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56 Cards in this Set
- Front
- Back
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Inverted T wave w/cp
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Ischemia,
Tx: Observe the pt. O2, get an IV site. Blood draw, VS, 12 lead EKG, Nitro (if BP not low), |
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ST elevation
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Tombstone, injury
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Pathologic Q wave
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Dead (infarction)
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Zone of injury and ischemia cause what
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Arrhythmias, they can kill, dead tissue does not, muscle malfunctioning cause problems, PVC's
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PVC's that are bad
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-Multifocal
->6/min -runs of V-tach -R on T |
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R on T is
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PVC occurs near the apex of the T wave
-occurs during the Relative refractory period of T wave |
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Idiopathic/agonal rhythem
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Ventricular rhythem, slow, with tombstone, BPM <20
-Call code, CPR |
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What do you assess with a pt in v-tach
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-Determine if awake
-if not assume v- fib -prepare to cardiovertion or defribulation |
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Difference between Cardioversion and Defribulation
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Cardioversion-don't shock on T wave (V-tach_
Defribulation- Shock at anypoint (V-Fib) |
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How long do you have to defibrulate a pt in V-fib
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3 minutes
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Defibrulate on What wave?
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R-wave, defibrulators are programed to do shock at apropriate time
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Drugs used to stop V-tach
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Lidocane
Amiodarone |
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Hypertrophic cardiomyopathy
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Cardiac muscle grows to large, cuts down CO
-genetic, HTN S/S: SOB, CP, low CO, Murmurs, fatigue. Dx w/ echocardiogram, CT, MRI, graded exercise test Tx: defibrulator, pacer, Calcium cannel bockers (Slow Ca, slows contraction), B-blockers (open vessels), heart transplant, disect out cardiac muscle. |
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Restrictive Cardiomyopathy
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rarest, growing inward
Not as much growth, restricts C/O -decreases diastolic fill, -heart less compliant |
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Most common cardiomyopathy?
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Dialated
-can see on CXR -can be 1/2to 3/4 of chest width (normal is 1/3) -Sloppy heart -stretch Chordae t. sloppy valves, regurge -Sudden death -Caused by alcohol abuse, pregnancy, idiopathic, less genetic, viral infections -5-8/100k have this. -cardiac meds decrease syst vascular resistance, no Ca channel, need to use B-blockers, need to increase contractility -confusion, low bloodflow to head -transplant and meds only Tx |
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Meds ed for hyertrophic cardiomyopathy
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-Tx like HF
-no digoxin, or nitrates -should have ace inhibitors, B blockers, Ca channel blockers, diaretics, take BP monthly, meds at night |
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Excercise program
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-no valsalva, no wts,
-cardio w/in pt limits |
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Smoking cessation
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ASAP, patch, hypnosis
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Diet control
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Decreased Na, fat, stimulants
-small meals, fq -increase fiber, stool softeners -fluid restriction |
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Limit Alcohol, how does it effect the heart?
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-Cardiac depressant
-causes this disease -possible arrhythmia's -interaction w/meds -SOB and fainting |
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Life expectancy w/ cardiomyopathy?
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5 years
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Normal pericadia fluid volume
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15 to 50ml
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Cardiac Tamponade
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Blood, pu, fluid acc. in the pericardial sac. Taken out through cardiocentesis
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Cardia Tamponade Tx
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O2, Mech. vent
Increase Bl. Vol. Ianotropes if Nec. Pt in semifowlers position |
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Becks traid
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Muffled HRT sounds
Hypotension JVD (Distended Neck veins) |
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Pulses paradoxis
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hypotension with inspiration, pulse change
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Cardiac tamponade
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Cardiac tamponade is defined as the accumulation of blood, effusion fluid and or pus into the pericardial space. This fluid accumulation compromises cardiac filling and cardiac output as a result of increasing pressure on the myocardium.
