Cardio Dysfunction and Delegation

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  1. Which lab test will be most accurate for a client having chest pain that started 3 days ago?
  2. All cardiomyopathies will present as....
    Heart Failure
  3. What is cardiomyopathy?
    heart muscle disease that affects the structural of functional ability of the myocardium
  4. What problem is the most likely to lead to heart transplant?
  5. What's the problem with dilated cardiomyopathy?  Solution?
    dilated ventricle

    • control CHF
    • Digoxin
    • Diuretics
    • Dobutamine

    ICD placement
  6. What's the problem with hypertrophic cardiomyopathy?  Solution?
    Impaired LV filling and obstruction to outflow of the aorta.

    • improve ventricular filling and relieve outflow obstruction
    • Ventriculomyomotmy 
    • myomectomy-debulks ventricle
  7. What's the solution to restrictive cardiomyopathy?
    improve diastolic filling
  8. Person comes in with chest pain...tests to look at?
    CK first  that indicates injury

    CK-MB next and it tells injury is heart specific
  9. Difference between CK-MB and Troponin tests?
    CK MB shows injury within 2-3 hrs and will be there for 2-3 days

    Troponin shows injury within 4-6 hrs and will be there for 10-14 days
  10. What does BNP dx?
    Heart failure....and the higher the number indicates worse failure
  11. BNP leves of normal, suggestion of failure and severe failure
    • Normal <100
    • possible failure 100-300
    • severe HF >900
  12. Which cardiac biomarker test is best for a person who thought they were having indigestion for past 8 days?
    Troponin...takes 10-14 days to be out of system
  13. Chest x ray is good to dx.....
    cardiomegaly...enlarged heart

    if cardiac silhouette is >50% of diameter of chest then cardiomegaly
  14. What test will look for occlussions of heart?
    Cardiac Catheterization
  15. Prior to sending a patient to cath lab check....
    • iodine sensitivities
    • NPO 6-18 hrs prior
  16. What does a stress test look for?  How?
    • myocardial ischemia......will show differences in left ventricular wall motion
    • and
    • thickening before and after exercise are evaluated.
  17. What test is used to assess heart wall motion and valve function in the atria?
  18. Echocardiogram is used is good to use check for....
    clots if they have a fib
  19. TEE gives a good view of....
    posterior portion of the heart
  20. How quickly do thrombolytics work and how will you know?
    within 15 min and they will have no chest pain
  21. What does nuclear cardiography look at? Using?
    • wall motion
    • EF
    • myocardial contractial
    • myocardial perfusion
  22. 3 types of nuclear cardiography
    • Technetium Pyrophosphate
    • Thallium
    • Cardiac Blood pooling imagng
  23. Technetium Pyrophosphate shows......
    Hot accumulation in damaged tissues
  24. Thallium shows.....
    cold spots....damaged or ischemic tissue that does not take up thallium
  25. Cardiac Blood Pool Imaging shows
    cardiac motion and calculates EF
  26. Who will be a part of Electrophysiology studies....why?
    survivors of V tach or V fib

    they have an irritable focus, but are having a hard time treating it
  27. Prior to Electrophysiology study the patient will.....
    • d/c anti-dysrhythmic meds for several days prior
    • NPO 6-8 hrs
  28. How does an electrophysiology studies work???
    • arrhythmia will be stimulated off med
    • defibrillated to terminate rhythm
    • start patient on new regime
    • take patient back to lab and stim arrhythmia....

