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163 Cards in this Set
- Front
- Back
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Widow maker
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LAD/circumflex
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Troponin I
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this is the one they are looking for
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stable angina
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gets better with sitting
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unstable
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gets worse no matter what you are doing // 50% will go into MI
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inverted T WAVE
ST segment depression |
signs of ischemia
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St elevation
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Infarction or zone of injury this is now ACS acute coronary syndrome.
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Q wave
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indicating zone of infarction of a hx of heart attack. due to to septal depolerization
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Three parameters used to diagnose MI
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EKG, patient HX, cardiac markers
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Transmural
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goes through heart muscle one section but all the way through. The best prognosis
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subendocardial MI
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does not go all the way through,
below endocardiam (this goes to many different areas of the heart) |
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Which ventricle is most likely to sustain an MI
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Left, because it is thicker and stronger
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Infarct locations are based on the coranary artery feeding systems
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inferior wall is fed by the Right coranary artery
-Lateral wall is fed by the circumflex and posterior -R coranary artery feeds the posterior wall - LAD anterior decending |
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lateral wall and inferior
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is what you will see due to the fact that lad will die
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when is it better to have an MI
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older due to collateral curculaiton
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what protien carries lipids away from arteries tothe liver
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HDL
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what is CRP
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c reactive protien
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obesity is a modest risk for heart disease
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true
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what lab test brings out the difference in MI s
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triponin I
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pericarditis is a
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complication of an MI
starts about 3 days later |
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ventricular aneurysm
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cause of cardiac tampinod
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papillary muscle rupture
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cause a huge murmer
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seek medical advice when
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chest pain is not releived within 15 min due to notros
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HDL should be greater than
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40
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LDL should be lower than
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less than 130
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Down syndrome babies
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VSD and PDA,, high incident of
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what compensation mechanisms are there in the early stages of heart failure
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activation of the central nervous system and activation of the RAAS (rennin angiotension aldosterone system
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What does cardiac output depend on
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Heart rate and Stroke volume
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What is nocternal dyspnea
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this is when a heart failure patient lays down and the venous blood returns to the thorax, this causes coughing and wheezing
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How much weight gain is cause for alarm in a heart failure patient
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3 pounds lasting longer than two consecutive days
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What can an echocardiogram show and what is it usefull for
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Most useful for showing heart failure, showing
abnormal chamber size valve deformities pericardial effusions ventricular thrombus ejection fraction |
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What is diastolic heart failure
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It occurs when the ventricle is unable to fill properly
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What is systolic heart failure
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this is when the heart is unable to empty properly
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what is the cure for heart failure
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there is none
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what is a Internal cardioverter defibrillator
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it is used to treat heart failure complications such as VT and V fib
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what is JVD caused from
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Heart failure, Right sided
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what should a heart failure pesons excercise routine look like
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walking 30 to 40 min 3 to 4 times a week
It is important for them to stop if they are short of breath |
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what does heart failure mean
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the heart cant support the bodys need for blood
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what is the HALLMARK for heart failure and usually the first symptom
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Exercise intolerance
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What is after load
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the pressure that the left ventricle must overcome to eject its contents during systole
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Is the RAAS good or bad in heart failure patients
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Very bad this leads to the retention of Na and water
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what is a sign that heart failure is getting worse
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tachycardia more than 100 beats per min
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how many people does heart failure effect
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Five million people and it is the only cardiac disorder that is increasing in prevalence
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what kind of therapy does end stage heart failure require
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inotropic therapy continuous in order to increase stroke volume.
