Nrs112A.cardiomod.2

Front 1

Tx plan for Heart pt.

Back 1

911-
-asprin (325 mg
-nitro 1/5 min upto 15 min
-morphine (vasodialtor, decrease afterload
-O2
-get a 12 EKG/labs drawn (within 10 min. @ ER)(****triponin/I**, CKCMB's)these enzymes peak w/in 24 hrs and return to normal w/in 3 days.
-

Front 2

Stable angina?

Back 2

Stable-predictable blockage that initiated with know causes, provoked with exertion, resolves w/rest
-EKG result:T flipped or ST segment is depressed, this is ischemia and returns to normal with increased blood flow (Nitro)

Front 3

Unstable angina?

Back 3

Unpredictable and not started with activity.

Front 4

Unrelieved chest pain, not stable, not relieved with Nito) ACS, (Acute coronary Syndrome)

Back 4

EKG= zone of injury, ST elevates (tombstone) (STEMI)

Front 5

Non STEMI?

Back 5

No ST elevation on EKG, triponin is high this is how we would know it is an MI.
-S/S Chest pain, elevated indicators, no positive EKG

Front 6

Zone of infarction?

Back 6

Significant Q wave, muscle damage

Front 7

Tranmural MI?

Back 7

One section of the Myocardium all the way through. Best prognosis. One clot one spot

Front 8

Sub-endocardial MI?

Back 8

below the endocardium, not all the way through, various areas are effected covering more muscle fiber. More problems.

Front 9

Which Ventricle will have more MI's

Back 9

Left, more muscle

Front 10

Inferior wall is supplied by?
=these people survive to the ER

Back 10

R Coronary artery

Front 11

Lateral wall supplied by?=
theses people survive to the ER

Back 11

Circumflex, right coronary

Front 12

Posterior wall supplied by: Dead

Back 12

Circumflex,

Front 13

Anterior Wall supplied by? Dead

Back 13

L anterior decending
-L main is the widow maker

Front 14

Older pt's are better of with MI's

Back 14

Collateral circulation improves circ to the heart

Front 15

CRP=c-reactive protien

Back 15

Inflammation of plaque build-up made at liver
-HDL lipids from arteries to liver
-LDL-Liver to the arteries

Front 16

Complications of an MI..

Back 16

-Arrthymias
-Pericarditis
-Vent. aneurysm
-Heart Failure
-Papillary Muscle rupture
-cardiogenic shock (in efficiant cardio performance)
-Fever (muscle damage)

Front 17

Diagnosis of MI

Back 17

-EKG 12 lead
-Cardiac Enzimes
-Hx

Front 18

1.Explain the term myocardial infarction in relation to acute coronary syndrome.

Back 18

(ACS) Cardiovascular disease and accounts for the majority of these deaths.1 Patients with CAD can be asymptomatic or develop chronic stable angina. Unstable angina (UA) and myocardial infarction (MI) are more serious manifestations of CAD and are termed acute coronary syndrome (ACS).

Front 19

Why do arrhythmias occur with ACS? *Group work #10*

Back 19

Ischemic and necrotic cells are incapable of normal electrical activity, resulting in various ECG changes (predominantly ST-T abnormalities),

Front 20

How does the electrical system change with ACS? *Group Work #10*

Back 20

resulting in various ECG changes (predominantly ST-T abnormalities), arrhythmias, and conduction disturbances. ST-T abnormalities of ischemia include ST-segment depression (often downsloping from the J point), T-wave inversion, ST-segment elevation (often referred to as injury current), and peaked T waves in the hyperacute phase of infarction.

Front 21

Priority info for cardio rehab? #11 group work*

Back 21

-Life-style changes must be initiated-
-S/S of angina, MI and why they occur
-A&P of heart and vessels
-Terminology
-Risk factors
-Rational for tests and Tx
-when to seek help

-Increased ex/activity is a gradual process, that will make recovery more likely.

