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110 Cards in this Set
- Front
- Back
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the left anterior decending coro arter supplies ____ conduction system
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supplies 2/3 conduction system
major clot here is know as the widower |
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health history
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childhood illness
infection dz immunization major illnesses/hosp meds allergies fam health hx occupation geo location environment nutrition substances elimination activity sleep and rest role in the life sexual orientation reproductive hx |
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acute coronary syndrome
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faitgue
sob sleep disturb anxiety passing discomfort neuropathy gender differences these are precurses to major events |
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phsical exam heart
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gen appereance
mental status skin/nails -color/texture bp -postural hypotension pulse -arterial -juglar -pulsus paradoxus or paradoxical pulse (heart rt decrease on inspiration) |
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heart phys exam: extremities
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cap refill
vascualr changes hematoma periph edma clubbing |
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heart phys abdomen
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hepatomegaly
hepatojugular refulx -venous overload -decreased returne ascites bladder distension |
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heart phys exam: heart sounds
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normal s1/2 sounds
pathologic splitting of s2 s3/4 abnormal clicks murmurs pericardiacl friction rub |
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heart phys exam: lung
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tachypnea/other patterns
crackles hemoptysis cough |
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s3 heart sound may be normal in what stage of lfe
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childhood
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s3 hear sound sounds like a ____ beat
____ ____ ____ |
triplet
lub dub dub |
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s4 heart sounds like
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a horse galloping
heard late is diastole just before s1 |
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rub sound around the heart are indivative of
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pericarditis
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s1 is
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depolarization of ventricles
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s2 is
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repolarization of the ventricles after teh t wave
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diagnostic tests for heart
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hematology
coagulation -ptt/inr liver function metabolic panel cardiac enzymes -ckmb -tropinin t or I blood chemistry -lipid profile -cholesterol level -bnp -c reactive protein -homocystein -thyroid function |
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cardiac cathetrization with angiography
indications |
sx environeent like in OR
mesure CO valve structures or defects |
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right heart cath
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usucally done before left heart cath
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where is the cath placed for a right heart cath
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radial vessel
femoral vein |
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if a study on the coronary arteries is indicated which side of the heart do you enter the cath from?
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left
otherwise go into the right |
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what is the major risk post cardiac cath
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bleeing
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during cardiac cath, dye is used. what boddy system ar you worried about
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renal system
can cause failure. flush them |
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cardiac cath fasting
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8-12 before the test
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sedations during cardiac cath
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moderate
versad/fentanyl pt will be awake but in a twilight |
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risk during cardiac cath
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death can occur. heart can stop
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bedrest for cardiac cath
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bedrest 4 hours post procedure
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hemodynamic monitoring cvp
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central venous pressure reading
-line is threaded into right side of heart. crude measuremtn of fluid volume in right side of heart. align the bottom of cvp device with 4th intecostal space, midclavicular line. |
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cvp monitoring
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fluid in right side of heart
normal 2-6mm/h20 >6indicated ^rventricular preload |
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pulmonary artery pressure monitoring
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ICU
arterial cath into radial artery -allows for frequent ABG -most monitor for disonnetion -set up with flush system: -transducer which converts the pressure into meaningful number |
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swan cath
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pulmonary artery pressure monitorying
--goes into pulmonary artery --gives us measurement of left ventricular functioning -more accurate than CVP |
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PAPM vs CVP
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PAPM=left heart
CVP=right heart |
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qrs complex rhythm strips
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5 are = 0.2 seconds
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p wave
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atrial depolarization
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qrs shouldnt be wider than
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3 squares, 0.12
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qt interval should be (in length)
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0.32-0.40
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reading ekg
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1. rate and rhythm
2. intervals |
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angina define
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clinical syndrom characterized by sudden onset of chest pain or pressure precipitated by an event the demands of the heart are ^ so the o2 supply to myocardium is diminished
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patterns of angina
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stable
unstable intractable varant silent |
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stable angina
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predictable
comes on with exertion relieved with rest or nitro when episodes worsen then they become more unpredictable |
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unstable angina
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event lasts longer
unable to tolerate as much as before |
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intractable angina
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severe incompasitating chest pain
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varient angina
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involuntarily contratction (spasm)
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silent ischemia
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no pain or discomfort felt
only seen during ekg |
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angina medical manage
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nitrates
beta block ccb asa/platelet aggregate inhibit |
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angina dx
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ecg/exercise stress testing
nuclear scanning coronary angiography |
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someone arrives with chest pain. golden rule?