    Has the fibrilation threshold been increased???
  29. Good part about thrombolytic therapy and bad part
    breaks up systemic clots

    but we have good clots that protect us from bleeding
  30. What do I need to know prior to giving a thrombolytic?  Why?
    Do they have high BP

    If they do and I give they are at risk for a hemorrhagic stroke
  31. Nuclear cardiography involves an injection of....
    radioactive isotopes
  32. Goal of fibrinolytic therapy
    reperfusion of the heart by reversing the thrombotic component of the coronary occlussion in order to limit infarct size
  33. Who is eligible for fibrinolytic therapy?
    • onset of chest pain between 3-6 hours previous
    • ST elevation
  34. Contraindications for fibrinolytic therapy
    • liver failure
    • stroke in last 3 months
    • surgery in last 3-6 weeks
    • coagulopathy
  35. Goal for fibrinolytic therapy?
    door to drug in <30min
  36. Why is tPA the preferred thrombolytic?
    big bad bleed happens right away....has a short half life 3-6 min
  37. When giving an IV thrombolytic make sure....
    2 IV lines

    one dedicated to thrombolytic and the other for fluids
  38. Nursing care after thrombolytic admin
    • Resolution of chest pain
    • NORMAL ST segment
    • Reperfusion arrhythmias
    • Wash out phenomenon
    • Hypotension
    • Evidence of re-occlusion of coronary artery
  39. What is wash out phenomenon with thrombolytic and PCTA ?  Do what?
    an increase in cardiac enzymes 3-4 hours after reperfusion.

    do serial cardiac enzyme tests q 6-8 hour for next 24 hours
  40. Once the heart has been reperfused what is expected and common?
    have reperfusion arrhythmias like PVC's.

    Watch the patient.....dont panic
  41. What does PCTA do?  How?
    non surgical alternative for treating obstructive CAD

    involves dilation of stenotic or occluded coronary artery using a balloon tipped catheter to deploy a stent to open the occluded artery
  42. How long does PCTA take?  Pre treatments?
    45min - 1.5 hrs

    NPO and Versed
  43. Nursing management during a PTCA procedure?
    *Patients response to the procedure by watching...

    • ECG
    • symptoms of chest pain
    • s/s of contrast sensitivity
    • anticoagulation status
  44. Prior to letting a person under go PTCA....what do I check?  Post care???
    do they have any problems with iodine or kidney disease?

    • watch BUN and Creatnine levels
    • admin lots of fluids to flush dye
  45. After a PTCA make sure.....
    • watch for check under the dressing with eyes and feel
    • watch for patient to brady down due to vagal response from pressure at entry site
    • check VS 
    • check distal pulses
    • HOB <20
    • Legs straight
  46. IF a person bradys down, I give them....
  47. How often do I check under the dressing for a person who just had a PTCA
    q 15 min for the first 2 hours
  48. After stent placement the patient becomes diaphoretic, chest pains and has an elevated ST what do I do?
    Call Dr. with SBAR...will probably go back to cath lab
  49. What is the GOAL of REPERFUSION?
    • to decrease complications from MI-examples
    • arrhythmias
    • heart failure
    • cardiogenic shock
  50. What is coronary athrectomy?
    suck out the placque
  51. What procedure will show blockages to the heart?
  52. Why would a person have a CABG?
    • High risk lesions....
    • -LAD
    • -3 vessel disease with good LV function
    • AMI with failed thrombolysis or PTCA
    • Cardiogenic shock due to AMI
  53. What is the result of a clogged chest tube?
    cardiac tamponade due to accumulation of stuff in the pericardium
  54. What do epicardial pacing wires help with?
    regulation of arrhythmias
  55. Why is morphine so good with heart patients?
    • MI and stress increases HR, which increases O2 demand even more
    • It cuts pain and relaxes the patient which decreases the heart rate
    • It decreases VENOUS CAPITOUS which decreases PRE LOAD which decreases the work the L ventricle has to do to contract
  56. POST OP problems in the 1st 24 hours after a CABG
    • LO CO
    • Hypertension....cuz was hypothermic, causing shivering and vasoconstriction
    • Hypotension
    • Hypovolemia....blood loss or vasodilated
    • Dysrhythmias
    • Neurologic dysfunction
    • F&E Imbal-mag and K and clotting
    • Bleeding
    • Renal Dysfunction
  57. How quickly do you rewarm a patient after CABG?
    1 degree/hr with bear hugger and watch BP
  58. Describe off pump coronary artery by pass
    • no bypass
    • use meds to slow down the HR
    • do bypass graph with slow heart

