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184 Cards in this Set
- Front
- Back
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What are the risk factors for coronary heart disease?
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diabetes, HNT, high LDL, low LDL, menopause, no physical activity/exercise, obesity, smoking
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What is coronary heart disease?
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The accumulation of atherscleroitic plaque in the coronary arteries.
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What does CHD contribute to?
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Angina, acute coronary syndrome, MI, heart failure
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What is CHD
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a fibrous lesion that develops which may advance to block the arteries.
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What is angina?
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Angina is chest pain that is caused by decreased coronary blood flow. This causes an imbalance between heart blood supply and o2 demand
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What is STABLE angina?
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Stable angina is chest pain that occurs with moderate or prolonged exertion--when active
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How is stable angina relieved?
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with rest and/or nitroglycerin. It is medically managed with Cal Chan Blockers, beta blockers etc
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What does nitroglycerin do?
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it is a vasodilator. It decreases preload and afterload.
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What are stable angina triggers?
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physical exertion, exposure to cold, stress, eating a heavy meal
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What is the difference between stable and unstable angina?
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Unstable angina still has pain @ rest. And is a bigger risk for MI. Unstable must limit activity
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What is prinzmetal or Variant angina?
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It is an atypical type of angina that usually occurs @ night, unpredictable, has no atherosclerotic lesions
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What is the LaVine sign?
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It is a clutching of the fist to the heart. A classic sign of an angina
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What is the pain described as with angina?
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tight, pressure, constricting, aching, heaviness, discomfort
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What are the manifestations of angina?
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pain, heaviness, dyspnea, pallor, diaphoresis, tachycardia, anxiety, fear, indigestion, nausea, vomiting, upper back pain
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How is angina diagnosed?
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History, 12 lead EKG, ischemic tissue does not repolarize normally so the focus on the ST segment and the Q wave
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on the 12 lead EKG, angina will show what?
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ST depression, T-wave inversion, or both
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What is the difference between an MI versus Angina?
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Angina = myocardial ischemia
MI = myocardial necrosis |
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Which artery is the most common cause of an inferior MI?
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the right coronary artery
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What is angina?
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the lack of O2 to the heart
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When you sit down and rest if you have angina and the pain goes away what type of angina do you have?
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Stable angina
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How do calcium channel blockers work to help people with angina?
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they are vasodilators
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Why do Beta Blockers help with angina?
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They decrease the work load of the heart. Beta blockers are all about heart rate and contractility
(decrease HR/contractility) |
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What catagory is nitro?
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they are vasodilators
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What is the percentage of people with unstable angina that go on to have a MI?
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10 to 30%
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Why is the pain go for angina?
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it warns us to change our ways, get help, etc
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the type of angina that has no atherosclerotic lesions and is just vasospasm is?
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Prinzmetal angina or Variant angina
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What is the first nursing action for someone who is walking down the hall and is experiencing angina?
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sit them down.
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When you give someone nitro, what do we monitor?
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BP
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What are the rules for nitro?
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give it then again in five minutes, up to 3 times. then IV nitro. Monitor BP because its a vasodilator
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What are the two factors we consider when titrating nitro?
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When the pain stops or BP drops below 90
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When questioning someone who reports chest pain, what else should we ask?
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Do you have any heaviness, back pain, crushing pressure pain, nausea, etc...
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Where should we focus when looking at a 12-lead EKG?
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the ST segment and the Q wave
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When we see a ST depression on a 12-lead EKG what is that?
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it is angina
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When you se a ST elevation on a 12-lead EKG what is that?
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it is a MI
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What type of MI is the most common and what does it affect?
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a inferior MI that affects the right coronary artery
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An inferior MI will show what changes on a 12-lead EKG?