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door too balloon time is 60 minutes
cath lab |
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risk factor management angina
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smoking
cholesterol control htn dm loose weight |
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injury to heart = _____ on ECG
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elevation ST
may not be elevated. but cardiac enzymes will be |
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infarction in heart = ____ on ecg
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inverted T wave
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CKmb elevates how long after injury?
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4-8
peaks 14 hours returns 24-48 |
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enzymes are drawn _____ during suspected heart injury
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admission
12hrs 24 hours |
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troponin 1 specific to _____ tissue
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cardiac
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tropin eleveated upon injury
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3 hours
peak 10-12 up for as long as 3 wks |
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troponin drawn when injury is suspect
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initially
12 hrs daily 3-5 days evaluate 5-6 wks |
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diagnosistics in ER for mi damage
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enzymes, cbc, electrolytes
12 lead ECG |
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drugs to give ER mi injury
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o2 keep %>90
iv + blood draw ms04 2-8mg iv asa 325 then maybe these thrombolytics antiplatelets nitrates aniticoag beta blockers antidysthymics ccb |
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revascularizzation
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restore blood supply
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how to revascularize
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pharm
-thrombolyitc glycoprotien receptor antagoinist persantine/pletal invasive |
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fibrinolytic therapy contraindivations
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active internal bleeding, inflam bowel disease, peptic ulcer disease
GI bleed < 6 mo known bleeding disorder aortic dissection neurosurgical proceduure <2mo |
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acute Mi med management : in patient
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treat the acute attack
manage pain improve perfusion monitor for complications tx dysrthimas and prevent life threatening ddysrthmias hemodynamic studies |
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collaborative problems in acute MI
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dysrhythmias
cardiogenic shcok hf PE P edema stroke recurrent MI |
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dresslers syndrom
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myocardical necrossic ocmp
fever pericarditis plueritis plureral effusion joint pain tx asa corticosteroids |
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acute mi nursing dx
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acute pain
impaired oxygenation activity intolerance risk for imbalance fluid volume decre cardiac output fear of dying impaired tissue perfussion altered nutrtition impaired gas exchange |
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acute MI rehab/edu
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strenthen the myocardium
phase 1 - get them up and ambulate. how to check pulse p2 - monitored situation. 12 wks. wear tele unit when in 3xwk p3 - outpatient not monitored p4 - maintenence |
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cardic sx goals
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repare, reconstruct, substitute
imporve cirucaltion and cardiac function |
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preop nursing care cardiac sx
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health hx/physical psychosocal assessment
reduce fear and anxiety discuss complications patient teaching -be clear about what to expect |
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what to expect after cardiac sx
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tubes
pace maker wires stockings dangle soon pain chest binder foley peripheral edema |
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complications post op cardiac sx: caridac
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hf
cardio shock mi dysrhyth pericardial effusion cardiac tampnade cardiac arrest |
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complications post op cardiac sx; pulmo
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pulmonary edema
PE pleural effusions pneumothorax hemothorax resp failure ARDS |
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permanent pacemaker
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placed beneath skin in pectoral region
lead is tunnelled subq between pacemaker and external jugalr vein pacemeaker lead enters external jugalr vein |
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placement of pacemaker is done
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during surgery under flouroscopy
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batteries in pacemakers need to be changed
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q10 yrs
outpatient |
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external temp pacemaker
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electrodes stuck to chest attatched to defrilator that is on at constant rate. defibr turned up until heart responds to electircal
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universal lettering
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5 letters
3 most common |
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first 3 letter on pacemaker
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signifies the chamber or chambers being paced
av or d |
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second letter in pace
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describes the chamber or chambers being sensed by the generator
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third letter in pace
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type of response by the pacemaker to what is sense
inhibited triggered dul or none |
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fourth/fifth letter in pace
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used for permanent pacemakers and generators
fourth has the ability to program or reset the device. fith indicates the anti tachycadia and or defibrillation capability |
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complications of pace maker insertion
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local infection
bleeding hematoma -localized pain at the site of insertion hemothorax dislocation of leads phrenic nerve stimulation and hicupping ventricular ectopy tachycard (irritation of centrical wall) movement of lead |