    shorter recovery and less complications
  59. Who can get a Pacemaker??
    Person with brady or tachy HR
  60. How does a pacemaker work?
    it senses the ability of the heart to initiate an impuolse.  If the intrinsic heart rate is not adequate the pacemaker will fire a pace
  61. What is the result of the pacemaker firing a pace?
    depolarization occur seen with a wide QRS....referred to as capture
  62. Have a pacer...MRI or CT scan?
    CT only....cuz MRI is with a magnet
  63. Who gets an ICD?
    • survivors of sudden cardiac arrest
    • or 
    • people with lethal dysrhtyhmias like V Tach or V Fib
  64. What does an ICD do?
    • it senses the patients HR and is able to:
    • cardiovert
    • defib
    • pace
  65. What does the patient do if their ICD fires?
    lie down
  66. What does the patient do if they have an ICD and they lose consciousness?
    • call 911 
    • defib with external paddles...but dont put pads over the ICD
  67. How often does a person with an ICD get it checked?
    q 2-3 months....can do it by phone
  68. 2 complications that occur 1 week after AMI
    • Papillary muscle rupture
    • Ventricular septal rupture
  69. What happens with papillary muscle rupture?
    this is what holds the valves, specifically mitral valve in place.  

    result is cardiogenic shock
  70. What happens with ventricular septal rupture?
    • ischemia
    • bi-ventricular failure
    • L>R shunting=
    • Hypotension
    • chest pain
    • murmurs
  71. What causes increase in SVR?
  72. What causes decrease in SVR?
  73. What causes low SVO2?
    • anemia
    • hemorrhage
    • hypoxemia
    • lung disease 
    • shock
    • fever
  74. What causes high SVO2?
  75. Before giving morphine know your patients....
    RR and BP
  76. If a person has had nitro x3 and still has chest pain....what next?
    IV morphine
  77. Nitro causes....
  78. IF a person took their nitro at home and they are still uncomfy I should....
    • ask to see their bottle
    • is it expired?
    • is it dark?
    • did it make his tongue tingle?
  79. Interventions done by the EMS
    • aspirin
    • oxygen
    • nitro
    • morphine
  80. When EMS is bringing a person in for chest pain and they run an EKG and dx of STEMI....then what?
    • time of onset of symptoms is noted and first medical contact
    • hospital alerts cath lab and cardio OR team
    • fibrinolytics are considered
  81. Person comes in to ED with chest pains....what happens?
    • seen in less than 10min
    • VS
    • O2 sats
    • IV access
    • Focused history
    • Labs-cardiac markers and electrolytes
  82. Goal for time to get a chest x ray for a person who comes in with chest pains
  83. Initial ED general treatment for chest pains
    • O2 sat <94% give O2 @ 4L/min
    • Aspirin
    • Nitro
    • morphine
  84. Person comes in to ED with chest pains but have normal or non cardiogenic changes in ST segment or T wave....with no cardiac hx.

    Now what?
    • Consider admission
    • perform serial cardiac markers
    • repeat EKG
  85. Person who came in with chest pains but had normal EKG...but turns to having a bad EKG or troponin is elevated.  

    Now what?
    • Start IV Nitro
    • Heparin

    consider BB, Clopidogrel, and Glycoprotein III

    admit to CICU
  86. What do BB do for a person having a heart attack?
    decreases the heart rate, which decreases the hearts O2 requirements
  87. Person comes in to the hospital with chest pains, ST depression, T wave inversion....high risk unstable angina.

    Now what?
    Troponins elevated

    • Start IV Nitro
    • Heparin

    • consider BB, Clopidogrel and Glycoprotein III
    • Admit to CICU
  88. What do Clopidogrel and Glycoprotein do?
    cause platelet platelets cant form and get stuck in an atherosclerotic spot
  89. Person comes in to the ED with STEMI or new BBB (seen as a wide QRS).

    Now what?