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Leads II, III, AVF with ST elevation. Reciprocal changes in V1-V4-depression
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How do you tell if you have an inferior Mi or an Anterior MI
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A anterior MI id the left anterior descending artery which is the most dangerous. On a 12 lead the V!-2-3-4 will have elevated ST, reciprocal changes in II, III and AVF
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Anterior Mi affect what artery?
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The left anterior descending artery, this is the most dangerous because if the left side of the heart
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What do you look for in a 12-lead EKG with a anterior MI?
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Leads V1, V2, V3, V4 ST-elevation, with reciprocal changes in II, III and AVF.
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What is the big danger of having a MI?and the precurecer to pvc
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having V-fib
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What clinical signs do we look for with a inferior MI?
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RT side heart failure.--edema, JDV
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What clinical signs do we look for with an Anterior MI?
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Pulmonary edema, crackles, etc things that go with left sided heart failure
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What leads look for in a inferior MI
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2,3, and AVF
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What is the gold standard for determining the extent and exact location of obstruction of the coronary arteries?
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Cardiac catherterization
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What is the only study that tells us about the heart ejection fraction?
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Dobutamine ECHO
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When is a Cardiac catherterization used?
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Performed in patients with angina and/or in acute MI. (pt with chest pain)
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What pre-procedure interventions do we need to do before a cardiac cath?
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consent, allergies to dye(seafood, iodine), Npo 6-10, shave area, antiseptic, IV acess and warn of feeling flush(hot Flash)
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What are the POST procedure interventions with a cardiac cath?
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flat for 6-8 hours, no leg bending, check pulses (distal to sight) every 30mn for 2 hrs, then q hour for 4 hr. Check femoral site for bleeding
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What should you do if bleeding occurs post cardiac cath?
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2 fingers direct pressure should be applied to the femoral artery. Notify physician of numb/ting or coolness or loss of pulse to extremity
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Whats the big deal with cardiac cath?
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BLEEDING.. check the site first. If numbness etc check the site first
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Why should we encourage fluid after a cardiac cath?
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to help flush the contrast
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What is a Percutaneous transluminal coronary angioplasty (PCTA)?
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A stint--put in to widen the artery
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What is the best diagnostic indicators for MI?
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12-lead EKG
Cardiac enzymes--troponin cardiac cath |
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Can a stint (PCTA) be put in during a cardiac cath?
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Yes, can occur as part of cardiac cath
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when tirating nitorglycerin iv drip, what do you titrate to?
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titrate to pain and syst BP of 90.Nitro decreases both afterload and preload
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What lab would be indicated when someone is suspected of having a MI
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CK-MB, Traponin, myoglobin
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What is the job of nitroglycerin?
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to increase venous return
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What is the most important thing to look for after a cardiac cath?
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BLEEDING
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The pt states they are pain free when on a nitro drip, what is the other factor to look for?
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styt BP
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Before you administer a thrombolytic what should you do?
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have IV's in, catheters, invasive proceedures all done before adminstration
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What drug treatment are the usual treatment for MI?
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Glycoprotien inhibitors(inhibits clot formation, Heparin(after thrombolytic), Calcium channel Blocker(reduce vasospasm), BB(slows HR, decreasescontractility)
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What is the best indicator of cardiac output/
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BP, and urine output
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How long after a MI should there be bed rest?
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24-36 hours
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Why should a pt have stool softeners after a MI?
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prevent valsalva maneuver
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What is good about cardiac rehab?
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comroderie, lifestyle changes and support, and specifice exercise program avoid stressful environment for life
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When can a pt have sexual relations after a MI
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5-8 weeks, when a client can walk up two flights of stairs or 3-4 mile walk without being SOB (Viagra is contraindicated
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What are MI complications?
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HF, necrosis of more than 40% of the left vent, failure of the heart to pump, low CO and tissue perfusion
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What are the manifestations of cardiogenic shock
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Chest pain, fast breathing, fast pulse , sweating, agitation, SOB, pallor, thready pulse, LOC decreased
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What is the goal of treatment for cardiogenic shock?