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Etiology for Cardiac Tamponade
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Blunt or penetrating trauma
Pericarditis Cardiac rupture Post CPR Rupture of the great vessels Electrical cardioversion Malignancy Radiation therapy Connective tissue disease Metabolic disorders Renal failure Hepatic failure Infections (viral, bacterial or fungal) Drugs (Procainamide, Methyldopa, Hydralazine for example) Post op mediastinal chest tube occlusion or removal Invasive catheters Cardiac needle biopsy |
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Pathophysiology of Cardiac Tamponade
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The accumulation of blood or fluid into the pericardial space (as little as 100ml) can cause cardiac tamponade. As pressure in the pericardium increases the following occurs within the heart:
When pericardial pressures equal atrial and ventricular pressures a fall in transmural cardiac pressure occurs. This leads to the inability of the heart to pump and fill. End-diastolic pressure then decreases. When end-diastolic pressure decreases so does cardiac contractility. This causes a decrease in cardiac output and stroke volume and ultimately leads to shock. |
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Clinical S/S
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Complaints of pericardial fullness
Complaints regarding feelings of doom Pain Dyspnea Tachycardia Pulseless Electrical Activity (PEA) in severe cases Beck’s Triad (hypotension, distended neck veins and muffled heart sounds) Increased right atrial pressure Increased Pulmonary artery diastolic pressure Decreased cardiac output and cardiac index |
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Beck's Triad
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Hypotension, distended neck veins (DJV), Muffled Heart Sounds
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Collaberative care plan for Cardiac Tamponade
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First priority is to maintain airway, ventilation oxygen and perfusion. Other interventions include:
Intubation and mechanical ventilation (in most cases) Replacement of circulating volume (Normal Saline or Albumin) Inotropes as necessary |
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Paricardiocentsis, what is it and what is the preparation
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Place patient in semi-Fowlers position
ECG pads should be placed on limbs and away from the chest wall if possible Monitoring of ST-segment elevation is required and will be seen when the needle touches the epicardium. Pain medication and sedation should be given when possible. Monitoring for other complications (pneumothorax, cardiac rupture or cardiac laceration). |
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Nursing Dx w/cardiac tamponade
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-Decreased cardiac output secondary to decreased contractility or hypovolemia
-Fluid volume deficit secondary to hemorrhage -Pain -Anxiety -Knowledge Deficit |
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Hx Questions to ask a pt w/ right sided IE?
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-IV drug abuse
-Left-sided endocarditis is more common in patients with other bacterial infections and underlying heart disease. |
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how do you confirm acute left sided IE
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-Blood cultures
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What do splinter hemorrhages look like?
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Black longitudinal streaks in nailbeds
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What do Osler's nodes look like?
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Painful red or purple lesions on fingers or toes
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What do Janeway nodes look like
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red, painless spots on the palms and soles of feet
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What do roth spot's look like
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Hemorrhagic retinal lesions
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What does petechiae look like
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Small hemorrhages in conjunctiva, lips, and buccal mucosa
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Pt w/IE of a prosthetic valve develops a L hemiparesis and visual change, collaborative mang. would include
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Drug therapy for patients who develop endocarditis of prosthetic valves is often unsuccessful in eliminating the infection and preventing embolization, and early valve replacement followed by prolonged drug therapy is recommended for these patients.
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pt w/ aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The nurse suspects that the patient is experiencing
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patients with aortic valve endocarditis as a result of aortic valve incompetence. Vegetative embolization from the aoritic valve occurs throughout the arterial system and may affect any body organ. Pulmonary emboli occur in right-sided endocarditis.
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When D/Cing an acute IE home on meds, what pt need need to be addressed
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most important to determine the adequacy of the home environment for successful management of the patient.
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When teaching a patient with endocarditis how to prevent recurrence of the infection, the nurse instructs the patient to
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obtain prophylactic antibiotic therapy before any invasive medical or dental procedures.