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what might cause hepatomegaly
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right sided heart failure
(venous blood is backing up) |
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what is the best measure of fluid retention
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daily weight (befor breakfast)
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what is ventricle remodeling
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Due to prolonged RAAS the heart myocytes hypertophy this increases the muscle mass of the heart and impairs pumping performance
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what is flash pulmonary edema
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life threatening complication of HF whne fluid suddenly shifts from th pulmonary vessels into lung alveoli causing frothy sputum and severe SOB
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what is the first drug usually prescribed for heart failure
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ACE inhibitor
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LAD/circumflex artery is known as the
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widow maker
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What are the 3 things used int the diagnosis of a MI
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Patient HX
Cardiac markers EKG with ST elevation in two contiguous leads and serial measurement of cardiac markers |
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what will increase HDL levels and collateral circulation
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physical excersize 3 times a weekfor 30 min causing sweating and an increase in heart rate 30 to 50 bpm
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what is included in acute coronary syndrome
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unstable angina
stemi and non stemi |
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when women have an MI what is the difference from men
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they have a higher mortality rate within one year
more likely to reinfarct the reason is older age and smaller vessels |
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when is abdominal obesity considered to be a risk factor for an MI
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over 40 inch
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Unstable angina is
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will occure even at rest and there is a change in pattern
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what is important for nursed to watch for when giving fibrolytics
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dangerous reperfusian arrhythmias
and bleeding |
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what are the major MODIFIABLE risk factors for an MI
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HTN
DIABETES HYPERLIPIDEMIA |
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what does smoking do for heart failure patients
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nicotine increases epinephrine
increases HTN increases peripheral vasoconstriction BP Cardiac workload O2 needs and increases platlet adhesion |
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How does nicotine decrease 02 carrying capacity
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it increases C0 carbon monoxide and also may injure vessel epithelium
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what are priorities for a nurse caring for a suspected MI patient
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O2
Pain relief EKG Labs assesment etc |
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How long should it take to get a 12 lead and labs
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10 min
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Describe Triponin I
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cardiac marker (muscle protein)
It elevates in 3 to 12 hours remains in circulation up to 10 to 15 days -good for diagnosing and MI in later stages |
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What do HDLs do
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have high protein content and carry lipids away from arteries to the liver for metabolism
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what infusion must be started after fibrinolytics are used
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IV heparin infusion to prevent reclotting
maintain PTT 1-2 times normal |
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What does a cardiac MI patient look like and why
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they look ashen, cool and clammy because of the sypothetic nervous system causes diaphoresis and vasoconstriction
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why is an echocardiogram done after an MI
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it is important for assessing for cardiac damage
-an ejection fraction of less than 40% is considered abnormal and makes the patient a high risk for heart failure |
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what is the most common cause of death after an MI
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cardiac arrythmias about 80% die like this
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when can an MI patient resume sexual activity
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when they can climb two flights of stairs
they may need to use prophylactic nitrates |
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what is a MET
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metabolic equavilent
the amount of O2 neede at rest -in cardiac rehab a patient can be discharged if they can tolerate moderate energy of about 3-5 mets |
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Stabel angine
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pain subsides with rest or one or two nitro tabs
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when should a patient call 911
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chest pain occurs at rest or is not relieved within 15 min
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describe some of the bad stuff that high blood pressure causes
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left ventricle hypertrophy
risk factor for atheroscloerosis increases ventricle afterload |
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ST segment elevation indicates
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acute coronary syndrome
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what is usually the cause of acute ischemia in the heart
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a thrombus in the coronary artery
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what would a q wave indicate
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injury at one time or another patients that have had an mi will have a q wave
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wht is the initial treatment for high blood pressure
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thiazides
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when do signs and symptoms of high blood pressure show
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after end organ damage has already happened
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what is the goal for HDL levels
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greater than 40 mg/dl
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what is the goal for LDL
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less than 130 mg/dl
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what are important diet tips for someone who has had a heart attack
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avoid hydrogenated and trans fatty acids and oils
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when do heart failure patients die
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half diagnosed die in 5 years
20% wil be alive in 8to10 years |
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what does a high BNP mean
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Brain nutrimic peptide used to indicate heart failure, over 400 we know you have heart failure 0-100 is normal. this peptide relaxes the vessels and should lower blood pressure
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what is another way to look at weight gain in chf
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2 in a day or 5 in a week is bad
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Diastolic heart failure
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stiff heart will interfere with starlings law (these are sick heart bed rest people)
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what is BUN and what is normal
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increased BUN levels suggest impaired kidney function,
-may be due to lack of blood flow due to CHF, heart attack or severe burns -less than 20 in normal |
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what is a good drug for systolic heart failure
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digoxin '
take pulse narrow therapy range |
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what will cause the kidneys to fail during heart failure
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during heart failure the sympathetic nervous system is going constantly, because of shunting the kidneys will fail
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CHF quality indicators
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-left ventriclur function asssessment with echo to check ejection
-ACE inhibitor at discharge and continued compliance -Discharge instructions -Smoking cessateion |
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8 symptoms of heart failure
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-SOB
-edema -non productive cough -fatigue |
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state differences unique to women that are suffering and acute MI
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Women are older than men when presenting with first MI.
• Once a women reaches menopause, her risk for an MI quadruples. • Fewer women than men present with “classic” signs and symptoms of UA or MI. • Fatigue is often the first symptom of ACS in women. • Women experience more “silent” MIs compared to men. • Among those who have an MI, women are more likely to suffer a fatal cardiac event within 1 yr than men. • Women report more disability after a cardiac event than men. • Women who have coronary artery bypass graft surgery have a higher mortality rate and more complications after surgery than men. |
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what is acute coronary syndrom in relation to an MI
group work 1 |
When ischemia is prolonged and not immediately reversible, acute coronary syndrome (ACS) develops and encompasses the spectrum of unstable angina (UA), non–ST-segment-elevation myocardial infarction (NSTEMI), and ST-segment–elevation myocardial infarction (STEMI) (Fig. 34-11). Although each remains a distinct diagnosis, this nomenclature (ACS) reflects the relationships among the pathophysiology, diagnosis, prognosis, and interventions for these disorders.