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the goal is to increase perfusion to all tissues. O2, morphine, intubation, diuretics, vasopressors, inotropens, dobutamine, dopamine, digoxin
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What is the most common cause of heart failure
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coronary artery disease
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Why should a pt be kept flat after a cardiac catheterization?
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To prevent bleeding. the affected leg should be straight for 6-8 hours. bedrest up to 12 hr
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a cardiac cath is used to determine what?
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the extent and exact location of the obstruction of the coronary arteries
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A patient with angina or acute MI will get what?
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a cardiac catheterization
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Atherosclerosis is the cause of what?
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angina, MI, heart failure
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The risk factors for coronary heart disease are?
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diabetes, HTN, high ldl, obesity, smoking, lack of exercise
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stable angina is described as?
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chest pain that is relieved by rest and or nitroglycerine
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unstable angina is described as?
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Chest pain that does not go away when at rest
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Which type of angina is the biggest risk to have an MI
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unstable angina
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angina = ?
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iscemia
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MI = ?
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necrosis
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What is the most common cause of cardiogenic shock
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acute MI
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What do all causes of cardiogenic shock lead to?
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Decreased in CO and MAP
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What kind of extra heart sounds will probably be heard in the pt in cardiogenic shock
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Murmurs and S3 gallops (floppy heart, ventricular problems
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When is BNP produced and what does it do?
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It is produced in response to HF when there's hypervolemia d/t increases in aldosterone and ADH.-
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Why is an ECHO useful in dx cardiogenic shock?
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Because it will show ejection fraction
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What is the main treatment in cardiogenic shock?
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Inotropic meds (dobutamine or inamronone
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Why is morphine a preferred method of pain relief in the pt in cardiogenic shock?
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Because it relieves pain and decreases afterload
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Why is Nesiritide (Natrecor) given in cardiogenic shock?
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Because it is a synthetice version of BNP and it decreases fluid levels
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if meds are not effective in treating cardiogenic shock what could be considered?
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intra-aortic balloon pump
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What is the defference between a person who is in a coma and person who is in a deep coma?
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coma-intact reflexes
deep coma-no intact refelexes |
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What are the 4 ways to apply painful stimuli to the unresponsive patient?
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supraorbital pressure
trapezius squeeze mandibular pressure sternal rub |
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what is the most significant assessment for the pt with a neurologic problem?
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change in level of consciousness
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What is the second most significan assessment for a pt with a neurologic probem?
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Pupillary response
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Which cranial nerve does tongue defiation assess?
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hypoglossal
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Describe decorticate posturing and what does it indicate?
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arms close to chest, elbows wrists fingers flexed, legs internally rotated, feet flexed-indicateds lesions of corticospinal tracts
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What is absent dolls eyes indicative of?
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deteriorated brainstem function
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What is caloric testing used to assess
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vestubular system function
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What test provides the best indicatior of brain death?
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cerebral blood flow study
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What is a concussion
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a momentary interruption of brain function
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what is a contusion
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bruising of the brain
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What is a contrecoup injury?
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When the brain injures itself against the cranium on the opposite side of injury
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What are the most common areas involved in a contrecoup injury
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base of the frontal lobe and temperal love
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what is an acceleration injury
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one caused by an external force contacting the head nd suddenly placing the head in motion
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what is a deceleration injury
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when the moving head suddenly stops or his a stationary object
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what are the most common types of skull fractures
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linear skull fractures
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what nursing intervention must be avoided when a patient has a basilary skull fracture
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placing an NG tube
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What should be done if the basilar skull fracture pt has clear nasal drainage and why
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test for glucose, because the dura could have been disrupted and CSF could be leaking through a tear duct
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what are two signs of a basilar skull fracture?