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The most important role of the nurse in preventing rheumatic fever is to
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promote the early diagnosis and immediate treatment of group A B-hemolytic streptococcal pharyngitis.
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A patient with rheumatic carditis asks the nurse whether his heart is infected with streptococcal organisms. The best response by the nurse is,
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Manifestations of acute rheumatic fever appear to be related to an abnormal immunologic response to group A B-hemolytic streptococcus. Antibodies produced in response to strep antigens cross-react with normal body tissues. Strep organisms are not found in the lesion and active strep infections are not present when rheumatic fever occurs.
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The diagnosis of acute rheumatic fever is most strongly supported in the patient with
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Major criteria for the diagnosis of rheumatic fever include evidence of carditis, polyarthritis, chorea (often very late), erythema marginatum, and subcutaneous nodules. Minor criteria include all laboratory findings as well as fever, arthralgia, and a history of previous rheumatic fever.
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A patient with rheumatic heart disease asks the nurse how long his activity will be restricted. The best answer by the nurse is that he
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When carditis (make sure you can define “carditis” - mwestphal) is present in the patient with rheumatic fever, ambulation is postponed until any symptoms of heart failure are controlled with treatment, and full activity cannot be resumed until anti-inflammatory therapy has been discontinued. In the patient without cardiac involvement, ambulation may be permitted as soon as acute symptoms have subsided, and normal activity can be resumed when anti-inflammatory therapy is discontinued.
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The nurse teaches the adult patient recovering from rheumatic heart disease that antibiotic prophylaxis
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The dosage of maintenance prophylactic antibiotics is not adequate for protection when the patient with rheumatic heart disease undergoes invasive procedures, and additional doses are necessary at this time. Prophylactic therapy following rheumatic fever should continue for life for those who had rheumatic heart disease, for at least 5 years for those without carditis after the age of 18, or indefinitely for patients with frequent exposure to group A streptococcus.
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Drugs that the nurse would expect to be prescribed for most patient with valvular heart disease include
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anticoagulants, nitrates are contraindicated.
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A patient with symptomatic mitral valve prolapse has atrial and ventricular dysrhythmias. In addition to monitoring for decreased cardiac output related to the dysrhythmias, an appropriate nursing diagnosis related to the dysrhythmias identified by the nurse is
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risk for injury related to dizziness and light-headedness.
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A patient is scheduled for a percutaneous transluminal balloon valvuloplasty. The nurse understands that this procedure is indicated for
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patients with valvular stenosis who are poor surgical risks.
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A patient is scheduled for an open surgical valvuloplasty of the mitral valve. In preparing the patient for surgery, the nurse recognizes that
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Repair of mitral or tricuspid valves has a lower operative mortality rate than does replacement and is becoming the surgical procedure of choice for these valvular diseases. Open repair is more precise than closed repair and requires cardiopulmonary bypass during surgery. All types of valve surgery are palliative, not curative, and patients require lifelong health care. Anticoagulation therapy is used for all valve surgery for at least some time postoperatively.
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A mechanical prosthetic valve is most likely to be preferred over a biologic valve for valve replacement in a
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Mechanical prosthetic valves require long-term anticoagulation, and this is a factor in making a decision about the type of valve to use for replacement. Patients who cannot take anticoagulant therapy, such as women of child bearing age or patients with a risk for hemorrhage (we didn’t mention this one in class -mwestphal, but it is true) or patients who cannot be compliant with anticoagulation therapy may be candidates for the less durable biologic valves.
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When performing discharge teaching for the patient following a mechanical valve replacement, the nurse determines that further instruction is needed when the patient says
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The greatest risk to a patient who has an artificial valve is the development of endocarditis with invasive medical or dental procedures, and before any of these procedures, antibiotic prophylaxis is necessary to prevent infection. Health care providers must be informed of the presence of the valve and the anticoagulatnt therapy, but the most important factor is using antibiotic prophylaxis before invasive procedures.
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