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103 Cards in this Set
- Front
- Back
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The measurement of pressure, flow, and oxygenation within the cardiovascular system
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Hemodynamic monitoring
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The volume within the ventricles at the end of diastole
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Preload
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The forces opposing ventricular ejection
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Afterload
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Positive inotropes do what?
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increase contractility
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Where is the phlebostatic axis?
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When supine, midchest deep at the 4th intercostal space
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How does an IABP (intraaortic balloon pump) assist in circulation?
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Reduces afterload by reducing systolic pressure and increases aortic diastolic pressure to increase coronary blood flow (It basically produces pressure at opposite times than the heart)
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Where is an IABP (intraaortic balloon pump) placed?
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In the descending thoracic aorta
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How long can you suction a patient who is on a ventilator?
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10 seconds
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What do you do when suctioning a patient on a ventilator to reduce risk of hypoxemia?
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hyperoxygenate patient before and after suctioning
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What should be monitored when suctioning a patient on a ventilator?
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SpO2,
HR, (hypoxia, vagal stimulation, and SNS stimulation can cause dysrhythmias) Blood in secretions, Characteristics of secretions |
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ABGs:
What value should HCO3 be? |
22-26mEq/L
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ABGs:
What value should PaCO2 be? |
35-45 mm Hg
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ABGs:
What value should PaO2 be? |
80-100 mm Hg
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A "shift to the left" of the oxygen-hemoglobin dissociation curve represents what?
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that hemoglobin picks up oxygen more readily but releases it into the tissue less readily
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A "shift to the right" of the oxygen-hemoglobin dissociation curve represents what?
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that hemoglobin picks up oxygen less readily but releases it into the tissues more readily
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What can cause a "shift to the left" of the oxygen-hemoglobin dissociation curve?
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increase in pH
decrease in temp decrease in PCO2 |
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What can cause a "shift to the right" of the oxygen-hemoglobin dissociation curve?
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decrease in pH
increase in temp increase in PCO2 increase in 2,3-DPG |
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What are the 2 biggest stressors to a patient in the ICU?
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Thirst
Pain |
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Figure 9-5 in Lewis
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need to know
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What does increased SNS activity do to breathing?
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increased and shallow
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What does increased SNS activity do to blood distribution?
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more blood to heart, lungs, brain
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What does increased SNS activity do to the adrenal medulla?
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causes increase epi and norepi release, which prolongs SNS activation
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What is MVO2
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myocardial oxygen demand
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What can SNS activation do to the digestive system?
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Stress ulcers
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What is ICU Syndrome/Delerium
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alterations in mental state (delusions, hallucinations, restlessness, lethargy, altered sleep-wake cycle)
Happens to 15-40% of patients Goes away when pt leaves ICU |
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What is the #1 cause of ICU syndrome?
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sleep deprivation
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What are the top 2 needs of the family of an ICU patient?
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Information (#1)
Proximity to patient (#2) |
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What are the 2 main complaints of families of pts in the ICU?
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Poor communication & Inadequate information
Restricted access to pt |
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What is the main Acid/Base buffer system?
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Bicarbonate-Carbonic Acid (responsible for 60% of the buffering)
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How does the body get rid of hydrogen ions?
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kidneys
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What effect does the autonomic nervous system have on the ventricles?
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None - there are no cholinergic receptors in the ventricles
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What is ectopy?
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extra heart beats
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What does Dobutamine do?
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Stimulates beta receptors (increased HR, contractility, conduction)
Too much can cause ectopy. |
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What can cause a peaked T wave?
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potassium imbalances
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What does abnormal S-T segments indicate?
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ischemic problems
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What drug do you give for symptomatic bradycardia?
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Atropine
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What second-line drugs can you give for symptomatic bradycardia?
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Dopamine or epi
Isoproterenol Pacemaker can be used |
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What does adensoine treat?
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SVT
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What do you use to treat SVT?
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adenosine
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What is the most common sustained dysrhythmia?
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atrial fibrillation
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What are the problems associated with afib?
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decreased CO
thrombi can form in the atria due to blood stasis (pts are almost always put on Coumadin) |
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How can you treat afib?
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Calcium Channel Blockers like diltiazem(Cardizem)
Can also use beta blocker |
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What can first degree heart block be a sign of?
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MI (ischemia of the AV node)
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What drugs can cause first degree heart block?
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beta blockers
digoxin |
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What is the number 1 thing we watch for after a MI?
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dysrhythmias
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Which type of heart block is the most serious?
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Mobitz type 2
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How many PVCs in a row is considered vtach?
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3
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How do you treat PVCs?
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oxygen for hypoxia
correction of acidosis electrolyte replacement amiodarone, lidocaine, procainamide |
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What drug do you mainly use to treat PVCs?
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amiodarone
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What is the first priority when a patient has vtach?
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See if they have a pulse.
Are they stable or unstable. |
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How do you treat vtach without a pulse?
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defib
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How do you treat stable vtach?
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amiodarone
lidocaine procainamide |
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How do you treat unstable vtach with a pulse?
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cardioversion
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How do you treat PEA?
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CPR
epinephrine |
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PEA is caused by...
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Hypovolemia
Hypoxia Hydrogen excess (acidosis) Hypo or hyperkalemia Hypothermia Hypoglycemia Toxins Tamponade Tension pneumothorax Thrombosis Trauma |
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What is the #1 drug used in cardiac arrest?
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epinephrine
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RBC transfusions must be ABO/Rh identical
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You can't just use O for RBCs
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What fluids are compatible with blood?