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The location of the infarction correlates with the involved coronary circulation. For example
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, inferior wall infarctions
result from occlusions in the right coronary artery. -Anterior wall infarctions result from occlusions in the left anterior descending artery. -Occlusions in the left circumflex artery usually cause lateral and/or posterior wall MIs. |
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Describe the signs and symptoms of an MI for a person with neuropathies may experience
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Patients with diabetes are more likely to experience silent (asymptomatic) MIs due to cardiac neuropathy and present with atypical symptoms (e.g., dyspnea)
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Describe the signs and symptoms an older patient may experience during an MI
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An older patient may experience a change in mental status (e.g., confusion), shortness of breath, pulmonary edema, dizziness, or a dysrhythmia.
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The big 3 things a women may feel during an MI is what
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some women may experience atypical discomfort, shortness of breath, or fatigue
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classic sign of heart attack
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Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration is the hallmark of an MI. Persistent and unlike any other pain, it is usually described as a heaviness, pressure, tightness, burning, constriction, or crushing. Common locations are substernal, retrosternal, or epigastric areas. The pain may radiate to the neck, jaw, and arms or to the back (see Fig. 34-7). It may occur while the patient is active or at rest, or asleep or awake. However, it commonly occurs in the early morning hours. It usually lasts for 20 minutes or more and is described as more severe than usual anginal pain. When epigastric pain is present, the patient may relate it to indigestion and take antacids without relief.
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what is collateral circulation and how does it help
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The growth and extent of collateral circulation are attributed to two factors: (1) the inherited predisposition to develop new blood vessels (angiogenesis) and (2) the presence of chronic ischemia.
-if more collateral circulation is present the MI may cause less damage. |
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what serological markers are used to determine an MI
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triponin I , most accurate and fastest
CKMB, greater than 5% of total cratine kinase is highly indicative of an MI, levels increase 4 to 6 hours after an MI -Myoglobin, serum concantrations rise 30 to 60 min after an MI, most diagnostic in first 12 hours of an Mi Myoglobin |
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what does a Q wave mean
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A pathologic Q wave that may develop during infarction will be deep and >0.03 second in duration. If it does appear it indicates that at least half the thickness of the heart wall is involved which is referred to as a Q wave MI.8 The pathologic Q wave may be present on the ECG indefinitely.
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What does ST depression and or T wave inversion mean
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Depression in the ST segment and/or T wave inversion occurs in response to the electrical disturbance in the myocardial cells due to an inadequate supply of blood and oxygen. Once treated (adequate blood flow is restored) the ECG changes will resolve and the ECG will return to the patient's baseline
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What does ST elevation mean
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ST segment elevation is significant if it is at least 1 mm above the isoelectric line (Fig. 36-29 B). If treatment is prompt and effective it is possible to restore oxygen to the myocardium and avoid infarction. This will be confirmed by the absence of serum cardiac markers. If serum cardiac markers are present infarction has occurred and is referred to as an ST-segment–elevation myocardial infarction.
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pneumonia
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seventh leading cause of death in us
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parenchyma
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lung tissue
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causes of pneumonia
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bacteria
viral mycoplasmasl, fungil, parasitic Noninfectious |
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pneumonia is
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inflamation of th parenchymea
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acquisition of organisms
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aspiration
inhalation hematogenisis |
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community acquired
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70% have preexisting disease
different organisms mortality is 1-30% |
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Hospitla acquired
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you get it 48 hours after admission
-rate is 1% -mortality rate is 54 to 71 rate is increased on vent - different oganisms like MRSA |
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noninfectious
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inhalation
aspirationi radiation |
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Complications
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pleurisy
pleural effusion Atelectasis Deayed resolution, it can hang on a long time Lung abscess empyema, pus in potential space. |
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typical defenses
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nasopharyngeal
glottic and cough mucociliary blanket pulmonary macrophages, they determine self if not self they eat it... |
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risk for hospital acquired
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icu
antacid use vent tracheostomy depressed level |
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interventions for ineffective airway clearance
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adequate fluid intake 3-4 L
move around /no stasis cough, cough, cough |
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IHI VAP bundle
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elevation of the head of bed
daily sedation vacations and assessment of extubate - peptic ulcer prophylaxis -DVT prophylaxis |
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medical interventions
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vaccine
drugs fluids |
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RSV
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most common cause of bronchiolitis and pneumonia among infants and children under 1 year
-During the first infection of RSV 25 t0 40 of infants have signs and symptoms -.5 to 2 get hospitalized |
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RSV
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it is an enveloped rna virus
-few hours on surface -spread from repiratory -outbreaks fall and winter |
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Treatment for RSV
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treat symptoms
may require mech vent and o2 |
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preention for RSV
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keep things clean no vaccine
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Atelectasis
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collapsed or airless condition of the lung
caused by -surgery -excessive secretions -mucous plug -compression tumors lymph nodes |
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Vats
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Video Assisted Thoracic Surgery,,
-Wedge resection -Decortication |
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Thoracotomy
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segmental resection
lung reduction, remove big section of lung to allow expansion of the lung... lobectomy, remove one lobe pneumonectomy, remove entire lung thoracoplasty, take entire rib out |
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Nursing management for thoracotomy post op
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cough deep breathing
-abdominal breathing -pain relief -monitoring for subcutaneous emphysema -maintaining chest tubes and drainage system |
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Pulmonary Embolism
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500,000 diagnosed each year
200,000 die each year |
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Risk factors for PE
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DVT
immobility recent surgery obesity CHF Fracture estrogen therapy pregnancy |
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PE clinial signs
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sharp pain sudden onset
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prevention of PE DVT
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SCD must be put on prior to general anesthetic.
