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21 Cards in this Set
- Front
- Back
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What is atherectomy?
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Rotablator device scrapes plaque from inside the artery while minimizing damage to vessel surface
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What is Laser angioplasty?
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-Catheter has a laser tip that opens the blocked artery
-Pulsating beams of light pulverize plaque build up |
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What is a coronary stent?
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-Expandable mesh devices used to maintain the patent lumen created by angioplasty or atherectomy
-Provides a supportive scaffold which prevents closure of the vessel from arterial dissection or vasospasm |
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What is thrombolysis?
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Thrombolysis is the breakdown (lysis) of blood clots by pharmacological means.
-Thrombolytic therapy uses fibrinolytics to dissolve thrombi in the coronary arteries and restores myocardial blood flow |
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What medications are used in the procedure?
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-Tissue plasminogen activator (t-PA, alteplase)
-Reteplase (Retavase) -Tenecteplase (TNK) |
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Given for?
Most effective when delivered w/i |
-Given for: chest pain longer than 30 min unrelieved by nitroglycerin w/ indications of transmural ischemia and injury show by ECG
-Most effective when delivered within 6 h of coronary event |
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Nursing Interventions/monitor
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-*monitor for bleeding by checking neurological status, check IV sites, monitor clotting studies, observe signs of internal bleeding (H&H, BP), test stools, urine and emesis for occult bleeding
-After clot lysis, lg amts of thrombin released into system increasing risk for vessel reocclusion. Aspirin & IV heparin is RX to maintain patency of coronary artery. Monitor aPTT |
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What is the criterion for reperfusion thrombolytic therapy?
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occlusion/clot
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What is the rationale for reperfusioning the heart?
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to prevent myocardial tissue from become necrotic
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What are the characteristics of pharmacological reperfusion?
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-Abrupt cessation of pain or discomfort
-Sudden onset of ventricular dysrhythmias -Resolution of ST-segment depression/elevation or T-wave inversion -A peak at 12 h of markers of myocardial damage |
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Other tx for obstructions/clots
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1) Precutaneous Transluminal Coronary Angioplasty (PTCA)
---->Atherectomy ---->Laser angioplasty 2) Coronary Artery Bypass Graft |
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What is coronary artery bypass graft surgery?
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-Most common type of cardiac surgery
--occluded arteries are bypassed w/ the pt's own venous or arterial blood vessels or synthetic grafts. -Internal mammary artery (IMA) is graft of choice because it has a 90% patency rate 12 years after |
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when is coronary artery bypass graft surgery indicated?
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-Indicated in patients who do not respond to medical management of CAD or when disease progression is evident
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What is Digoxin?
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-Digoxin is a cardiac glycoside which increases the force and velocity of myocardial contraction w/o increasing O2 consumption
-it decreases the HR by increasing the force of contractility |
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What is the normal dose?
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Normal dose: 0.125-0.5 mg/day Therapeutic dose: 0.5-2.0
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What laboratory data is monitored?
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Electro: K, Na, Mg, CA,
ECG, renal fx: BUN/creatinine liver fx: AST,ALT, CPK, LD, ALP |
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What nursing assessment is done before giving this medication?
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check apical pulse for a full minute for rate and quality
--> if below 60 or above 100, notify **does NOT need to be withheld for HR < 60 bpm if patient is in sinus rhythm b/c digoxin does not affect SA node automaticity |
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How do you digitalize a patient?
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Patient started on digoxin is usually digitalized and that can be up to 1 mg, can be 0.25mg times 4.
(PO/IV 1-1.5 mg/day) |
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What patient teaching would you do for nitroglycerin SL?
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-hold tablet under tongue and drink 5 mL of water to help dissolve
-pain relief 1-2 minute, but definitely in 3-5 min -take 5 min apart, total of 3 doses (after 1st call 911) -keep in original dark glass container, but remove cotton to prevent absorption exposure to air, heat & moisture loses potency -tablets should be replaced 6 months after opening |
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nitroglycerin SL action
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*Nitro increases collateral blood flow, redistributes blood flow toward subendocardium and dilates coronary arteries. It also decreases myocardial 02 demand by peripheral vasodilation which decreased both preload and after load
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For digoxin?
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-antidote is Digoxin immune Fab (Digibind)
-antacids decrease absorption, do not take w/in 2 h -take at same each day -missed dose…take w/in 12 h; do not double dose -check for pulse < 60 or > 100 -s/s of dig toxicity: confusion, irregular pulse, anorexia, N/V, diarrhea, palpitations, visual disturbances, fatigue |
