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14 Cards in this Set

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PTT
Monitors effects of pharmacological tx following administration of heparin. TX level=1.5-2.5 times normal (35-40 seconds)
PT
Monitors effects of COUMADIN. TX level = 1.5-2.5 times normal (12-13 seconds)
INR
Most current test to monitor COUMADIN. TX level = 2.5-3
WBCs
Elevated r/t inflammation and stress
ESR
Erythrocyte Sedimentation Rate is a nonspecific test revealing inflmmation.
P.T.D.P.C.D.H.C.N.V.F.DCO.
Pain Tachy(palpitations) Dyspnea(may be early indicator of CHF or PE) Peripheral edema Cyanosis Dysrythmias (r/t MI) Hypotension (dec CO) Cold/Clammy skin (diaphoresis) Nausea Vomit Feeling of impending doom Dec C.O.
Myocardial Ischemia ETTC
1. EKG: ST segment evaluation; repeat with a return of pain 2. Treadmill study: assesses tolerance to activity 3. Treadmill with Thallium: assesses perfusion of coronary arteries during exercise 4. Coronary Angiograph: provides diagnostic data regaurding the location and extent of coronary artery occlusion.
Independent N.I. for an Acute MI V.C.V.A.
1. Monitor Vs and cardiac rhythm (EKG) 2. Monitor for complications (chf-pe-cardio shock-dysryth-infarction extending-ventricular rupture) 3. Teach pt to avoid Valsalva maneuver 4. Appropriate interventions to reduce Anxiety.
Dependent N.I. for an Acute MI O.N.M.A.T.H.P.S.C.
1. O2 2. NTG x3 if unrelieved call dr. Always start IV bcx NTG can cause vasodilation. 3. MS IV given after NTG causes resp depression. 4. ASA 5. Thrombolytic Tx 5. Heparin (lovenox-give w/air bubble in SQ) 6. PCTA 7. Stents 8. CABG
Thrombolytic Agents (E.T.H.C.R.)
high risk need consent 1. tPA RPA TNKase Streptokinase Alteplase 2. Must be administered within a short period of TIME following onset of pain (w/in 6hrs-otherwise damage is already done) 3. Usually follows HEPARIN tx 4. COMPLICATIONS: cva reperfusion dysrythmias allergic reactions bleeding 5. Nurse RESPONSIBLE for potential complications reportind and intervening.
Coronary Angiography H.H.T.M.O
1. Complications include HEMORRHAGE from puncture site 2. HEMOSTATIC puncture closer device seals a single femoral artery puncture 3. THROMBUS formation is possible 4. Nurses MONITOR PEDAL PULSE color temp of effected extremity 5. Monitor for OSMOTIC DIURESIS (Dye pulls fluid into the vascular compartment and the kidneys diurese. This can lead to dehydration hypovol chest pain and dysrythm.)
PCTA (C.B.R.S.R.I.C.C.R.)
1. Coronary Angiography 2. OPENIING OF THE NARROWED CORONARY ARTERY WITH A “BALLOON” 3. REPERFUSION dysrythmias with blood flow restored to cardiac tissue 4. STENTS may be placed 5. RUPTURE of vessel possible (r/t widening and vessel walls not as elastic due to age) 6. INFARCTION possible (plaque could break off) 7. May need CABG for infarction 8. CVA possible (r/t plaque breaking off and traveling to cerebral vessel 9. RESTENOSIS is a concern (20-30% r/t not changing lifestyle)
CABG (G.S.A.F.)
1. open heart surgery with or without bypass machine. Affected CORONARY ARTERY/BRANCHES ARE BYPASSED USING A GRAFT HARVESTED FROM THE SAPHENOUS VEIN IN LOWER LEG. 2. Swan-Ganz (Pulmonary Artery Pressure Line) catheter used. 3. Atrial line (measures arterial blood pressure during systole and diastole. 4. Foley 2Peripheral lines Mediastinal chest tubes (drainage for surgery) Hyper/othermia blankets
CABG Nursing Responsabilities (E.I.C.)
1. Monitor an maintain tx and diagnostic EQUIP. 2. INTERVENE to address pain anxiety O2(abgs) elimination(i+o) fVol/Elec C.O. needs 3. Monitor for Complications (Hemorrhage from graft site. Hypoxia. Dysrythmias. LOC. Cardiac shock. Stress ulcers.