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58 Cards in this Set
- Front
- Back
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What is CABG?
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Coronary Artery Bypass Grafting (CABG)
-sx is indicated for >50% occlusion in L main coronary artery or severe blockage in several vessels -diseased arteries are "bypassed" with saphenous veins, mammary arteries, or artificial grafts -for myocardial ischemia that cannot be managed my drug tx |
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What does CABG look like after sx?
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-Incision looks like a zipper down chest
-Little poke holes in leg where saphenous vein is taken out, elevate limb |
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How does circulation work after saphenous vein is taken out in CABG?
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Collateral circulation: other large veins take over function; other circulation takes over
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Where is pt after CABG sx?
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immediate postop care in CICU
Within 1-2 days pt is transferred to a step-down/tele unit |
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Indications for pacemakers
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Permanent pacemakers are inserted to tx permanent cardiac conduction defects
-Generator box is implanted under chest wall and wires are threated into blood vessel thru R atrium for implantation in right ventricle |
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How often should pt check pulse with pacemaker?
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Daily one minute pulsecount will be required
-should be equal or > than preset rate |
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Types of pacemakers
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-Synchronous (demand) pacemaker senses the pt's rhythm and paces only if the pt's intrinsic rate falls below the preset rate to stimulate depolarization
-Asynchronous (fixed rate) pacemaker paces at a preset rate regardless of the pt's intrinsic rhythm and is used when pt is astolic or very bradycardic -overdrive pacing suppresses the underlying thythm in tachydysrhythmias so that the sinus node will regain control of the heart |
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Pacemaker spikes on ECG
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When a pacing stimulus is delivered to the heart, a spike (straight vertical line) is seen on the monitor or ECG strip
-spikes precede the chamber being paced -a spike before a P wave indicates that the atrium is paced -a spike before the QRS indicates that the ventricle is being paced |
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With pacemakers what is a "capture"?
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An atrial spike followed by a P wave indicates atrial depolarization and a ventricular spike followed by a QRS represents ventricular depolarization; this is referred to as "capture"
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Pt teaching with pacemakers
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-report pulse rate lower than set rate
-avoid leaning over a car with the engine running -stand 4-5 feet away from electromagnetic sources, like microwaves and radar detectors -avoid MRI dx testing |
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What is the relationship of the kidneys to the CV system?
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-If CO is decreased, the amt of blood going thru the kidneys is decreased; urinary output is decreased. So a decreased urinary output may be a sign of cardiac problems
-when the kidneys produce and excrete 30mL/hr output, the blood supply is considered to be minimally adequate to perfuse the vital organs |
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What is angina?
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Chest discomfort or pain that occurs when myocardial oxygen demands exceed supply
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What are common causes of angina?
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-atherosclerotic heart disease
-HTN -coronary artery spasm -hypertrophic cardiomyopathy |
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What does angina chest pain feel like?
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mild to severe intensity
heavy, squeezing, pressing, burning, choking, aching, and feeling of apprehension substernal, radiating to L arm and/or shoulder, jaw, R shoulder Transcient or prolonged, with gradual or sudden onset Typically of short duration |
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What often produces angina?
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Often precipitated by exercise, exposure to cold, a heavy metal, mental tension, sex
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What does an ECG look like with angina?
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-Baseline if pt is not currently having angina
-ST depression if pt is currently having angina |
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During an angina attack what should nurse do?
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1) Provide immediate rest
2) Take vital signs 3) Record an ECG 4) Administer no more than 3 nitro tablets, 5 minutes apart 5) Seek emer tx if no relief by nitro |
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Can nitro be taken prophylactically to avoid angina?
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Yes, may take before sex
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What are medical interventions of angina?
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1) PCTA or Percutaneous transluminal coronary angioplasty. A balloon catheter is repeatedly inflated to split or fracture plaque, and the arterial wall is stretched, enlarging the diameter of the vessel. A rotoblade is used to pulverize the plaque.
2) Coronary artery bypass graft (CABG) |
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What is an MI?
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disruption in or deficiency of coronary artery blood supply, resulting in necrosis of myocardial tissue
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What are causes of an MI?
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A) thrombus or clotting
B) Shock or hemorrhage |
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What pain is associated with MI?
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Sudden onset of pain in substernal region
-severity increases till its nearly unbearable -heavy pain often radiates to shoulders and down arms -not relieved by pain or Nitro -pay persist for hours or days -may not have pain at all (silent MIs) |
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How is an MI different from angina?
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MI:
-has a more sudden onset -pain is not relieved by nitro -pain is longer lasting |
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What are some nsg assessments associated with MI?
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-rapid, irregular, feeble pulse
-decreased LOC f/ cerebral perfusion -cardiac dysrhythmias -cardiogenic shock or fluid retention -HF indicated by wet lung sounds |
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What are some nsg dx associated with MI?
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-ineffective tissue perfusion
-decreased CO -activity intolerance -pain |
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What cardiac medications are appropriate and not appropriate for acute angina?
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APPROPRIATE:
-Nitroglycerin-causes dilation of coronary arteries, allowing more oxygen to get to the heart muscle NOT APPROPRIATE -Dig-increases strength and contractility of heart muscle, does not solve problem of needing O2 |
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What med is often prescribed in MI and why?
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IV Morphine
-reduces pain -increases O2 perfusion: acts as a peripheral vasodilator and decreases venous return |
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What should the nurse do when pt has MI?
