-
List SNS s/s of MI
- Release of glycogen
- Diaphoresis
- Vasoconstriction of peripheral vessels
- Skin: ashen, clammy, cool to touch
-
List cardiac s/s of an MI
- Initially increased HR & BP, then lowered BP secondary to lowered CO
- Crackles
- JVD
- Abnormal heart sounds (new murmur)
-
Describe first 24 hours of MI healing process
The 4th day?
- 24 hours: Elevated WBCs and fever occurs
- By 4th day: Heart walls thins as macrophages remove necrotic tissue
- - Collagen matrix laid down
-
List healing process of MI by 14th day
- Scar tissues have been produced, but tissue is still weak
- - d/t this, myocardium vulnerable to stress
- - Pt. increase activity slowly slowly
-
List healing process of MI by 6 weeks
What is ventricular remodeling?
- Scar tissue replaced necrotic tissue, but it is less compliant than normal tissue.
- Ventricular remodeling: normal myocardium will hypertrophy and dilate in an attempt to compensate for the infarcted muscle (dead cell)
-
List cause, s/s, and prevention of cardiogenic shock
- Cause: decreased myocardial contraction (diminished CO, undetected dysrhythmias, sepsis)
- s/s: low SB/P, tachycardia, diaphoresis, restlessness, cold clammy gray skin
- Prevention: IV fluids, prevent pain
-
After giving fluids to treat Cardiogenic shock, list next treatment therapies/drugs
- Vasopressors: Norepinephrine and Dopamine
- Vasodilators: Nitroprusside
- Positive Inotropic agents: Dobutamine
- - Increase cardiac contractility and cardiac output
- Oxygen
- antiarrhythmics
- Diuretics for fluid overload
-
What is Papillary muscle dysfunction? Match with type of complication:
A.
-
What is a ventricular aneurysm? Match with this of MI complication:
B.
-
What is acute pericarditis? Match with type MI complication:
C.
-
What is Acute pericarditis? Match:
B.
-
What is Dresler syndrome? Match:
D.
-
Which complication are NSAIDS and Toradol are used to treat for and why?
B. Acute pericarditis results in inflammation of visceral or perietal pericardium, which can lead to cardiac tamponade
-
Which of these do you treat with short-term corticosteroids?
A. Dressler Syndrome: pericarditis w/ effusion and fever developing 4-6 weeks after MI
-
List INITIAL interventions for Acute coronary syndrome
- 12 lead ECG
- Semi-fowler and O2
- IV access
- Nitro (SL) and ASA (chewable)
- Morphine
-
What is a PCI and when is it used?
What do you provide if PCI is not available?
- PCI (Percutaneous coronary Intervention): opens blocked arteries, used as a tx of choice for confirmed MI
- If not available: put on thrombolytic therapy
- - Used within 6 hours of onset, ideally within first hour
-
Explain the trombolyic therapy for MI
What reassessment is the best marker of reperfusion?
Which drug do you give to prevent reocclusion?
- Before starting, draw blood after first IV start and initiate 1 or 2 more
- - Also make sure to complete invasive procedures prior
- Once administering TPA, monitor closely for bleeding
- - Assess for signs of reperfusion
- Best marker: return of ST segment to baseline
- Prevent reocclusion: Give IV Heparin
-
List immediate postop care of a CABG pt.
- ICU for first 24-36 hours
- Will be on:
- - ventilator
- - chest tubes
- - ECG
- - foley
- - NG tube
-
What is CBP, when is it used, and its complications?
- Cardiopulmonary bypass: technique that temporarily takes over fxn of the heart and lungs during surgery (CABG)
- Complications: bleeding and anemia when RBCs and platelets
- - fluid and lyte imbalance
- - hypothermia as blood is cooled
- - infection
|
|