early ambulation -passive range of motion - assess - low dose unfractionated heparin - lowmolecular weight heparin - oral anticoagulants |
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respiratory acidoses
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CO2 is up
and patient is acidotic |
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PCO2
HCo3- P02 base ex plus/- 2.0mEq/L |
35 to 45
20-30 mEq 80 to 100 |
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read page
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337
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Need to know noraml volumes
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need to read
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Asthma
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Obstructive pulmonary disease
chronic inflammatory disorder of the airway, 20 million americans have it 4000 deaths per year |
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Oral steroids
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make an improvement in asthma patients
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Cause of asthma
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results from
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triggers
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allergens
excercise air pollution respiratory infecitons sinus problems |
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aspirin
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big trigger for asthma
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early phase of asthma
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bronchospasm
IgE receptor on mast cells release of inflammatory mediators -histamin, prostaglandins, cytokines vasodialtion and smooth muscle constriction and epithelial damage |
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asthma clinically early
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bronchospas
mucus edema tenacious sputem peak 30 to 60 minutes |
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late phase of asthma or secondary attack
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-4 to 10 hours
-lasts hours or days -increased eosinophiles and neutrophiles -release of mediators -A self sustaining cycle |
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Clinical manifestations of late phase of asthma
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-wheezing
-cough -dyspnea -chest tightness -prolonged expiration 1-4 |
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extreme cases of asthma can do what to the heart
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pulses paridoxis
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Acute attacks
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upright
accessory muscles anziousness hypoxemia increased pulse increased blood pressure increased rate of repirations |
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status asthmaticus
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seer and life threatening
1 million ER visits a year 500 thousand admissions |
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Classifications of asthma
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mild to severe
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nursing implicaitons of asthma
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ineffective airway clearance
anxiety ineffective regimen management |
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before letting asthma patients go home make sure they have what
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their drugs and great teaching
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is prevention good
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yes
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tuberculosis
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1900 leading cause of death in the us
1940 anti drug therapy today 2 million deaths a year |
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TB is a
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bacterium 1/3 of the world population infected
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us increase in TB from
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86 - 92
becuase of |
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how do you get TB
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inhalatioin of Tubercle Bacilli 6 inch away droplet precaution.
the bodies response is dependent on susceptibility , dose and virulance |
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response for TB
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macrophages
T cells CD 4 cells lymphokines lymph nodes primary tubercle |
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primary tubercle
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walled off
necrosis calcified vs liquefaction cavitary disease |
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active TB
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1 in 10
harbor for the rest of life defects in t cells or magrophages |
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clinicle macrophages of tb
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low grade fever
pallor chills night sweats cough blood stained sputume if cavitaion has occurred -dyspnea and chest pain late in disease |
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Vaccination
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none in US
bacille calmettte-Guerin (BCG) |
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Treatments
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INH, Rifammpin, Pyrazinamide and either Ethambutol or Streptomycin for two months
-INH and Rifampin for an additional 4 months -compliance is a problem becasue it makes you feel crapy and you cant drink..... |
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DOT
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Direct observation treatment
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best way to treat TB
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find the people infected and treat them, Maybe DOT
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how long does treatment for TB take
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6 months
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Nursing diagnosis for TB
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risk for infection
risk for reinfection prevention of spread |
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intervention for TB
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treat infected patient
decrease droplet discharge into air -teach prevention -teach stress management to avoid conversion from latent stage |
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interventioin for TB
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sit upright
place feet on floor or chair dep breath cough into tissue water water water |