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1) Administer meds as prescribed
2) Obtain VS and ECG 3) Administer O2, 2-6L/min 4) Assess breath sounds for rales (indicating pulmonary edema) 5) Keep in semi-Fowler posn to assist with breathing 6) Maintain bedrest for 24h |
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What is the order of blood flow thru the heart?
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1) Unoxygenated blood from the superior and inferior vena cava
2) into R atrium 3) to R ventricle 4) out of the heart thru Pulmonary Artery 5) to the lungs for oxygenation 6) Pulmonary vein delivers oxygenated blood 7) back to L atrium 8) then to L ventricle 9) out the aorta |
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What is the P wave?
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atrial depolarization or contraction
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How long does the P wave normally last?
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no longer than 0.11 seconds
< 3 small squares |
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What does the QRS wave indicate?
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ventricular depolarization or contraction
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How long does the QRS wave normally last?
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not longer than 0.10 seconds
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What is the ST segment?
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Indicates early ventricular repolarization
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What is the T wave?
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Indicates ventricular repolarization
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What is the PR interval?
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Indicates AV conduction time
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What is the QT interval and how long does it last?
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Measures from the Q to the end of T
Normal < 0.46 sec |
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What may a prolonged QT interval indicate?
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may be acquired or inherited
may indicate MI |
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How do you prepare skin for ECG/electrode placement?
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-shave hair away from site
-rub briskly with alcohol pad -rub site with 2x2 gauze -place electrode with adequate gel |
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What does each small square on an ECG represent?
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Each small square is 1 mm in length and lasts 0.04 seconds
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What does each larger square on an ECG represent?
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Each large square is 5 mm in length and lasts 0.2 seconds
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How do you determine HR from ECG?
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Count the number of R waves (high pointy one) in a 6 second strip and multiply by 10
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What are characteristics of a normal SR?
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Rate: 60-100, atrial and ventricular rates are the same
Rhythm: Regular PR Interval: 0.12-0.20 seconds, all P-R's are the same QRS Duration: <.12 seconds, skinny, all same shape |
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What is a PAC?
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Premature atrial contractions
-an atrial beat that is premature -followed by a QRS that is usually normal -Not really a big deal, often due to caffeine |
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What is sinus arrhythmia?
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A relatively normal SR, HR 45-100, rhythm is "regularly irregular", no tx unless asymptomatic bradycardia is present
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What is atrial fibrillation?
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atrial HR: 350-650 bpm
V HR: slow to regular Rhythm: irregularly irregular P wave: fibrillatory, fine to course, wavy baseline is seen instead One of most common arrhythmias with increasing age Tx: Dig or other anti-dysrhythmias, cardioversion may also be needed |
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What is atrial flutter?
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Rhythm: regular or irregular
P wave sawtoothed appearance Almost always happens in diseased hearts, frequently before CHF Tx depends on the level of hemodynamic compromise: Cardioversion, vagal maneuvers and verapamil are used when prompt rate reduction is needed Dig and other antiarrhythmic drugs can be used |
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What is ventricular tachycardia?
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Rate: 100-250 bpm
P wave: obscured if present at all QRS: wide and bizarre morphology Almost always occurs in diseased hearts Some common causes are: CAD, acute MI, dig toxicity, CHF, ventricular aneurysms Patients are often symptomatic; can quickly deteriorate into ventricular fibrillation V tach for more than 30 seconds is life threatening call code; patient usually passes out and has no pulse, unstable, no CO Treatment: electrical countershock for patient who is symptomatic and rapidly deteriorating; amiodarone, procanimide, and lidocaine |
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What is PTCA?
What is PCI? What is coronary catheterization? |
PTCA: percutaneous transluminal coronary angioplasty: balloon
PCI: percutaneous coronary intervention: stent coronary catheterization.. ALL VERY SIMILAR |
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Who is PTCA/PCI/coronary cath often done to?
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Increaes blood flow to coronary arteries for pts who have chronic stable angina who have a coronary lesion
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How is PTCA/PCI/coronary cath done?
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Increases blood flow to coronary arteries by inserting a catheter with a balloon tip (PTCA) into affected artery, inflating balloon to expand vessel lumen and removing catheter
may also include insertion of an expandable intracoronary stent (PCI), which is inserted over balloon and remains in place after balloon is removed |
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What is usually administered for PTCA/PCI/coronary cath?
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Anticoagulants to prevent thrombus formation, and monitor coagulation studies as indicated
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Site of PTCA/PCI/coronary cath?
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B/c of antiocoagulants used during procedure, site may have a vice-type pressure device requiring a longer period of hourly site checks
monitor closely for changes in ECG or signs of chest pain (even minor changes may indicate ischemia) obtain a 12 lead ECG and notify doc of any complications |
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What must you assess if pt complains of chest pain after PTCA/PCI/coronary cath?
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The puncture site immediately
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What are some post-op considerations in pt with PTCA/PCI/coronary cath?
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Keep legs straight: puncture site is femoral artery so keep straight; after 1-2 hrs head may be elevated up to 30 degrees
Assess for bleeding at site |
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What is a stent (associated with PTCA/PCI/coronary cath?
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expandable meshlike metalic devices that are positioned within the artery immediately after the balloon angioplasty is performed
-designed to maintain vessel patency after the procedure |
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What drug is pt usually treated with (associated with PTCA/PCI/coronary cath)?
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Because stents are thrombogenic, pt is usually treated with oral antiplatelet like aspirin
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What commonly happens after PTCA/PCI/coronary cath?
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restonosis, but many stents are covered with a drug that prevents the overgrowth of new intima, the primary cause of restenosis
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