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patient teaching with pace maker insertion
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no airport metal detector
no heavy lifting no pulling activity no raising over head identifying |
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post operative complications of pacemaker implant
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hemorrhage or coagulopathy
stroke renal failure hepatic failure inection sepsis hypothermia |
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infectious cardiac disorders
types |
rheumatic endocarditis
infective endocarditis myocarditis pericarditis -sub acute, acute, chronic |
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medical management of infectious cardiac disorders
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eradicate infection
maximize cardiac output promote comfort avoid nsaids |
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which microbe can effect cardiac through infection
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strep
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nursing problems for infectious cardiac disorders
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activity intolerance
acute pain decreased cardiac output ineffective health maintencne ineffective tissue perfusion risk for imbalanced nutrition |
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valvular diesea and septal defects
types |
mitral
aortic tricuspid ulmonic |
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valvular disease and petal defects pathophys
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prolapse
regurgitation stenosis ruptured papillae related to infection or damange with disease congenital defects |
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clinical manifestations of valvular disease/septal defects
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activity intolerance
murmer fatiuge sob syncope palpatations chest pain |
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tx valvular disease/septal defect
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sx to correct
atb to prevent infxn during procedures |
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mardiomyopathy
types |
dilated
hypertrophic restrictive series of events that end up in a decreased cardiac output |
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dilated myopathy
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most common
pregnant women etoh intake viral infections that cause great deal of stress on theart |
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hypertrophi myopathy
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inherited condition
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medical management of myopathy
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correct heart failure
implantable cardioverter defib, pacemaker infective edocarditis prophylaxis alcohol septal ablation systemic anticoagulation |
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sx managment of myopathy
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heart transplatation
mechanical assist devices artificial hearts |
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HF etology/risk factors
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abnormal loading conidtions
abnormal muscle function conditionas that precipitate heart failure |
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causes of HF, chronic
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CAD
hypertensive heart disease rheumatic /congenital heart disease disease of heart valves -valves can be leaky or overly stiff cor pulmonale/pulmonary hypertension cardiomyopathy anemia damage to hear from etoh/other drugs |
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acute causes of hf
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acute mi
arrhythmias PE thyrotoxicosis/hypothyroidsm HTN crisis rupture of papillary muscle ventricular septal defect myocarditis |
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HF pathophys
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ventricular dilation
increased sympathetic nervous system stim stim of RAAS decompensation heart failure |
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HF class
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high/low ouutput failure
left/right acute/chron back/forward |
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HF med management
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improve ventric pump
reduce workload reduce fluid retention reduce stress/risk of injury |
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HF sx manage
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ventricular assist device
heart transplant |
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dx of hf is made when ejection fraction is less that what %?
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40-systolic heart failure
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when the ejection fraction is >40 but symptomatic it is called
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diastolic heart fialure
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factorsa aggravating HF
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ischemia/infart
sodium excess excess fluid med noncompliance arrthmias intervurrent illness conditions associated with increased metabolic demand |
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left vent dysfunction s/s
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DOE
paroxysmal nocturnal dysnea tachy/palpitations cough/wheeze/hemoptysis AMS rales pulmonary edmea S3 oliguria decreased tissue perfusion, peristalsis, abosorption |
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right sided HF s/s
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abd pain
anorexia nausea bloating/depend edmea swelling nocturia decreased frequency |
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physical s/s right sided hf
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periphreal edema
venous engorgement JVD abd jugular reflux hepatomecaly ascites murmurs AMS |
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compensated HF
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whenc ompensatory mech are successfull at maintaining cardiac output need for metabolic demands and tisue perfusion
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general measures for lifestyle mod in HF
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weight reduction
stop smoking avoid ETOH daily weight exercise nutrition therapy -reduced sodium intake |
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medical considerations for HF
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treat HTN, hyperlipidema, diabetes, arhythmias
coronary revascularization anticoag immunization cose outpatient monitoring reduce readmissions |
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outcomes and interventions
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maintina fluid balance
decrease anxiety improved qual of sleep adhere to regimine stop smoking stop ETOH daily weight na restrict ortho hypo |