Front 22

Left sided: Heart failure etiology (#12 group)

Back 22

Typically manifests as pulmonary edema caused by LV failure secondary to CAD.
Think Lungs!

Front 23

Right Sided Heart failure S/S(#12 group:

Back 23

Think the rest of the body.
-RV heaves
-Murmurs
-Jugular venous distention
-Edema (scrotum, Low leg)
-Wt gain
-Inc Hr
-Ascites
-Anasarca (mass body edema)
-Hepatomegaly
Sympt: Fatigue, anx, depress, RUQ pain, anorexia, GI Bleed, Nausea.

Front 24

Left sided Heart failure S/S(#12 group)

Back 24

-LV heaves
-Pulses alternans
-Inc. HR
-LV Hyperttophy (PMI: inf/Post)
-Slight Decr. PaO2/Incr. PCO2
-Crackles (Pul. Edema)
-S3, S4 Heart sounds
-Pleural effusion
-^Mental status, restless, confussion, weakness/fatigue, anx/depress,
-dyspnea, shallow breaths (32-40/min, Orthopnea, dry cough
-Nocturia
-Frothy pink sputum

Front 25

Right Sided Heart failure etiology (#12 group)

Back 25

Usually occurs due to LV Failure

Front 26

Nursing interventions an collaberative Tx for HF? (#12 group)

Back 26

Treatment of underlying cause

Oxygen therapy at 2-6 L/min by nasal cannula

Rest-activity periods

Drug therapy (see Table 35-9)

Daily weights

Sodium-restricted diet

Circulatory assist devices (e.g., ventricular assist device)

Cardiac resynchronization therapy with internal cardioverter-defibrillator

Front 27

Pulmonary Emboli (#12 group)
-etiology and Nurs interv.

Back 27

-Caused by a DVT
-Monitor serial ABG values, increased PaO2 (>60 mm Hg) and correction of respiratory alkalosis (PaCO2 35–45 mm Hg and pH 7.35–7.45). Report lack of response to treatment.
-Monitor oxygen saturation via continuous pulse oximetry.
•Monitor S/s of increasing respiratory distress, and consult Dr.: RR increased from baseline, increasing dyspnea, anxiety, cyanosis.
•deliver prescribed concentrations of oxygen.
•Position patient with the unaffected side down, and elevate HOB 30 degrees. This will ensure a better ventilation-perfusion match, thereby improving PaO2.
•Avoid positioning patient with knees bent, this decr. venous return.
•Ensure that patient performs deep-breathing exercises 3–5 times q2h.
•Decrease metabolic demands for oxygen by limiting or pacing patient act.
•Explain all procedures, and offer support to minimize fear and anxiety, which can increase oxygen demands.
•Schedule rest times after meals

Front 28

Mural Thrombi? (#12 group)

Back 28

-A thrombus formed on and attached to a diseased patch of endocardium

Front 29

Ventricular Aneurysm Complications? (Group #12)

Back 29

-refractory HF, dysrhythmias, and angina. Besides ventricular rupture, which is fatal, ventricular aneurysms harbor thrombi that can lead to an embolic stroke.

Front 30

Pericarditis S/S (#12 group)

Back 30

-Mimics HF and Cor Pulmonale
-Dyspnea (exertional)
-periferal edema, ascites, fatigue, wt. loss and anorexia
-jugular distention
-pulsus paradoxis is rare
-paracardial knock
-

Front 31

Pericarditis assessment, tx, Nurse care? (#12 group)

Back 31

-Paricardiectomy

Front 32

Dressler's syndrome (#12 group)

Back 32

-characterized: pericarditis w/ effusion & fever, develops 4 to 6 weeks after MI. Also occur after open heart surgery. Thought to be caused by an antigen-antibody reaction to the necrotic myocardium.

Front 33

Papillary muscle dysfunction(Group #12)

Back 33

-Creates leaky mitral valves, a Systolic murmur can be heard.