Exam 1 - Cardiac Care

  1. What does ACS stand for
    acute coronary syndrome
  2. Acute coronary syndrome is the umbrella term for what?
    acute myocardial ischemia
  3. According the the AHA what are the major risk factors of ACS?
    • Age
    • Male gender
    • heredity
  4. According the the AHA what are the modifiable risk factors of ACS?
    • tobacco
    • cholesterol
    • HTN
    • physical inactivity
    • obesity
    • diabetes
  5. According the the AHA what are the contributing risk factors of ACS?
    • stress
    • alcohol
    • diet/nutrition
  6. What are the three categories of ACS?
    • STEMI - ST segment elevation MI
    • NonSTEMI - Non-ST segment elevation MI
    • Unstable angina
  7. What is the pathophysiology of ACS?
    • plaque ruptures and travels
    • platelets are activated and attach to plaque
    • 40% occlusion - interruption in blood flow
  8. What is the priority of the nurse?
    12-lead EKG within 10 min of arrival
  9. Which leads are elevated in ST segment elevation?
    • V2
    • V3
  10. What cardiac biomarkers identify MI?
    • Troponin (specifically troponin I)
    • CK - but not specific to heart muscle
    • BNP
  11. In a NSTEMI (non-ST segment elevation MI) what will the EKG show?
    ST segment depression or T wave inverted

    positive biomarkers
  12. What do EKG and biomarkers show in a patient with unstable angina?
    • Normal EKG
    • Inverted T-waves
    • ST segment depression
    • WITHOUT Troponin elevation – no MI
    • Will stay and get stress test
  13. What are the S/S of cardiac disease?
    • Fever = inflammatory process
    • Nausea
    • Pain
    • Poor profusion – elevated BP and HR = more O2 demand (metoprolol to decrease HR)
    • Dizziness/syncope
    • Cardiac arrest
  14. What are the S/S of the female one month before a heart attack?
    • unusual fatigue
    • sleep disturbance
    • SOB
    • indigestion
    • anxiety
    • heart racing
    • arms weak/heavy
  15. What are the S/S of the female during a heart attack?
    • SOB
    • weakness
    • unusual fatigue
    • cold sweat
    • dizziness
    • nausea
    • arms weak/heavy
  16. What are some unusual risk factors for CVD (cardiac vascular disease)?
    • Psoriasis
    • migraines
    • sleep apnea
  17. What are the nursing priorities of care when a patient presents with MI?
    • EKG
    • V/S
    • O2 (2L)
    • Labs
    • IV access (2 - large bore)
    • Meds (ASA, beta blocker, NTG, Morphine)
  18. What does MONA stand for?
    • O2
    • ASA
    • NTG
    • Morphine
  19. What would be a contraindication of NTG?
    • if BP is <90
    • vasodilators (viagra, revatio...)
    • Inferior wall MI (II, III, AVF)
  20. What would be a contraindication of morphine?
    if BP is <100
  21. A change in leads II, III, AVF indicate MI to what part of the heart?
    inferior
  22. A change in leads II, III, AVF indicate damage to which artery?
    RCA (right coronary artery)
  23. A change in leads V1, V2, V3, V4 indicate MI to what part of the heart?
    left ventricle
  24. A change in leads V1/V2 specifically indicate MI to what part of the heart?
    Septum
  25. A change in leads V3/V4 specifically indicate MI to what part of the heart?
    Anterior
  26. A change in leads V1/V2/V3/V4 indicate damage to which artery?
    LAD (left anterior descending artery)
  27. A change in leads V5/V6/AVL/I indicate MI to what part of the heart?
    lateral (posterior)
  28. A change in leads V5/V6/AVL/I indicate damage to which artery?
    Circumflex artery
  29. In an inferior wall MI (II/III/AVF) what do we do?
    • NO NTG
    • give fluids!
  30. When inferior wall MI - what do we usually see?
    • bradycardia
    • blocks
  31. When the left ventricle is involved what happens?
    • blood isn't supplied to the rest of the body
    • low ejection fraction
  32. When the anterior of the heart is involved what happens?
    • ventricles are irritable
    • see more dysrhythmias (VT, heart blocks)
  33. What are the three I's of acute coronary event?
    • ischemia
    • injury
    • necrosis
  34. This tissue alive and viable, if reprofused then viable tissue to limit the size of injury
    ischemia
  35. This tissue if reprofusion therapy occurs, then viable tissue
    injury
  36. This is dead tissue, even with correction the tissue will never be the same
    necrosis
  37. What are the causes of infarction?
    • thrombosis
    • coronary artery spasm
    • decreased coronary arterial blood flow
    • increased myocardial workload
    • hypoxemia
    • toxic exposure (cocaine, meth)
  38. How long can troponin I levels be expected to detect in the blood?
    7-10 days
  39. What does SAMPLE stand for?
    • S – S/S
    • A – allergies
    • M – meds
    • P – past med hx
    • L – last oral intake
    • E – events leading up to it
  40. When a patient presents with possible MI what is the acronym that we use to assess quickly?
    • SAMPLE
    • S – S/S
    • A – allergies
    • M – meds
    • P – past med hx
    • L – last oral intake
    • E – events leading up to it
  41. Abnormal heart sounds on auscultation?
    • S3
    • S4
  42. This abnormal heart sound occurs during the rapid ventricular filling of diastole; low pitched; use bell
    S3
  43. This abnormal heart sound is linked to resistance in ventricular filling or a vibration caused by atrial contraction; low pitched use bell
    S4
  44. What are the core measures and guidelines for treatment of MI?
    • 10 minutes for 12 lead EKG
    • 30 minutes from diagnosis to thrombolytics if no contraindication- if PCI not available
    • 90 minutes from diagnosis to cath lab
  45. Pt with chest pain, negative cardiac markers or slightly elevated troponin, ST segment depression or T wave inversion?
    unstable angina
  46. Pt with chest pain, positive cardiac markers, ST segment elevation?
    STEMI
  47. pt with or without chest pain, positive cardiac markers, ST segment depression or T wave inversion?
    Non-STEMI - still an MI
  48. What do inverted T waves represent?
    Ischemia - long term (older than 24 H)
  49. When do we give O2 in STEMI, unstable angina, NSTEMI?
    O2 sat <90%
  50. What type of MI?
    Image Upload 1
    anteriolateral MI
  51. What type of MI?

    Image Upload 2
    Lateral MI
  52. What type of MI?

    Image Upload 3
    Anteriolateral MI
  53. What is the role of the RN Post PCI?
    • Monitor for bleeding Q15 x2H, Q30 x1H, Q1H x4H
    • Site check palpate for softness
    • Pulses
    • Keep the pt lying flat – per policy protocol
    • Retroperitoneal bleed: initially when lose volume BP down, HR up, RR up (RR increases first, HR second, BP then goes down)
  54. How much drainage from a chest tube is too much post CABG
    • 100H for 2H
    • there should be no bubbling
  55. What is MIDCABG?
    • smaller incision over breast
    • uses mammary artery
    • heart remains beating
    • no perfusion pump
  56. Why are pacer wires in place after CABG?
    Increased chance of heart block - may need pacing
  57. When JVD is present what do we do to the HOB?
    45 degrees or >
  58. What is the rationale for administering diuretics in a patient with low BP but high HR - when crackles are present?
    it will ultimately increase cardiac output and then increase BP
  59. if a patient has 3 PVC's in a row, what does that mean?
    VT
Author
cbennett
ID
342014
Card Set
Exam 1 - Cardiac Care
Description
Exam 1 - Cardiac Care
Updated