? |
|
Definition
| Reperfusion arrhythmia (Part of <3 reperfused gets irritated) |
|
|
Term
| Do you treat reperfusion arrhythmia? |
|
Definition
|
|
Term
|
Definition
| CP radiating to L arm or Jaw; n/v/ diaphoresis, pressure on chest |
|
|
Term
| This condiiton modifies MI presentation |
|
Definition
|
|
Term
|
Definition
Troponin I
CKMB
ST elevation
Q waves |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Contraindications for thrombolytic therapy |
|
Definition
Uncontrolled HTN
Chest compressions
trauma
past bleed
surgery (6 wks)
Head bleed |
|
|
Term
| Can you give postpartum women tPA? |
|
Definition
|
|
Term
|
Definition
| Pain, transient arrhythmia |
|
|
Term
| This medication is given to people post MI b/c reduces workload, dec HR & contractility & helps protect <3 for 6 months |
|
Definition
|
|
Term
| Significance ST elevation |
|
Definition
| Not enough O2; damage to <3 muscle |
|
|
Term
| What should your post-cath pt do if they think they are bleeding? |
|
Definition
| Pressure & call nurse. Don't try to look. |
|
|
Term
| Why is an IABP helpful with cardiogenic shock? |
|
Definition
| Inc. filling & dec. afterload |
|
|
Term
| Clinical significance of S3 |
|
Definition
|
|
Term
| What is IABP filled with, why? |
|
Definition
| He+, so pt doesn't die if it bursts |
|
|
Term
|
Definition
| renal artery vasodilation |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Pressor (vasoconstriction & inc. SVR) |
|
|
Term
| Difference between systolic & diastolic pressures. |
|
Definition
|
|
Term
|
Definition
Prevent cardiac remodeling
Inc. vasodilation by inhibiting ang I -> ang II |
|
|
Term
| failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart |
|
Definition
|
|
