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What is the nursing diagnosis for CABG post-op?
Decreased cardiac output
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CABG-Post op:
What are signs of Mediastinitis?
- Fever > 4 days
- Boggy sternum
- Signs of infection at suture site
- Elevated WBC
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CABG-Post op:
What are signs of Postpericardiotomy syndrome?
- Pericardial & pleural pain
- Friction rub
- Fever, elevated WBC, dysrythmias
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A patient has just underwent a CABG and there was a sudden cessation of previously heavy CT output, what should the nurse suspect?
Cardiac Tamponade
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CABG-Post op:
What are signs of Cardiac Tamponade?
- Sudden cessation of CT output
- JVD with clear lung sounds
- Tachycardia
- Hypotension
- Muffled heart sounds
- Diminished peripheral pulses
- Pulsus paradoxus
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What should be immediately reported to a MD after a CABG?
Chest tube outputof >150ml/hr
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Healthy Triglyceride levels in men?
< 150
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Healthy Triglyceride levels in women?
< 135
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Healthy Cholesterol levels?
- < 200
- LDL (0-130) - lower the better
- HDL (>40) - higher the better
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T/F: Men have a greater chance of CAD until women reach menopause
True
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Chronic stable angina?
- Chest discomfort precipitated by stress/exertion
- *Relieved by rest and/or NTG*
- Less than 15 min of duration
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Chronic Unstable angina?
- chest pain > 15 min. duration
- Poorly relieved by rest or NTG
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If someone is having a heart attack what should they do?
Chew 325mg of Aspirin, rest & call 911
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How often can you administer NTG sublingually?
Every 5 minutes - up to 3 times
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When should you notify position after taking NTG?
If BP <100 mm HG or drop of 25 mm Hg - & lower head of bed and call doctor
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NTG Patch teaching?
Remove 8-10 hours everyday to prevent tolerance
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Expected side effect of NTG?
- Headache (back of head)
- Hypotension
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NTG tablet patient teaching?
- replace pills every 3-5 days
- Store in dry, dark place
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When would you want to hold a Beta-Blocker and notify physician?
- HR < 60 bpm
- BP < 100 mm Hg
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If a patient comes in with chest pain what actions should the nurse take?
- Pt. should be placed on a stretcher with HOB at level of comfort & do MONA
- -Morphine (contraindicated in low BP & bradycardia)
- -Oxygen 4L (>95% O2 sat)
- -Nitroglycerin
- -Aspirin (chew 325mg)
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ST Depression represents what?
Non-Stemi
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ST elevation represents what?
Stemi
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What assessment finding would indicate thrombolytic therapy is needed?
- ST Elevation
- Continuous chest pain > 30 min unrelieved by NTG
(most effective within 6 hrs of onset)
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What is the exclusion criteria for thrombolytic therapy?
- Any condition predisposing hemorrhage
- Active bleeding
- Uncontrolled hypertension
- CVA
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How do you know if Thrombolytic Threapy has worked?
- Resolution of chest pain
- ST segment return to baseline
- Reperfusion dysrhythmias
- Rapid rise in cardiac enzymes
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What does MOVE IT C stand for?
- Monitor
- Oxygen
- Vital Signs
- EKG Stat
- IV Access
- Treatment-thrombolytics
- Chest x-ray within 30 min
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What is the normal range for troponin?
<.35 mcg/L
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What is the normal range for myoglobin?
<90 mcg/L
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An increase in cardiac enzymes is indicative of _______.
Non stemi/unstable angina or that the clot has been dissolved
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If your pt's monitor is showing PVCs what do you need to watch for especially in the first hour?
V fib
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What is a dysrhythmmia commonly follows an MI?
PVCs
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Nursing interventions for Post procedure-cardiac cath (PCTA):
- HOB 30 degree or less for 4-6 hr
- maintain pressure dressing
- avoid flexion of extremity for 12-24 hrs
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Complications of MI?
S/S include: pericarditis with effusion, chest pain, dyspnea
dressler's syndrome
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What is the nursing diagnosis for STEMI?
ineffective tissue perfusion
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Who are beta blockers CI in?
asthma patients
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What would you monitor after adminstering thrombolytic therapy?
- Bleeding at IV site
- Occult blood in urine, feces, emesis, etc.
- H&H
- neurological status (obtain baseline prior to adminstration)
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Thromobolytic post infusion nursing interventions :
- bed rest for 6 hr
- pressure at site after catheter removal
- neuro checks
- antiplatelets as ordered
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What drug should you stop before having a CABG?
coumadin
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