    • Cath Lab
    • Fibrinolysis
  90. Goal time for balloon inflation?
    • balloon 90 minutes
    • fibrinolysis 30 min
  91. Unstable angina gets
  92. NSTEMI gets
    possible PCI....NO thrombolytics
  93. STEMI gets
    PCI or CABG
  94. What's the goal of reperfusion?
    reestablish blood flow within 90 minutes
  95. Person that has pulmonary edema will look like this
    • that look of terror
    • feet dangling over the bed-decreases pre load
    • increase HR and RR
  96. How does CHF occur?
    LV fails causing alveoli to get filled with crackles
  97. How does Pulmonary edema occur?
    after HF the lungs alveoli are filled with fluid causing dyspnes, orthopnea, decreased sats....all leading to decreased CO.....causing cardiogenic SHOCK
  98. Goals for pulmonary edema
    • increase ventricular function
    • decrease pre load
    • decrease after load
    • Improve gas exchange
    • increase CO with dopamine
    • give morphine
  99. Sign of CHF
    gain more than 3lbs in 48 hours

    or 3-5 lbs over a week
  100. How do you distinguish MI from pericarditis?
    pericarditis will have inflammation markers

    increased ESR, C reactive proteins

    increased WBC

    Will hear pericardial friction rub
  101. How will you dx pericarditis?
    Echo....or chest x ray
  102. Treatment for pericarditis
    • treat the pain
    • ASA
    • Tylenol
    • Steroids
    • raise HOB to 45
    • provide over bed table for support
  103. Complication from pericarditis...describe dx
    cardiac tamponade...increase in IVC/SVC pressure.  Decreased SV and pt is hypotensive and tachy....decreased CO

    Beck's Triad
  104. Beck's Triad seen in cardiac tamponade
    • muffled heart sounds
    • paridoxical pulse-SBP increase 10-15 on expiration
    • hypotension
  105. Result of rheumatic heart disease
    valve dysfunction....causing it to be replaced
  106. S/S or aortic aneurysm
    chest or back pain
  107. What is the goal of care for aortic aneurysm?
    prevention of rupturing
  108. Goal of treatment for CHF
    improve ventricular function
  109. Diuretics
    decrease fluid volume.....and pre load
  110. ACE Inhibitors
    cause vasidilation....decrease preload and afterload
  111. Vasodilators
    decrease afterload
  112. B-Adrenergic blockers
    decrease contractility by decreasing HR and after load
  113. Positive inotropes
    increase contractility and CO
  114. How much sodium with HF?
    2-2.5 grams
  115. If a person has cardiogenic shock what needs to be done?  How?
    maximize CO

    • dilate coronaries with CCV
    • improve contractility with Dopa
    • reduce pre load with morphine, nitro, lasix
    • reduce afterload with nitro
  116. What is Intra-aortic balloon pump used for?
    • person with cardiogenic shock...improves myocardial perfusion
    • reduces afterload
    • facilitates emptying of the LV
  117. What is the LVAD used for?
    a bridge to cardiac transplant

    no real pulse
  118. What puts a person on transplant list?
  119. If a person has cardiogenic shock we look at BP to determine what is given
    70-100 w/shock signs
    70-100 w/out shock signs
    • <70=norepi
    • 70-100 w/shock=Dopamine
    • 70-100 w/out shock=dobutamine
    • >100=nitro
  120. Who is most likely to have heart disease
    african americans and native amerians
  121. Nutritional considerations for people with heart disease
    • <10% saturated fat
    • <30% of total calories from fat
    • <200mg cholesterol/day
    • <2g sodium/day
    • 50-60% carbs in diet
    • 15% protein in diet
    • 20-30g fiber/day
  122. Antiplatelet/Anticoagulant drugs
    • coumadin
    • aspirin
    • plavix
  123. B adranergic blocker
    • lopressor
    • Inderall
    • Coreg
  124. CCB
    • anything with a pine and
    • cardizem
    • verapimil
  125. ACE Inhibitors
    • catopril
    • enalapril
  126. Glycoprotein III
    • ReoPro
    • Integrilin
    • Aggrastat
Card Set
Cardio Dysfunction and Delegation
Test 2
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