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NS only
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How long can blood be hanging?
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4 hours
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What is the worst type of transfusion reaction?
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Acute hemolytic - preventable!
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Symptoms of what?
Tingling of extremities Confusion Deep, rapid breathing Seizures |
Respiratory Alkalosis
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What is a common cause of metabolic acidosis?
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Ketoacidosis
Also: lactic acid accumulation (shock) severe diarrhea kidney disease salicylate intoxication (late) starvation low-carb diet |
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Acidosis does what to the heart?
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Causes serious dysrhythmias like PVCs, vfib, vtach
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Symptoms of what?
Drowsiness, headache, coma Hypotension Dysrhythmias Kussmaul respiration Kidney's excrete acid Disorientation |
Metabolic acidosis
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Symptoms of what?
Dizziness, irritability, confusion Nausea and vomitting Diarrhea Slow respirations Arrhythmias |
Metabolic alkalosis
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Atheromas
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soft deposits of fat that harden with age; can form in any artery, but prefer coronary arteries
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What do HDLs do?
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transport lipids from the arteries to the liver
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What do LDLs do?
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stay in the blood vessels
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What is the main class of drugs that lower cholesterol?
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Statins
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What are some SE of statins?
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muscle pain - muscles can break down, cause rhabdomyalysis, which can cause kidney failure
Need to check liver status 2x a year |
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What are some drugs that restrict lipoprotein production?
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statins
niacin |
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What are some drugs that increase lipoprotein removal?
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Bile acid sequestrants like Questran or Colestid
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What are some drugs that decrease cholesterol absorption?
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Ezetimibe (Zetia) may be used with statins
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What dietary issues are there with statins?
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Grapefruit can increase amount of free statin in the bloodstream
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Why is antiplatelet therapy important for pts with CAD?
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It keeps the platelets tied up so that they won't attach to the plaque lesions
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Which antiplatelet drugs have a longer effect than aspirin?
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Plavix and Ticlid (must stop 10-14 days before surgery)
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What is the ejection fraction?
Calculated using echocardiogram (sonogram) |
58% for normal healthy male
The percentage of blood that is ejected during systole Gives info on left ventricular function |
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When would you stop a stress test (exercise tolerance test)?
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chest pain
significant BP changes significant ECG changes (ischemia) |
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What are the nursing considerations prior to a cardiac cath?
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NPO 6-18 hours prior
Assess for iodine allergy Teach that the dye may cause a "flushing" feeling; the cath may cause a "fluttering" feeling as it passes through the heart |
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How do nitrates work?
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They decrease preload to the heart
They dilate the coronary arteries (So they decrease demand or increase supply) |
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What are 3 types of drugs used for chronic stable angina?
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Nitrates
Beta Blockers Calcium Channel Blockers |
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Prinzmetal's angina
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type of unstable angina caused by spasms in the coronary artery
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What are the SE of beta blockers?
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hypotension
bradycardia n/v/d Bronchospasm Congestive heart failure |
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What is a PCI?
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Percutaneous coronary intervention (balloon angioplasty)
Often combined with a stent to keep the artery open once it is forced open by inflating the balloon |
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What are the nursing considerations for PCI?
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They have been on heparin and anti-platelet drugs for the procedure
Must monitor activated clotting time; should be <200 seconds before they can get out of bed and the sheath is pulled Make sure pt denies chest pain; remember plaque can migrate after procedure |
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What are anastomosis?
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Collateral arteries that form to get blood around a blocked artery
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Why is diabetes a risk factor for CAD?
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It damages the intimal layer of the blood vessels
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Metabolic syndrome
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HTN, obesity, abnormal lipids, elevated fasting blood glucose
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CRP (C reactive protein)
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nonspecific marker for inflammation, increased in many pts with CAD, chronic exposure can cause plaques to rupture
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Homocysteine
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blood amino acid that promotes atherosclerosis; can treat with folic acid and other B vitamins (B6, B12)
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What is the main adverse effect to watch out for with statins?
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muscle pains; can be a sign of rhabdomyolysis
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What are the diet restrictions with statins?
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grapefruit - decreases statin metabolism, which increases the level and puts you at greater risk for side effects
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What is the ejection fraction in a normal healthy male?
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58% (percent of blood ejected from the left ventricle during systole) - diagnosed with echocardiogram
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Why would a exercise tolerance test be stopped?
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Also known as stress test
chest pain drop in BP significant changes in ECG (ischemia) |
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What is an angiography
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Diagnositic study - Xray looking at the blood vessels in the heart done in the cath lab
(cardiac cath) |
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Which type of angina is potentially reversible?
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Chronic Stable Angina
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What is Prinzmetal's angina?
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Type of chronic stable angina
Occurs at rest Is because of spasm of the coronary artery (d/t calcium balance) Treated with CCBs |
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How do you treat chronic stable angina?
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Nitrates
Beta Blockers CCBs |
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How do nitrates work?
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Decrease preload to the heart
Dilate coronary arteries |
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How do beta blockers and calcium channel blockers work?
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decrease HR; thus decreasing oxygen demand on the heart
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SE of beta blockers..
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?
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What is a PCI?
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Percutaneous coronary intervention
i.e ballon angioplasty and stent placement |
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After PCI, what do you need to check?
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check for bleeding
assess their ACT (activated clotting time) because they get heparin and antiplatelet therapy during the procedure Monitor circulation and sensation Assess for chest pain - PCI stent can rupture; plaque can migrate |