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blood over the mastoid process (Battles sign) and bilateral periorbital ecchymosis (raccoons eyes)
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What does an epidural hematoma result from
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a fast arterial bleed
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what are epidural hematomas most commonly caused by
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fracture of the temporal bone which houses the meningeal artery
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What happens to the epidural hematoma pt's LOC
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it declines rapidly from drowsiness to coma
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what needs to happen to epidural hematoma patients?
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surgery to evacuate the blood
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what does a subdural hematoma result from
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slow venous bleed
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what are subdural hematomas usually caused by
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tearing of the bridging veins within the cerebral hemispheres or from a brain tissue laceration
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what has the higher mortality rate epidural or subdural hematomas
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subdural
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what is important to assess when a pt has a intracerebral hemorrhage in the frontal lobe?
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personality changes
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What is the normal ICP?
(intercranial pressure) |
less than or eq ual to 10-15mm HG
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What does management of ICP require
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prompt determination of the cause and specific treatment measures
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what amount of blood goes to the brain a minute
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750mL/minute which is 15% of the cardiac output
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If a ICP monitor is in place, what in important to assess to assure the reading is accurate?
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the ICP wave form
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what does an increased ICP lead to?
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decreased cerebral perfusion and/or herniation
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if an ICP monitor shows a patients ICP suddely increasing, what should be the first thing to assess?
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pt's positioning (ead alligned, on back, HOP at 30 degree)
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what are the three components of ICP?
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brain tissue edema
vasculature CSF |
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what is the tratment for brain tissue edema?
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Osmotic diuretic---MANNITOL
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What is important to monitor when pt is being treated for brain tissue edema?
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electrolyes, osmolality are the diuretics working (decrease ICP and I & O
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what is the goal of treating the brain tissue vasculature in pt with increased ICP
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vasoconstriction to make more room in the brain
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How do we treat the brain blood vessels with increased ICP
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hperventilate the pt because a decrease in CO2 levels causes vasoconstriction
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what is the target CO2 level when treating brain tissue vasculature
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27-35
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how do we treat CSF when incrased ICP
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drain it off
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what is the landmark for an intra ventricular drain
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Foramen of Monroe
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what does an increased ICP lead to?
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decreased cerebral perfusion and/or herniation
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if an ICP monitor shows a patients ICP suddely increasing, what should be the first thing to assess?
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pt's positioning (ead alligned, on back, HOP at 30 degree)
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what are the three components of ICP?
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brain tissue edema
vasculature CSF |
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what is the tratment for brain tissue edema?
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Osmotic diuretic---MANNITOL
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What is important to monitor when pt is being treated for brain tissue edema?
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electrolyes, osmolality are the diuretics working (decrease ICP and I & O
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what is the goal of treating the brain tissue vasculature in pt with increased ICP
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vasoconstriction to make more room in the brain
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How do we treat the brain blood vessels with increased ICP
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hperventilate the pt because a decrease in CO2 levels causes vasoconstriction
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what is the target CO2 level when treating brain tissue vasculature
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27-35
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how do we treat CSF when incrased ICP
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drain it off
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what is the landmark for an intra ventricular drain
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Foramen of Monroe
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At what number do we like to see the cerebral perfusion pressure? (CPP)
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greater than 60
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How is the CPP calculated? (Cerebral perfusion pressure)
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CPP=MAP-ICP
Cerebral perfusion pressure = mean arteral pressure minus intercranial presure |
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What does a CPP of < 50 indicate
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that he BP is not high enough to get perfusion to the brain. ischemia
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what drugs do we use to increase the BP to get more brain perfusion
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levophed or vasopressin
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what are the three components of the intracranial compartment?
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brain - 80%
blood - 105 CSF - 10% |
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What does the Monroe-Kellie hypothesis state?
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to maintain ICP WNL a change in the volume of one of the components must be offset by a reciprocal change in the volume of another component
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What components normally control the ICP?
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Blood and CSF
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What is Cushing's triad?
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a classic late sign of increased ICP, an increase so severe that the brain starts to push on the brainstem
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At what number do we like to see the cerebral perfusion pressure? (CPP)
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greater than 60
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what are the 3 components of cushings triad?
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HTN, bradycardia, widened pulse pressure (between sys/dy
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How is the CPP calculated? (Cerebral perfusion pressure)
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CPP=MAP-ICP
Cerebral perfusion pressure = mean arteral pressure minus intercranial presure |
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What drug is given to reduce brain tissue edema
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Mannitol
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What does a CPP of < 50 indicate
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that he BP is not high enough to get perfusion to the brain. ischemia
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what drugs do we use to increase the BP to get more brain perfusion
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levophed or vasopressin
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what are the three components of the intracranial compartment?
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brain - 80%
blood - 105 CSF - 10% |
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What does the Monroe-Kellie hypothesis state?
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to maintain ICP WNL a change in the volume of one of the components must be offset by a reciprocal change in the volume of another component
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What components normally control the ICP?
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Blood and CSF
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What is Cushing's triad?
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a classic late sign of increased ICP, an increase so severe that the brain starts to push on the brainstem
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what are the 3 components of cushings triad?
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HTN, bradycardia, widened pulse pressure (between sys/dy
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What drug is given to reduce brain tissue edema
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Mannitol
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What labs should be monitored in the pt who is taking Mannitol?
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Urine osmolality and serum/urine electrolytes
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what drug is used for the pt experiencing cerebral edema d/t tumor
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decadron
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what is pentobarbital used for in the pt with Increased ICP?
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to place pt in induced coma to decrease cerebral metabolism and O2 requirements
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What is the goal of treament of Increased ICP?
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to maintain the Cerebral perfusion pressure (CPP)
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What temperature would cause concern in the pt with Increased ICP?
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>100.5
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What type of meningitis is more lethal, bacterial or viral?
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bacterial
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What 2 bacteria usually cause bacterial meningitis?
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Streptococcus pneumonia
Neisseria meningitides |
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What antibiotic do those who have been unknowingly exposed to a bacterial meningitis pt need to be on?
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Cipro
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What is the only type of meningitis that occurs in outbreaks?
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Meningococcal meningitis
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What are the 3 signs of meningeal irritation?
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Nuchal rigidity (stiff neck)
Positive Bradzinski's sign (pain in back when chin to chest) Positive Kernig's sign (pain in back when bending kee up |
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What is the characteristic sign of Meningococcal meningitis>
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petichial rash
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How is viral meningitis treated?
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treat symptoms. most commonly used drug is decadron
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What is the difference between primary and secondary tumor?
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primary originates in the brain structure
secondary originates somewhere else and metastasizes to brain |
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What is the most common type of primary tumor?
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Glioblastoma
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What are common medications use on pt with a brain tumor
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dilantin-prophylactic for seizures
decadron-corticosteroid |
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What needs to be monitored with pt having seizure?
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length
what side it is exacerbating on O2 sat |
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what is the first drug to give when a pt is having a seizure?
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Ativan
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What is the difference between a partial and generalized seizure?
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Partial begins in one part of cerebral hemisphere
generalized may occur and involve both cerebral hemispheres |
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What are the 2 types of partial seizures? describe them
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Complex partial-pt loses consciousness 1-3 minutes;lip smacking, patting, picking at clothes
simple partial-pt remains conscious;often reports an aura before seizure |
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what is the main type of generalized seizure?
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tonic-clonic seizure;may last 2-5 minutes;begins with tonic (stiffness or rigidity of muscles) which is followed by clonic state (jerking of extremities
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What medication is commonly used to treat seizures?
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Dilantin
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What is Dilantin's major long term side effect
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gum hyperplasia (other s/e rash,
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Who is vagal nerve stimulation treatment used for?
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pt's with partial onset seizures who do not respond to AED's
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What is coronary hear disease?
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accumulation of atherosclerotic plaque in the coronary arteries
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